FR3095121A1 - Medical device such as a lumbar puncture chair - Google Patents

Abstract

The invention relates to a medical device such as a chair comprising a frame (1) on which are mounted a seat (3) and a facial support (2), respectively in a position such as a person sitting on said seat (3). ) leans forward to rest his face on the facial support (2). The invention consists in that the device comprises a cushion (4) at least semi-rigid having at least one rounded face (4a), this cushion (4) being mounted on the frame (1) between the seat (3) and the face support (2), adjustable in position, the rounded face (4a) of said cushion (4) being intended to exert a support on the abdomen of the seated person leaning forward with his head resting on the support facial (2) to bring the spine of said person, at the level of his lumbar region, in a kyphosis position. Figure 1

Description

Medical device such as a lumbar puncture chair

The present invention relates to a medical device such as a chair for performing a lumbar puncture on a patient.

Lumbar puncture or spinal tap is a medical examination consisting in collecting cerebrospinal fluid (CSF), or cerebrospinal fluid in the subarachnoid cavity through a puncture in the back, between two lumbar vertebrae.

This spinal tap can be performed under local anesthesia, using a fine needle inserted between the third and fourth or between the fourth and fifth lumbar vertebra. It is an examination of great diagnostic contribution, but which is not without side effects or potential complications.

A lumbar puncture is performed to analyze the cerebrospinal fluid for signs of infection or disease. It is useful for the diagnosis of meningitis, meningeal or subarachnoid hemorrhage and other infections of the nervous system such as meningoencephalitis, brain abscesses or myelitis.

It is used to measure the pressure of the cerebrospinal fluid, to inject anesthetics (for pain relief) or drugs (spinal anaesthesia). A lumbar puncture is performed in case of suspected meningeal involvement, whether infectious, such as meningitis (inflammation of the meninges), meningoencephalitis, abscess (accumulation of pus after necrosis), myelitis (acute inflammation of the marrow spine) are suspected, or inflammatory (such as in multiple sclerosis).

This medical gesture is also used for the injection of drugs: antibiotics, analgesics which are drugs intended to reduce pain, chemotherapy, anesthetic.

Such a medical act therefore has many interests and is very often performed in emergency departments.

Lumbar puncture is a medical procedure and is performed under strict aseptic conditions. The patient is installed on a bed or an examination table, seated (or sometimes lying on the side), the back as round as possible in order to clear the spinal column. The puncture site is then identified: it must be between the ^4th and ^5th , or between the 3rd ^{and 4th} lumbar vertebra (which correspond to two intervertebral spaces where there is no risk of touching the spinal cord, whose terminal cone is located higher). A careful antisepsis of the identified area is made using sterile compresses, antiseptic products.

The doctor is dressed in sterile gloves and can then introduce a specific needle on the midline, almost perpendicular to the skin, until having crossed the dura mater (sensation of resistance to the penetration of the needle) and being thus in contact with the CSF. The correct position of the needle is verified by a trickle flow of CSF at the tip of the needle.

When the position is good, the CSF is collected in specific tubes (as many tubes as examinations requested) and several samples are always taken because the first can be distorted by the presence of blood in the needle. The appearance of the CSF is analyzed (normally the liquid is transparent and colorless (known as "water-of-rock"). The liquid must flow naturally and never be aspirated (risk of haemorrhage). The sample must be as minimal as possible (a few drops per tube) to minimize side effects.

When a patient has to undergo a lumbar puncture, the latter must therefore remain motionless throughout the procedure, which requires great precision on the part of the practitioner. Usually, the patient is therefore seated, most often on the edge of a bed with the help of a carer who stands in front of the patient to support him in the correct posture, while the qualified medical practitioner positions himself on the opposite edge of the bed to perform the puncture. Such an installation is not satisfactory either for the patient who is often in an uncomfortable position, or for the carer who must hold the patient, or for the practitioner who must be able to be sure of his movements in an ergonomic position.

In addition, this examination which makes it possible to carry out a diagnosis is often carried out at the level of the emergency department which does not always offer consultation spaces equipped with a bed or an auscultation table with a surrounding space allowing to carry out this exam in good conditions

In order to guarantee greater safety in the performance of this delicate medical procedure, several patient positioning aids have been proposed in recent years.

