RU2463007C1 - Hemostatic catheter and method of its application - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: group of inventions relates to medicine, namely to otorhinolaryngology, and can be used in case of necessity to stop nose bleeding, mainly in patients with impairment of consciousness in extreme conditions. For this purpose hemostatic catheter is introduced into one or both nasal passages. Catheter consists of case with two balloons, one of which is fastened in back part of device and is provided with canal, inside which placed is plastic rod, made for modeling case in accordance with anatomy of nasal cavity, and valve for its inflation on anterior end of device. Second - anterior balloon, surrounds device case and is movable along it and has canal for air supply via valve. One catheter is introduced into each nasal passage with further filling of back and anterior balloons with air in volume 10-12 ml and 5-7 ml, respectively.

EFFECT: inventions make it possible to efficiently stop different types of nose bleedings, including in patients with impairment of consciousness in extreme conditions.

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Description

The invention relates to medicine (catastrophe medicine), in particular otorhinolaryngology, resuscitation, and can be used to stop nosebleeds mainly in patients with impaired consciousness under extreme conditions (earthquakes, floods, landslides and other disasters).

Epistaxis in patients with impaired consciousness, especially with severe traumatic brain injuries, can lead to death in a few minutes due to not only blood loss, but more often due to blood entering the respiratory tract with the subsequent development of asphyxiation.

A device for preventing nasal bleeding is known, which contains plates with work surfaces and a thrust through which they are interconnected (patent No. 2177747, published January 10, 2002, IPC A61B 17/12, A61B 17/24).

A disadvantage of the known device is the complexity of its use, the need for special conditions and intubation anesthesia, restriction to only certain areas of the nasal cavity and the loss of a long time for its installation.

The closest technical solution is a device in which a guide catheter is inserted into a blood vessel, consisting of a cylindrical inflatable balloon and an air duct, one end of which is placed in the thickness of the balloon wall, and the other end has the possibility of rigid fixation to the proximal end of the guide catheter (patent No. 2354310 , published on 05/10/2009, IPC А61В 17/12, А61М 25/10).

However, the prototype device is used only inside blood vessels and is not applicable for stopping nosebleeds of various localization.

There is a method of stopping nosebleeds, based on irrigation or the introduction of tampons in the nasal passages soaked in 4% potassium chloride solution at a temperature of 43-44 ° C (Prevention and treatment of major dental diseases / A.P. Kravchuk. - Part 2. - Izhevsk, 1995 .-- S.7-8).

The disadvantage of the analogue is low reliability and efficiency due to the complexity of mechanical compression through tampons of gaping blood vessels, and also does not provide the necessary urgency. In addition, an aqueous solution of potassium chloride dilutes blood, which weakens the density of the thrombus formed from it, and also has an irritating effect on the mucous membranes, causing their inflammation.

A known method of stopping nosebleeds by introducing into the nasal cavity using a forceps prepared from a gauze bandage swab 1-2 cm wide and up to 70 cm long, impregnated with liquid paraffin, to a depth of 6-7 cm, which we took as a prototype as the closest method (Otorhinolaryngology: textbook / ed. By I. B. Soldatov, V. R. Hoffman. - St. Petersburg, 2000 - p. 245).

The disadvantage of this method is the low efficiency in hypertension due to the difficulty of mechanical compression through the gauze bandage of the bleeding blood vessels inside the nasal passages, bursting with blood, flowing under high pressure with hypertension, because of the inhibition of the blood coagulation system and the slowing of the process of thrombosis in the nose due to the introduction a swab moistened with vaseline oil at room temperature (about 24 ° C), and also because of the possibility of repeated bleeding in case of sudden increase of systemic blood pressure. In addition, the technical complexity does not provide the necessary urgency, which can lead to death in patients with impaired consciousness.

This method is not effective enough in extreme situations. The technical result is an increase in the efficiency of the method, the provision of expanded and accelerated use of the method using the device for all types of nosebleeds in extreme conditions.

The technical solution of the claimed object is that, unlike the prototype, the device consists of a body with two cylinders, one of which is attached to the rear of the device, is equipped with a channel passing inside the body, and a valve for inflating it at the front end of the device, and the second the front cylinder, grasping the device body, is movable along it and has a channel for supplying air through the valve. The device is used with preliminary local anesthesia and, if necessary, is used in both nasal cavities for 5-8 hours, one catheter in each nasal passage, with the posterior and anterior cylinders being filled with air in a volume of 10-12 ml and 5-7 ml, respectively.

