RU216712U1 - Universal support for upper limb segment - Google Patents

Abstract

The utility model relates to the field of cardiovascular surgery and endovascular diagnostics and treatment, and is intended to facilitate vascular access to the radial artery at the back of the hand when performing endovascular interventions. The technical result achieved by using the utility model is to expand the functionality of the stand to support the arm and wrist during X-ray endovascular interventions through arterial access on the back of the hand with the possibility of immobilizing the shoulder and forearm in the physiological position of pronation and eliminating the possibility of voluntary movements of the patient's limb with an increase in the range movement and rotation of the connecting elements of the structure relative to each other and providing a more flexible and accurate mechanism for adjusting the position of the stand to the individual anthropometric data of a particular patient. The specified technical result is achieved by using a stand for a segment of the patient's upper limb for performing X-ray endovascular interventions through a vascular access to the radial artery at the back of the hand, made with the possibility of immobilizing the shoulder and forearm in the physiological position of pronation and eliminating the possibility of arbitrary movements of the patient's limb, which: contains non-metallic elements with smooth surfaces and edges and is made of X-ray negative materials with the ability to move the structure along the patient's body and change the angles of the ratio of the shoulder and forearm in the area of the elbow joint, equipped with Velcro forearm fixators and pads that ensure the arm fits to the stand and the physiological position of the patient's hand, part of the stand for the location of the hand is removable, contains hinges made with the possibility of changing the spatial position of the stand in three planes (x, y, z) and in three Euler angles due to the change and the height of its fixation relative to the operating table, depending on the individual anthropometric data of the patient, is equipped with a substrate for fixing the stand on the operating table, which can be placed under the patient's body, which acts as a payload. At the same time, the part of the stand for the location of the hand is provided with side bumpers, made to limit the movement of the hand and forearm beyond the limits of the stand, and the bumpers on the part of the stand, made for the location of the hand, are located at an angle to the bumpers on the part of the stand, made for the location of the forearm, while the lining are made of silicone, and the substrate for fixing the stand on the operating table is made with a slot for moving the guide cylinder with the first clamping handle, connected to the washer of the rotary lock, equipped with the second clamping handle and installed with the possibility of interacting with the first sleeve clamp, installed with the possibility of rotation and movement on a vertical post, to which, by means of a second sleeve clamp, provided with a third clamping handle, a part of the stand for locating the brush, mounted with the possibility of rotation and movement, is attached.

Description

The utility model relates to the field of cardiovascular surgery and endovascular diagnostics and treatment, and is intended to facilitate vascular access to the radial artery at the back of the hand when performing endovascular interventions.

Improving the efficiency of X-ray endovascular interventions through vascular access on the back of the hand is achieved by using special devices (stands, holders, forms), in which you can quickly, simply, comfortably lay the patient's hand, fix it if necessary, and use this design for both right and for the left hand. When laying the patient's hand without fixators and special devices, it is difficult to achieve immobility of the upper limb, especially in patients with an insufficient level of productive contact.

Known apparatus for immobilization and positioning of the hand during x-ray studies (US 5485856 A, 23.01.1996), made of radiolucent material. The channel member of the apparatus has a bottom wall connected to two opposite side walls and is sized so that the back of the hand can be placed flat against the bottom wall. The side walls of the channel are provided with fasteners such as Velcro fasteners or glue for removable fixation. The palm of the hand is preferably held within the channel element by means of fixing straps. This device allows you to fix the hand during the study, but it is not intended for immobilization of the shoulder and forearm during X-ray endovascular interventions through the arterial access on the back of the hand.

The closest analogue to the claimed utility model (prototype) is a stand to support the hand and wrist (US 2017042751 A1, 02/16/2017). It is a stand for the segment of the upper limb, designed for X-ray endovascular interventions. During the intervention, the patient is placed on his back on the operating table, and his arm, on which the arterial access is to be performed, is placed on the armrest, which is used to support and position the arm in accordance with the intervention. The device is characterized by:

- Has the ability to position the limb in space while respecting the convenience of both the operating doctor and the patient due to the degrees of freedom provided for by the product ([0031], [0034]);

- The armrest and wrist rest are made of transparent, rigid, non-magnetic material for ionizing radiation, including X-rays, i.e. having the property of x-ray transparency [0032];

- Consists of detachable parts ([0022], [0025], [0030]);

- Equipped with wrist and forearm straps [0026].