Thus, in WO-A-02/09634 there has been described a support for the patient which fits on the edge of a bed, this support comprising an upper part on which the patient comes to rest his chest by leaning towards the front so as to bend the back and which has a footrest in the lower part. Such a device can be advantageous, however, it always requires the presence of a bed which, especially in emergency examination boxes is not always the case and therefore requires being able to find an adequate examination room.

In US-B-6182663 has been described a device consisting of a movable mast on which are mounted a support to allow a patient seated on an examination table or a bed to lean, bent forward by finding a resting on a support carried by the mast which also carries a support for the patient's feet. Such a device, mobile in itself, can thus be moved from one place to another more easily.

However, these two devices are not very comfortable for the patient, who must however be able to remain still for the duration of the examination, which can be long in the event of discomfort.

In EP-A-1148859 there is proposed a patient support, for use with a bed, chair, stool or operating table, to provide additional support to a patient in a seated position, said patient support comprising: a main support column composed of an elongated post and a foot; a support pivotally connected to the upright of said main column and capable of serving as a support for the main column. The patient support further comprises an elongated post of said floor anchor support which is provided with pivotally adjustable and telescoping interlocking means, said adjustable interlocking means being capable of interlocking below a horizontal member of a bed, chair, stool or operating table so that when in use the patient support cannot roll off the bed or table . The patient therefore leans forward from his sitting position on the bed, for example, which allows him to be in a relatively comfortable and stable position. The device includes a face rest on which the patient leans and a footrest, thus ensuring a more comfortable position over time.

Although these devices help to provide better conditions for performing lumbar puncture, they are however used with beds or examination tables on which patients are seated. The lumbar puncture must be performed under aseptic conditions, it is then always necessary to change the bed sheets between each patient, this represents a cost both material and human. In addition, as already mentioned, the examination boxes are not always large enough to accommodate a bed or an examination table, which means having to take the patient to a room equipped with a bed and the device mentioned above. above to practice the exam.

In US-A-2004/0070253, a medical surgical chair of the massage seat type has been proposed in which the patient is seated leaning forward. Thus, the seated patient leans forward where his chest is supported by a support and his head rests tilted forward on a face rest while his knees also rest on two lower cushions. This chair thus provides patients with a stable and secure platform which reduces the need for additional personnel to maintain the patient's position while ensuring desirable ergonomic alignment of the spinal processes, contributing to successful lumbar puncture and spinal tapping. insertion of the spinal catheter. Such a device also offers the advantage of being able to be installed in an examination box and no longer requires beds or examination tables. We can thus dedicate a room to this examination by installing such a surgical chair there, which makes it possible to contribute to the requirements of asepsis.

However, despite the fact that the patient is thus in an ergonomic position for sampling, there is still the need for the practitioner to be assisted by another caregiver so as to allow compliance with the rules of asepsis.

The equipment necessary to carry out a lumbar puncture which, as already seen, is a delicate technical act includes in particular a decontaminated and cleaned tray, several single-use protections, antiseptics, equipment for performing local anesthesia (lidocaine, syringe, pump, needle subcutaneous), sterile material such as compresses, gloves, lumbar puncture needle, labeled tubes.

As mentioned, the practitioner must perform wide asepsis, and must therefore have his equipment nearby. In general, a caregiver (nurse, nursing assistant) serves the doctor during the puncture, in particular by passing him his puncture equipment and the collection tubes. Therefore, such an examination requires at least the person performing it and a person to help him, which implies the unavailability of at least two people for a puncture, or even three when there is no equipment. specific to help the patient maintain the correct position.

The object of the invention is therefore to propose a medical device making it possible to carry out a sampling or an injection at the level of the lumbar spine under comfortable conditions both for the patient and for the practitioner who performs the medical act and without requiring the systematic presence of a helping staff.

To this end, the subject of the invention is a medical device such as a chair comprising a frame on which are mounted a seat and a facial support, respectively in a position such that a person installed on said seat leans forward to resting one's face on the facial support, characterized in that it comprises an at least semi-rigid cushion having at least one rounded face, this cushion being mounted on the frame between the seat and the facial support, adjustable in position , the rounded face of said cushion being intended to exert pressure on the abdomen of the seated person leaning forwards, his head resting on the facial support, to bring the spine of the patient to the level of his lower back in the position of kyphosis .

