RU2722819C1 - Intranasal tampon for stopping nasal bleeding after surgical management, spontaneous nasal bleeding in hospital environment - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, particularly to otorhinolaryngology, and can be used in treating patients after surgical management for haemostasis, as well as patients with spontaneous epistaxis in hospital. Intranasal tampon for stopping epistaxis is irregular octagon and comprises a two-section working chamber separated by a soldering suture into two compartments. One of the compartments – the proximal balloon – corresponds to the posterior postoperative bleeding loci, and the other compartment – the distal balloon – to the anterior-middle postoperative bleeding loci. Fluid is supplied into tampon compartments by means of two tubes with diameter of 2 mm, on which at 1 cm from tampon there are label-strips for proximal balloon – one strip, for distal balloon – two strips.

EFFECT: invention provides fast and reliable nasal haemorrhage stopping from the nasal cavity following the surgical treatment and minimizes the risk of undesirable effects from the tamponade with the possibility of independent combined physical and mechanical exposure on the bleeding loci.

4 cl, 3 ex, 1 dwg

Description

The invention relates to medicine, in particular to otorhinolaryngology, and can be used in the treatment of patients after surgical treatment with the goal of hemostasis as well as patients with spontaneous nosebleeds in a hospital.

Endonasal operations occupy a leading place in the structure of surgical treatment of ENT pathology. Due to the abundant blood supply to the nasal cavity and the limited use of “bloodless” methods in the surgical treatment of diseases of the nasal cavity, issues of adequate hemostasis for nosebleeds remain extremely relevant (Piskunov S.Z., Piskunov G.Z. Clinical rhinology. - M .: Miklosh, 2002 . - S. 390).

Ways to stop bleeding of any localization, depending on the nature of the methods used, are divided into mechanical, physical, chemical and biological (Petrov SV. General Surgery: textbook (2nd ed.). - St. Petersburg: Publishing House "Peter"., - 2002. - S. 213). Mechanical stopping of bleeding is achieved using tamponade wounds, dressings, flashing or embolization of a bleeding vessel. Physical methods include the effects of low and high temperatures on bleeding vessels, diathermocoagulation (high-frequency currents), and laser photocoagulation. Mechanical methods of stopping bleeding are the most reliable, but, given the anatomical features of the nasal cavity, the most common is the plugging method (Soldatov I.B. Guide to Otorhinolaryngology. M .: - 2000. - P. 102). Carrying out this manipulation requires certain skills from the doctor. But the difficulties arising from the impossibility of targeted impact on bleeding areas of the middle and posterior parts of the nasal cavity often do not lead to a positive result, which leads to an increase in the traumatic component in the total volume of the operation and, as a result, aggravation of the patient's condition. At the moment, the most effective and less traumatic are elastic and pneumatic tampons, which have pronounced anti-adhesive properties. Known intranasal swab for stopping bleeding from the posterior nasal cavity (Patent RU 0002676663), as well as an intranasal swab for stopping bleeding from the anterior nasal cavity (Patent RU No. 2621951).

A tampon for stopping nosebleeds from the anterior parts of the nasal cavity contains a basis of elastic material - silicone rubber with a shore hardness of A-60. The basis is made in the form of a chamber (tampon) of small size (optimal size 600 × 300 mm) connected to a tube for feeding filler 2-3 mm thick and 1000 ± 50 mm long, at the distal end of which there is a clamp (250 × 100 mm) and an end connecting element configured to connect to a camera filler supply source (liquid or gas may be used as filler). This invention we take as a prototype

But, despite the positive aspects, these types of tampons have a number of common disadvantages:

- isolation of the tampon configuration from the anatomy of the nasal cavity - tampons can stop bleeding from the front or rear sections of the nasal cavity, but in the case of the development of a combined injury, these tampons are ineffective,

- the absence of targeted mechanical effects on the bleeding loci and areas of the main blood supply to the nasal cavity,

- the lack of the possibility of a complex effect on the bleeding area, i.e. the simultaneous use of a physical and mechanical method of achieving hemostasis.