This stand provides immobilization of the shoulder and forearm during X-ray endovascular interventions through arterial access on the back of the hand and allows you to change the spatial position of the individual elements of the stand in space. However, this design has a limited range of change in the tilt angles of the stand and the height of its fixation relative to the operating table.

The objective of the utility model is to facilitate, simplify and increase the possibility of performing arterial access on the back of the hand when performing X-ray endovascular interventions both on the right and on the left hand. This utility model facilitates puncture of the artery at the back of the hand and intra-arterial insertion of conductors and catheters during X-ray endovascular interventions.

The technical result achieved by using the utility model is to expand the functionality of the stand to support the arm and wrist during X-ray endovascular interventions through arterial access on the back of the hand with the possibility of immobilizing the shoulder and forearm in the physiological position of pronation and eliminating the possibility of voluntary movements of the patient's limb with an increase in the range movement and rotation of the connecting elements of the structure relative to each other and providing a more flexible and accurate mechanism for adjusting the position of the stand to the individual anthropometric data of a particular patient.

The specified technical result is achieved by using a stand for the patient's upper limb segment for performing X-ray endovascular interventions through vascular access to the radial artery at the back of the hand, made with the possibility of immobilizing the shoulder and forearm in the physiological position of pronation and eliminating the possibility of arbitrary movements of the patient's limb, which:

- contains non-metallic elements with smooth surfaces and edges and is made of X-ray negative materials with the ability to move the structure along the patient's body and change the angles of the ratio of the shoulder and forearm in the area of the elbow joint,

- it is equipped with Velcro forearm fixators and pads that ensure that the arm fits to the stand and the patient's physiological position of the hand,

- part of the stand for the location of the brush is made removable,

- contains hinges made with the possibility of changing the spatial position of the stand in three planes (x, y, z) and three Euler angles by changing the tilt angles of the stand and the height of its fixation relative to the operating table, depending on the individual anthropometric data of the patient,

- equipped with a substrate for fixing the stand on the operating table, which is configured to be placed under the patient's body, which acts as a payload.

At the same time, the part of the stand for the location of the hand is equipped with side bumpers, made to limit the movement of the hand and forearm beyond the limits of the stand, and the bumpers on the part of the stand, made for the location of the hand, are located at an angle to the bumpers on the part of the stand, made for the location of the forearm, while the lining are made of silicone, and the substrate for fixing the stand on the operating table is made with a slot for moving the guide cylinder with the first clamping handle, connected to the washer of the rotary lock, equipped with the second clamping handle and installed with the possibility of interacting with the first sleeve clamp, installed with the possibility of rotation and movement on a vertical post, to which, by means of a second sleeve clamp, provided with a third clamping handle, a part of the stand for arranging the brush, mounted with the possibility of rotation and movement, is attached.

Brief description of drawings:

- in Fig. 1 shows the puncture sites on the back of the hand in the projection of the radial artery for vascular access,

- in Fig. 2 shows the design of the stand (front view),

- in Fig. 3 shows the design of the stand (side view),

- in Fig. 4 shows the placement of the patient on the operating table before the start of the X-ray endovascular intervention using a stand.

Due to the standard position of the operator and equipment in the operating room, the operator always stands to the right of the patient. The use of a universal support for the upper limb segment will allow achieving the physiological position of the patient's hand in the pronation position and contribute to the ergonomic working position of the surgeon at the operating table.

The device must exclude the presence of metal elements and be completely X-ray negative. The universal stand must be made of chemically resistant and non-toxic materials, with smooth, easy to work surfaces and edges due to the need to disinfect this device. Important is the possibility of moving the structure along the patient's body and the possibility of changing the angles of the ratio of the shoulder and forearm in the area of the elbow joint for comfortable and reliable fixation of the patient's hand. The device should be freely installed on the operating table, taking into account the length of the patient's torso and its constitutional features.

For penetration into the vessel, a puncture site is used on the back of the hand in the projection of the radial artery for vascular access (Fig. 1): in the anatomical snuffbox area (A) and somewhat distally - in the metacarpal space between fingers I and II (B). One of the conditions for arterial access on the back of the hand for the purpose of X-ray endovascular interventions is high-quality immobilization of the shoulder and forearm in the physiological position of pronation and the exclusion of the possibility of voluntary movements of the limb by the patient.