Thus, advantageously, the medical device according to the invention allows a patient having to undergo a medical act of the lumbar puncture type, to sit down and rest his face on the facial support, so that the patient is thus leaning forward while being held. The patient thus offers his back for a medical intervention at the level of his spine, the position-adjustable cushion making it possible to impose on the patient's body a position in kyphosis favoring the puncture and this, in a comfortable way for the patient and without requiring the help of an additional caregiver to hold the patient in position.

Thus, advantageously, the medical device according to the invention makes it possible to install the patient in a comfortable sitting position, the back bent forwards, the patient's body being held in particular by his head while thus promoting correct positioning. spine using the cushion.

According to a preferred embodiment of the invention, the frame also comprises a second seat, allowing a person to sit behind the person installed on the first seat and in particular usable by the practitioner. It can thus be installed so as to face the patient's back to perform the lumbar puncture.

The medical device according to this embodiment of the invention therefore makes it possible to guarantee both a correct and comfortable position of the patient but also of the practitioner who is installed in a safe manner to work.

According to a variant of the device of the invention, the latter comprises at least one articulated arm, the free end of which carries a support for equipment such as medical equipment. This arm is preferably mounted articulated on a part of the frame or can be mounted on the underside of the main seat of the device. It is thus possible to position the arm so that the support is close to the operating area within easy reach of the practitioner.

Preferably, the support is of the tray type, collection tube holder or any other suitable support. According to a preferred variant, the device according to the invention comprises two arms, one having a plate on which a set of instruments for the puncture can be positioned and the other having a support for the sampling tubes.

Thus, the medical staff can prepare the equipment necessary for the doctor, the puncture kit (sterile gloves, needles, etc.) on the tray carried by one arm and the tubes for sampling on the tube holder carried by the other arm , the assembly being positioned, preferably, on either side of the patient comfortably installed on the device. The doctor can then sit either on an independent seat such as a stool or on the second seat provided on the device and thus perform the lumbar puncture alone without the need for assistance while respecting the required asepsis. The staff usually present to assist the doctor or even the patient can then be occupied with other tasks.

According to a variant embodiment of the invention, the frame also comprises support for the patient's forearms, thus offering him additional support contributing to making his position even more comfortable.

In a very advantageous way, the equipment thus offers both greater physical comfort to the patient, favoring with the aid of the ventral cushion a good positioning of the latter contributing to the smooth running of the intervention and this, while offering the practitioner safe operating conditions in terms of ergonomics and asepsis thus also contributing to the smooth running of the operation without the need for the presence of additional people.

According to a preferred embodiment, the frame comprises an elongated main upright and a secondary support upright, the main upright having one end that bears on the ground and being provided at its opposite end with a facial support, the secondary upright having one end that rests on the ground while its opposite end is fixed to the main upright between the two ends of the latter, thus constituting a frame substantially in the shape of a trestle, the main upright extending inclined forwards between its floor support and face support, the main seat for the patient being also mounted on the elongated upright between its two ends so that a patient can sit on the seat and position his face on the support face, its bust extending inclined forward substantially parallel to the elongated main upright, the ventral cushion being mounted on the main upright between the seat and the facial support, forcing at the level of the patient's abdomen the curvature of his back.

Preferably, the frame consists of different uprights pivotally assembled with each other so as to allow a deployed position for use of the device and a folded position of the frame allowing it to be transported and/or stored. The device according to the embodiment of the invention can therefore easily be used and transported to the places where it is necessary without requiring dedicated spaces.

Preferably, lockable/unlockable wheels are provided at the level of the feet of the device allowing easy movement of the device if necessary from one place to another according to the needs.

A medical device according to the invention has many advantages. Thus, it offers comfortable operating conditions for the patient, ergonomic for the practitioner, safe in terms of compliance with the rules of asepsis and economically advantageous by requiring only one person with the patient, which frees up other personnel who may perform other tasks without interfering with the smooth running of the lumbar puncture.