It should be noted that the failure of physical methods of stopping nosebleeds, which are based on the temperature effect on bleeding vessels of the nasal cavity (short-term hypo- and hyperthermia), is explained by the fact that the structure of the vascular wall in different parts of the nasal cavity is not taken into account.

In connection with the foregoing, we were tasked with developing an intranasal swab to stop nasal bleeding after surgical treatment in the nasal cavity in a hospital with the following characteristics: ease of use and installation in the nasal cavity, the ability to correct the tampon function without removing the tampon, the possibility of influencing most of the possible sources of bleeding of the anterior and posterior parts of the nasal cavity, where the vessels of the nasal septum, nasal concha and structures of the nasal cavity can be the source of bleeding, and the possibility of mass production.

The technical result achieved by the implementation of the device we developed is to ensure a quick and reliable stop of nosebleeds from the nasal cavity after surgical treatment and to minimize the risk of unwanted effects from tamponade with the possibility of independent combined physical and mechanical effects on bleeding loci.

The invention is illustrated in the drawing.

Figure 1. Intranasal swab to stop nosebleeds (side view).

1 - proximal balloon tampon;

2 - distal tampon balloon

3 - tube for the filler of the proximal balloon;

4 - tube for the filler of a distal balloon;

5 - clamp on the tube;

6 - end connecting element;

7 - seam-soldering between the swab chambers;

8 - double strip - label for filler in the distal balloon of the swab;

9 - a single strip - a label for feeding filler into the proximal tampon balloon.

Internal corners of the device: <A = 150 °, <B = 91 °, <C = 136 °, <D = 164 °, <E = 163 °, <F = 155 °, <G = 131 °, <K = 90 °.

Given the features of the nasal cavity blood supply, the syntopia of the main great vessels and vasal plexuses, the main drawback of pneumotampons, when the compression created in the balloon is evenly distributed over the entire nasal cavity, we decided to divide the total tampon cavity into two compartments that correspond to the posterior and anterior-middle loci of postoperative bleeding . This division was achieved by means of a transverse seam-soldering, passing through the middle between points E and F. As a result, we received two cylinders located in a single tampon block, with separate filling channels. Sectioning the tampon allows you to independently mechanically act on the back and front-middle sections of the nasal cavity.

Based on the study, a vector analysis of computer-assisted reformation of the septum and lateral wall of the nasal cavity, corresponding to the loci of the main blood supply to the nasal cavity and the areas of intranasal surgery, an optimal profile of the intranasal swab was obtained.

The tampon is made of an elastic material - silicone rubber with a shore hardness of A-60. The basis is made in the form of two small-sized compartments, separated by soldering. Liquid is supplied to the tampon compartments using two PVC tubes with a diameter of 2 mm. The tampon has the shape of an irregular octagon with sides equal to: AB = 16 mm, BC = 20 mm, CD = 12 mm, DE = 17 mm, EF = 16 mm, FG = 18 mm, GK = 13.2 mm, KA = 53 , 5 mm and internal angles: <A = 150 °, <B = 91 °, <C = 136 °, <D = 164 °, <E = 163 °, <F = 155 °, <G = 131 °, < K = 90 °. The corners are smoothed. Considering the peculiarities of the nasal cavity blood supply, the syntopy of the main great vessels and the vasal plexus, the total cavity of the original tampon was divided by a transverse suture-soldering, passing through the middle between points E and F, into two compartments that correspond to the posterior and anterior-middle loci of postoperative bleeding. On the filler tubes at a distance of 1 cm from the tampon there is a label strip for the proximal balloon one - strip, for the distal - two strips - this is necessary to determine the accessories of the tubes of the proximal and distal compartments, as well as to determine the correct installation of the tampon. There are also clips on the tubes to close the bottle.