In FIG. 2, 3 shows a support for a patient's upper limb segment, which, in accordance with the claimed utility model, contains non-metallic elements with smooth surfaces and edges and is made of X-ray negative materials with the ability to move the structure along the patient's body and change the angles of the ratio of the shoulder and forearm in the area of the elbow joint. The stand is equipped with fasteners 1 forearms with Velcro and pads 2, ensuring the fit of the hand to the stand and the physiological position of the patient's hand. Part of the stand for the location of the brush is made removable. The stand contains hinges made with the possibility of changing the spatial position of the stand in three planes (x, y, z) and in three Euler angles by changing the tilt angles of the stand and the height of its fixation relative to the operating table, depending on the individual anthropometric data of the patient. Substrate 3 provides fixation of the stand on the operating table and is made with the possibility of placement under the patient's body, which acts as a payload.

Part of the stand for the location of the hand is provided with lateral sides made to limit the movement of the hand and forearm outside the stand. The sides on the part of the stand, made for the location of the hand, are located at an angle to the sides on the part of the stand, made for the location of the forearm. The pads are made of silicone, and the substrate for fixing the stand on the operating table is made with a slot 4 for moving the guide cylinder 5 with the first clamping handle 6, connected to the washer of the rotary lock 7, equipped with the second clamping handle 8 and installed with the possibility of interacting with the first sleeve clamp 9, mounted with the possibility of rotation and movement on a vertical stand 10, to which, by means of a second sleeve clamp 11, provided with a third clamping handle 12, a part of the stand for the location of the brush, installed with the possibility of rotation and movement, is attached.

An example implementation of the utility model

Before the start of the endovascular intervention, the patient is placed on the operating table, placing a substrate under it to fix the stand on the operating table (Fig. 4). The patient's hand is placed on a silicone-lined stand, the forearm is fixed with Velcro fasteners. The guide cylinder is moved into the slots of the substrate parallel to the patient's body to achieve the desired position of the stand, allowing the personnel to adjust to the patient's anthropometry and provide the proper level of ease of use. By adjusting the swivel joints by changing the angles of their inclination and spatial position, they provide more flexible and precise adjustment of the position of the stand to the individual anthropometric data of a particular patient. After processing the surgical field, the operating surgeon is located to the right of the patient, performing a puncture of the radial artery in its distal part on the dorsum of the hand. The operator uses a standard puncture of the radial artery according to the Seldinger technique, followed by the installation of an introducer. At the stage of completion of the operation, the patient's hand should be easily removed from the device.

Thus, the use of a universal support for the segment of the upper limb makes it possible to conveniently and reliably fix the hand for further precision puncture of the radial artery at the back of the hand. The hand is comfortably positioned in the pronation position during the entire intervention.

Claims (8)

Stand for a segment of the upper limb of the patient for performing X-ray endovascular interventions through arterial access on the back of the hand, made with the possibility of immobilizing the shoulder and forearm in the physiological position of pronation and eliminating the possibility of voluntary movements of the patient's limb, characterized by the fact that: - contains non-metallic elements with smooth surfaces and edges and is made of X-ray negative materials with the ability to move the structure along the patient's body and change the angles of the ratio of the shoulder and forearm in the area of the elbow joint, - it is equipped with Velcro forearm fixators and pads that ensure that the arm fits to the stand and the patient's physiological position of the hand, - part of the stand for the location of the brush is made removable, - contains hinges made with the possibility of changing the spatial position of the stand in three planes (x, y, z) and three Euler angles by changing the tilt angles of the stand and the height of its fixation relative to the operating table, depending on the individual anthropometric data of the patient, - equipped with a substrate for fixing the stand on the operating table, which is made with the possibility of being placed under the patient's body, which performs the function of a payload, characterized in that the part of the stand for the position of the hand is provided with side boards designed to limit the movement of the hand and forearm outside the stand, and the boards on the part of the stand made for the placement of the brush are located at an angle to the boards on the part of the stand made for the placement of the forearm, while the pads are made of silicone , and the substrate for fixing the stand on the operating table is made with a slot for moving the guide cylinder with the first clamping handle, connected to the washer of the rotary lock, equipped with the second clamping handle and installed with the possibility of interacting with the first sleeve clamp, mounted with the possibility of rotation and movement on the vertical stand , to which, by means of a second sleeve clamp, provided with a third pressing handle, a part of the stand for locating the brush, mounted with the possibility of rotation and movement, is attached.

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