The invention will now be described in more detail with reference to the drawing in which the figures represent:

a schematic rear side perspective view of a first embodiment of the invention;

a schematic side view of the device of FIG. 1;

a schematic rear side perspective view of a second embodiment of the invention;

a schematic side view of the device according to FIG. 3;

a schematic view of the device of the invention during an intervention;

a schematic view of the device of Figure 4 in the folded position.

As can be seen in Figure 1, the medical device according to the invention consists of a frame 1 comprising an elongated main upright 11 and a secondary support upright 12, the main upright 11 having a support end at the ground 14 comprising two feet 13 and, at its opposite end, a facial support 2.

The secondary upright 12 has one end of support on the ground provided with two feet 13 also while its opposite end is fixed to the main upright 11 between the two ends of the latter. The two uprights 11, 12 thus constitute a frame 1 substantially in the shape of an easel, the upright 11 being inclined with respect to the support surface such as the ground. The secondary upright 12 can be mounted fixed on the main upright 11 or, according to a preferred variant, it is pivotally mounted on the main upright 11, thus making it possible to fold the upright 12 along the main upright 11 with a view to transporting or storing it. storage (see figure 6).

Between the two uprights 11 and 12 extends an upright forming a spacer 15, one end 15a of which is fixed to the support upright 12 and the other end 15b extends beyond said main upright 11. The spacer 15 is also integral at a point 15c, with the main upright 11. The free end 15b of the spacer 15 carries a seat 3.

Thus, a patient can sit on the seat 3 facing the upright 11 and can then lean forward following the inclination of the upright 11 to come and rest his face on the facial support 2, thus exposing his back for a lumbar puncture-type sample.

On the main upright 11, between the facial support 2 and the spacer 15 carrying the seat 3, there is provided a semi-rigid cushion 4 having a rounded face 4a and whose position is preferably adjustable along the upright 11, the cushion 4 having a fixing element on the main upright 11 adjustable along said upright 11. Such a fixing element can be a rod made projecting from the face of the cushion 4 opposite the rounded face 4a and engageable in holes made along the main upright 11. Any other fixing element allowing adjustable positioning of the cushion 4 on the main upright 11 is also suitable, for example by sliding.

Thus, the cushion 4 can be positioned at the level of the abdomen of the seated patient (see FIG. 6) in order to exert a support against said abdomen and to push the patient's spine back into the kyphosis position, thus favoring the sampling conditions.

To further promote the comfort of the patient thus installed, a forearm rest 5 is provided mounted on the secondary upright 12.

One can also provide, as is visible in the first embodiment, that the end 15a of the spacer is pivotally mounted on the secondary upright 12, the spacer 15 being integral with at least one stop on the main upright 11 ensuring the maintenance of the spacer 15 in the position of use substantially parallel to the support surface such as the ground while the pivoting on the secondary upright 12 makes it possible to fold said spacer 15 along the uprights 11 and 12 also folded .

In Figures 3 and 4 is shown a preferred embodiment of the device of the invention in which the frame 1 comprises a second seat 6 for the practitioner who performs the lumbar puncture.

Thus, an auxiliary upright 16 extends from the main upright 11 from one end 16a fixed to said upright 11 and an opposite end 16b having a ground support part consisting of a foot 16c. On this end 16b is mounted a seat 6 allowing a person to sit so as to face the back of the patient who is also seated on the device as can be seen in Figure 5.

Preferably, the position of the seat 6 on the auxiliary upright 16 is adjustable in position along said upright 16 to allow the practitioner to stand at the right distance from the patient, for example sliding on the upright 16. The auxiliary upright 16 is preferably pivotally mounted on the main upright 11 and can thus be folded along said upright 11 as can be seen in Figure 6. In addition, a spacer 17 extends between the spacer 15 and the auxiliary upright 16 to promote the stability of the device in the position of use, the end of the spacer 17 being pivotally mounted on the spacer 15 and its opposite end being slidably mounted on the auxiliary upright 16 to allow the folding of the frame 1. spacer 15 is for its part supported on the secondary upright 12 by its end 15a, while it is pivotally mounted on the main upright 11 in the foldable version of the device.

As can be seen in Figure 2, the frame 1 further comprises two arms 7, 8 respectively carrying a plate 71 on which the sampling kit can be deposited and a sampling tube holder 81.