The implementation of the invention. The swab installation is carried out as follows: the swab is inserted into the nasal cavity and is installed so that its choanal edge and the coulter are flush. Filling the cylinders with saline is carried out through the connectors until hemostasis is achieved. The peculiarity of inflation is that at first the posterior tampon balloon is distilled, and then the front one is proximal (otherwise, the tampon is displaced towards the vestibule of the nasal cavity).

While the patient is in anesthesia, the viability of hemostasis is assessed with anterior rhinoscopy. After extubation of the patient, the posterior pharyngeal wall is examined.

With the development of spontaneous bleeding in the ENT department or at the hospital admissions stage after local anesthesia with a 10% lidocaine solution, an application swab is inserted into the nasal cavity with the help of bayonet tweezers and a nose dilator, alternately in each half of the nose. The next step is to fill the tampon cylinders and control the stop of nosebleeds, examining the posterior pharyngeal wall.

Complete removal of saline from sections of the anatomical hydrotampon is carried out 24 hours after surgery, while the tampon in the deflated state remains in the nasal cavity for a “control period” of 6 hours, after which (provided there is no recurrence of nosebleeds) it is completely removed.

Clinical example M1.

Patient K., 20 years old, turned to the clinical diagnostic department of GBUZ NIKIO them. L.I. Sverzhevsky with complaints of nasal congestion, mucous discharge from the nose. Hospitalized in the ENT department for planned surgical treatment.

On examination, the region of the paranasal sinuses is not changed, the mucous membrane of the nasal cavity is slightly swollen, cyanotic. The nasal septum is curved S-shaped in the bone and cartilage. The lower nasal concha is enlarged due to edema, is cyanotic, and decreases poorly with adrenalization. The nasopharynx is free. The mucous membrane of the oropharynx is pink. Palatine tonsils are not enlarged, gaps are free. The mucous membrane of the larynx is pink, the vocal folds are mobile. Ears: The external auditory meatus is clear on both sides. Left - the eardrum is not changed, the identification marks are contoured. Right - the eardrum is not changed, the identification marks are contoured. Diagnosis: Curvature of the nasal septum. Hypertrophic rhinitis.

The patient underwent surgical treatment of septoplasty, bilateral lower sparing conchotomy. The operation was performed under combined endotracheal anesthesia. The first step was septoplasty. The next step was a bilateral lower sparing conchotomy with lateroconchopexy. The operation was completed by installing an intranasal swab to stop nosebleeds after surgical treatment. The tampon cylinders are filled with physiological saline 3 ml into a distal balloon and 2 ml into a proximal balloon. Hemorrhage stopped. After the patient exited anesthesia, the posterior pharyngeal wall was examined - there was no hemorrhage. The patient spent the night calmly. A day later, liquid was removed from the filling cylinders. The back wall of the pharynx was examined - there are no signs of bleeding. On the 2nd day, intranasal tampons were removed from the nasal cavity. There is no hemorrhage. Conducted toilet nasal cavity and adrenalization. Mild swelling of the mucous membrane is noted, nasal breathing is satisfactory. The patient was discharged for outpatient aftercare. When viewed on the 7th day - nasal breathing is free, edema is not pronounced.

Clinical example No. 2.

Patient T., 16 years old, turned to the clinical diagnostic department of GBUZ NIKIO them. L.I. Sverzhevsky with complaints of nasal congestion, mucous discharge from the nose. Hospitalized in the ENT department for planned surgical treatment.

On examination, the region of the paranasal sinuses is not changed, the mucous membrane of the nasal cavity is slightly swollen, cyanotic. The septum of the nose is in the middle position. The lower nasal concha is enlarged due to edema, is cyanotic, and decreases poorly with adrenalization. The nasopharynx is free. The mucous membrane of the oropharynx is pink. Palatine tonsils are not enlarged, gaps are free. The mucous membrane of the larynx is pink, the vocal folds are mobile. Ears: The external auditory meatus is clear on both sides. Left - the eardrum is not changed, the identification marks are contoured. Right - the eardrum is not changed, the identification marks are contoured. Diagnosis: Hypertrophic rhinitis.