The device is shown in figures 1, 2 and 3. In figure 1 is a General view. In Fig.2, the device consists of a rear balloon - 1, a housing - 2, a plastic rod - 3, a rear balloon valve - 4, a front balloon valve - 5, a channel for supplying air to the front balloon - 6 and the front balloon (movable) - 7 .

The device operates as follows.

The patient is in a sitting or lying position. First, a thorough local anesthesia of one or both halves of the nose is performed.

For this purpose, aerosol anesthetics (2% lidocaine) and applications of 1-3% dicaine solution, 5% trimecaine solution on the mucous membrane of the nasal cavity using a cotton wool probe can be used.

Upon completion of anesthesia, the body of the device - 2 is modeled in accordance with the anatomy of the nasal cavity by bending the plastic rod - 3. Under the control of vision, the device is inserted into the nasal cavity along the lower part of the general nasal passage to the nasopharynx (Fig. 3).

Then in the nasopharynx the posterior balloon - 1 is inflated. To do this, 10-12 ml of air is introduced through a valve - 4 through a syringe. Then the front balloon of the device - 7 is inflated, for which as much air is introduced through valve - 5 as is necessary for obturation of the vestibule of the nose. Usually enough 5-7 ml of air (figure 3).

If necessary, this procedure can be supplemented with a classic nasal tamponade.

The rationale for the selected parameters of the method (5-8 hours) is explained by the fact that the use of the device for less than 5 hours can cause a relapse of bleeding, and more than 8 hours may cause infection of the object.

The introduced air volumes (10-12 ml) of the posterior and anterior cylinders (5-7 ml) are substantiated by the anatomical features of the nasopharynx and the anterior part of the human nasal cavity, respectively.

The device can be used in both nasal cavities in the presence of bilateral bleeding, one catheter in each nasal passage. With unilateral nasal bleeding, one device is used accordingly.

Example 1. Patient R., 38 years old, was admitted in critical condition to the intensive care unit after a car accident with the diagnosis: Closed craniocerebral injury. Fracture of the arch and base of the skull. Coma II. Fracture of the nasal bones. Epistaxis. There was pronounced nosebleed from both nasal passages against a background of lack of consciousness, leading to aspiration of blood into the respiratory tract with independent breathing. To stop nosebleeds, two claimed devices, called hemostatic catheters, were used simultaneously. The measures taken for health reasons allowed stopping nosebleeds and preventing aspiration (getting) of blood into the respiratory tract. According to neurosurgical indications, the patient underwent surgical and medical treatment, as a result of which the patient's condition improved. After 12 hours, hemostatic catheters were removed from the nasal cavity. Severe nosebleeds were not observed. A purification of the nasal cavity from blood clots and a planned anterior tamponade of the nasal cavity were performed. On the 3rd day, the tampons were removed. Repeated bleeding was not observed.

Example 2. Patient B., 67 years old, was admitted in serious condition to the intensive care unit with an diagnosis of acute ischemic cerebrovascular accident. Coma I. Arterial hypertension. Epistaxis. The patient had severe nosebleeds from the right nasal passage against a background of lack of consciousness, right hemiplegia, bulbar syndrome, leading to aspiration of blood into the respiratory tract with independent breathing. To stop nosebleeds, the claimed device “Hemostatic catheter” was used. The measures taken have stopped nasal bleeding and prevent aspiration of blood into the respiratory tract. The treatment of the underlying disease was carried out, as a result of which the patient's condition improved. After 8 hours, the hemostatic catheter was removed from the nasal cavity. Epistaxis was not observed. A purification of the nasal cavity from blood clots was performed. Repeated bleeding was not observed. On the 5th day after admission, the patient was transferred to the neurological department to continue treatment of the underlying disease. Repeated bleeding was not observed.

Thus, the proposed solution makes it possible to quickly and effectively stop nosebleeds and prevents relapses mainly in patients with impaired consciousness in extreme situations and disasters.

Claims (2)

1. Hemostatic catheter, including inflatable balloons located on the catheter, a channel for supplying air, characterized in that it consists of a housing with two balloons, one of which is attached to the rear of the device, equipped with a channel, inside which is placed a plastic rod made for modeling the body in accordance with the anatomy of the nasal cavity and the valve for inflating it at the front end of the device, and the second - the front balloon, wrapping around the body of the device, is movable along it and has a channel for supplying air through valve. 2. The method of using the hemostatic catheter according to claim 1, characterized in that it is inserted into one or both nasal passages, one catheter into each nasal passage, and the rear and front cylinders are filled with air in a volume of 10-12 ml and 5-7 ml respectively.

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