These arms 7, 8 can be mounted articulated on the frame 1 for example on the upright 11, or for example on the transverse upright 15 (see Figure 2). These arms 7.8 can also be mounted articulated on the underside of the seat 3 (see Figure 4). Thus, the plate 71 and the tube holder 81 can be positioned close to the patient's back. Preferably, these arms 7, 8 are also articulated and/or deformable to allow their easy positioning with a view to ergonomic use for the practitioner.

Thus, once the patient is installed on the chair according to the invention as can be seen in FIG. 5, the medical personnel installs on the plate 71 the equipment necessary for the puncture in the form of a sterile sampling "kit" comprising gloves, the sampling needle, etc., and on the tube holder 81, the tubes for sampling. The practitioner taking the sample then sits either on an independent seat or on the seat provided on the device for this purpose (see figure 5) and can then carry out his intervention independently, thus freeing the nursing staff who can then perform other tasks.

Preferably, the main seat 3 and the secondary seat 6 can be removably mounted on the frame 1 so that they can be removed when folding the device as can be seen in Figure 6.

Such a device according to the invention therefore makes it possible to guarantee good examination conditions both for the patient and for the practitioner in terms of comfort, ergonomics and compliance with the rules of asepsis, while offering an economic interest because simple implementation, use without the need for dedicated places, being in particular easy to transport or store.

Claims (12)

Medical device such as a chair comprising a frame (1) on which a seat (3) and a facial support (2) are mounted, respectively in a position such that a person seated on said seat (3) leans forward to rest one's face on the facial support (2), characterized in that it comprises an at least semi-rigid cushion (4) having at least one rounded face (4a), this cushion (4) being mounted on the frame (1) between the seat (3) and the facial support (2), adjustable in position, the rounded face (4a) of the said cushion (4) being intended to exert a support on the abdomen of the seated person leaning towards the front his head resting on the facial support (2) to bring the spine of said person, at the level of his lumbar, in the position of kyphosis. Device according to Claim 1, characterized in that the frame (1) comprises a second seat (6) enabling a person to sit behind the person seated on the first seat (3). Device according to one of Claims 1 or 2, characterized in that it comprises at least one articulated arm (7, 8) the free end of which carries a support for equipment such as medical equipment. Device according to Claim 3, characterized in that the support is of the tray (71) or sampling tube holder (81) type. Device according to one of Claims 3 or 4, characterized in that the at least one arm (7, 8) is mounted articulated on the underside of the first seat (3). Device according to one of Claims 1 to 5, characterized in that the frame comprises an elongated main upright (11) and a secondary support upright (12), the elongated main upright (11) having a support end at the ground (14) and being provided at its opposite end with a facial support (2), the secondary upright (12) having an end that rests on the ground while its opposite end is fixed to the elongated main upright (11) between the two ends thereof, the elongated main upright (11) extending inclined between the support surface of the device and the facial support (2). Device according to Claim 6, characterized in that an upright forming a spacer (15) extends between the two uprights (11) and (12), one end (15a) of the said spacer (15) being integral with the upright of support (12) and the other end (15b) extending beyond said elongated main upright (11) with which it is integral at a point (15c), the free end (15b) of the upright (15) bearing the seat (3). Device according to one of Claims 6 or 7 when dependent on Claim 2, characterized in that the frame (1) comprises an auxiliary upright (16) extending from the main elongated upright (11) from one end (16a ) integral with the elongated main upright (11) and an opposite end (16b) having a ground support part consisting of a foot (16c), this end (16b) comprising a second seat (6). Device according to Claim 8 in its dependence on Claim 7, characterized in that a spacer (17) extends between the spacer (15) and the auxiliary post (16) to favor the stability of the device in the position of use. Device according to one of Claims 1 to 9, characterized in that the frame (1) consists of elements such as uprights and spacers (11, 12, 15, 16) pivotally assembled making it possible to fold/unfold the said frame (1) between a use position and a storage and/or transport position. Device according to Claim 10 when dependent on Claim 9, characterized in that the end of the spacer (17) is pivotally mounted on the spacer (15) and its opposite end is slidably mounted on the auxiliary upright (16) to allow folding of the frame (1). Device according to one of Claims 1 to 11, characterized in that the first seat (3) is removably mounted on the frame (1).