The patient underwent surgical treatment of bilateral lower sparing conchotomy. The operation was performed under combined endotracheal anesthesia. The operation was completed by installing an intranasal swab to stop nosebleeds after surgical treatment. The tampon cylinders are filled with physiological saline 3 ml into a distal balloon and 2 ml into a proximal balloon. Hemorrhage stopped. After the patient exited anesthesia, the posterior pharyngeal wall was examined - there was no hemorrhage. The patient spent the night calmly. A day later, liquid was removed from the filling cylinders. The back wall of the pharynx was examined - there are no signs of bleeding. On the 2nd day, intranasal tampons were removed from the nasal cavity. There is no hemorrhage. Conducted toilet nasal cavity and adrenalization. Mild swelling of the mucous membrane is noted, nasal breathing is satisfactory. The patient was discharged for outpatient aftercare. When viewed on the 7th day - nasal breathing is free, edema is not pronounced.

Clinical example No. 3.

Patient M., 40 years old, turned to the admission department of GBUZ NIKIO them. L.I. Sverzhevsky with complaints of nosebleeds from the left half of the nose. Hospitalized in the ENT department. The patient had previously had surgery on the nasal septum and nasal concha 14 days ago (septoplasty, bilateral conchotomy). From the anamnesis it is known that bleeding began at home amid rising blood pressure to 150/100. Itself did not stop. I turned to the front desk. Hospitalized. Diagnosis: Epistaxis. Condition after septoplasty, bilateral conchotomy.

On examination, the area of the paranasal sinuses is not changed, bleeding from both halves of the nasal cavity, flowing down the back wall of the pharynx. The nasal cavity was adrenalized, hemorrhage does not stop, and the source of bleeding is presumably from the lower nasal concha. The septum of the nose is in the middle position. After m / a lidocaine 10% spray 1 ml with the help of bayonet tweezers, intranasal tampons in each half are installed in the nasal cavity.

The tampon cylinders are filled with physiological saline 3 ml into a distal balloon and 2 ml into a proximal balloon. Hemorrhage stopped. A day later, liquid was removed from the filling cylinders. The back wall of the pharynx was examined - there are no signs of bleeding. On the 2nd day, intranasal tampons were removed from the nasal cavity. There is no hemorrhage. Conducted toilet nasal cavity and adrenalization. Mild swelling of the mucous membrane of the nasal cavity, crust on the lower nasal concha is noted, nasal breathing is satisfactory. The patient was discharged for outpatient aftercare. At the control examination on the 14th day - nasal breathing is free, edema is not pronounced, bleeding did not recur.

Claims (4)

1. Intranasal swab for stopping nosebleeds after surgical treatment, spontaneous nosebleeds in stationary conditions, characterized in that it has the shape of an irregular octagon and contains a two-section working chamber, divided by seam-soldering into two compartments, one of which is the proximal balloon - corresponds to the rear loci of postoperative bleeding, and the other is a distal balloon to the antero-middle loci of postoperative bleeding, the fluid is supplied to the tampon compartments using two tubes with a diameter of 2 mm, on which there are markers at the distance of 1 cm from the tampon - one strip for the proximal balloon, for distal - two strips. 2. The intranasal swab according to claim 1, characterized in that the sides of the octagon have dimensions AB = 16 mm, BC = 20 mm, CD = 12 mm, DE = 17 mm, EF = 16 mm, FG = 18 mm, GK = 13 , 2 mm, KA = 53.5 mm, and its internal angles are <A = 150 °, <B = 91 °, <C = 136 °, <D = 164 °, <E = 163 °, <F = 155 °, <G = 131 °, <K = 90 °. 3. The intranasal swab according to claim 1, characterized in that the working chamber is made of silicone rubber with a shore hardness of A-60. 4. The intranasal swab according to claim 1, characterized in that the end element of the fluid supply tubes is made for connection to a fluid source.

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