RU62826U1 - KIT FOR DRAINING THE CAVIAR CAVITY - Google Patents

Abstract

The invention relates to medicine, namely to surgery, and can be used to drain the pleural cavity when pneumothorax occurs. The task is carried out by a drainage system including a catheter, a trocar, a one-way valve, fixed in the catheter on the thread.

Description

The invention relates to medicine, namely to surgery, and can be used to drain the pleural cavity when pneumothorax occurs.

Pneumothorax is a pathological accumulation of air in the pleural cavity. Pneumothorax is divided into spontaneous (not associated with trauma or some obvious reason), traumatic and iatrogenic (Spasokukotsky SI Surgery of purulent diseases of the lungs and pleura. - M., 1938). Primary spontaneous pneumothorax occurs in the absence of clinically significant pulmonary pathology, secondary spontaneous pneumothorax is a complication of existing pulmonary pathology. Primary spontaneous pneumothorax occurs with a frequency of 1 to 18 cases per 100,000 population per year (Guidelines for pulmonary surgery. - Edited by I.S. Kolesnikov. - L., 1969). Usually it appears in tall, thin young people aged 10 to 30 years and rarely in people older than 40 years, that is, in the most able-bodied population (Petrovsky B.V., Perelman M.I., Koroleva N.S. Tracheobronchial surgery. M.: "Medicine", 1978. - 296 s). Iatrogenic pneumothorax appears as a result of complications of a medical or diagnostic intervention. Traumatic pneumothorax is a consequence of a penetrating or blunt chest injury, while air can enter the pleural cavity from an exploding lung tissue or chest wall defect (Wagner E.A. Surgery for damage to the chest. - M.,: Medicine, 1981, 288 pp. ) One of the common and dangerous forms of pneumothorax, both spontaneous and traumatic, is intense pneumothorax, which is characterized by a progressive increase in air pressure in the pleural cavity, lung collapse,

displacement of the mediastinum, the development of cardiopulmonary failure and death. The only way to save the life of this category of patients is to drain the pleural cavity, and the sooner this intervention is performed, the greater are the chances of success, and the score for intense pneumothorax is minutes. In peacetime, chest injuries account for 8-10% of all mechanical injuries and such patients constitute a large and practically important group of victims. The main method of treating pneumothorax today is the drainage of the pleural cavity (Emergency breast surgery. - Ed. By L.N. Bisenkov. - St. Petersburg, 1995.).

Today, even in most medical institutions involved in thoracic pathology, the simplest drainage according to Bülau is used as the drainage system (Vagner E.A. Surgery of breast injuries. - M.,: Medicine, 1981, 288 pp.). In such a drainage system, the role of the valve is played by a water lock made of a finger from a rubber glove fixed on a drainage tube and immersed in an antiseptic solution in a glass or plastic container. Reusable metal trocars with a metal stylet are used for thoracocentesis, and tubes from blood transfusion systems are used as drains. With this technique, the presence of a sterile trocar is necessary, and the number of reusable instruments is always limited, that is, with the simultaneous admission of not 2, but 4-5 patients, difficulties arise due to the lack of a sterile trocar. The use as a drainage of tubes from systems for blood transfusion also has significant disadvantages including: the small diameter of such drainage, low elasticity and the possibility of bending, the absence of dimensional divisions. A patient who is treated with the Bulau drainage system is constantly forced to ensure that the vessel with the fluid is below the level of drainage, so that the fluid from the vessel does not

spilled out and, finally, so that the drainage does not rise above the liquid level in the vessel. Manipulations associated with reusable instrumentation, cutting out lateral openings on the tube just before drainage, tying a finger from the glove to the tube and immersing in a solution, all this significantly reduces the aseptic nature of such manipulations as drainage of the pleural cavity, and the procedure described at the prehospital stage is generally extremely difficult.

There are foreign disposable sets for drainage of the pleural cavity (info@dina-medika.ru,,).

However, they are characterized by high cost and, as a rule, do not include a valve device and consist only of a drainage tube and stylet for conducting this tube into the pleural cavity.

The closest in technical essence is a thoracic catheter with a trocar of the company Bicakcilar manufactured in Turkey (mfo@dina-medika.ru).

This catheter is made of adhesion resistant polyvinyl chloride. The tip of the trocar has a smooth transition to the catheter to reduce the invasiveness of the insertion. There is a radiopaque line, indelible marking, a connector for connecting to the drainage system, drainage eyes are rounded.

However, there is no valve in this kit, which is a significant drawback, especially when using this drainage in the field. And, in addition, as in all models of drainage systems, the connection of a set catheter with a drainage tube extending the catheter to a water valve or any other valve is carried out by simply selecting and inserting a thinner tube into the lumen of a thicker one.

The task of drainage of the pleural cavity, eliminating the spontaneous disconnection of the drainage and valve.

The task is carried out as follows.

The main technical characteristics of the catheter: the material for drainage is medical polyvinyl chloride, the length of the product is 30 cm, the outer diameter is 10 mm, the inner 7 mm, the drainage must not fall off. The catheter includes an X-ray contrast strip throughout, a large-scale marking, applied at five-centimeter intervals from the distal end - 3 marks, lateral openings in the amount of 2 oval in size 8 × 4 mm at a distance of 1 cm and 3 cm from the distal end. The distal end with a hole for the tip of the trocar, while providing an internal stop for the trocar.

The trocar is made on the basis of economically alloyed maraging steels alloyed with titanium. The main technical characteristics of the stylet are determined: the length of the product is 35 cm, the diameter is 6 mm, the trocar must not bend and deform. The trocar includes a metal rod, the tip of the trocar has a smooth transition to the catheter to reduce the invasiveness of the insertion and an emphasis to fix the distal part of the catheter. The end opposite the tip is closed with a plastic nozzle of spherical shape with a diameter of 12 mm and is an emphasis for the doctor’s hand.

The valve device is made from a composition based on high molecular weight siloxane rubber and is a slit valve enclosed in a silicone housing. The external dimensions of the valve device: a cylinder whose length is 8 cm and an external diameter of 1 cm, inside there is a valve which is a tube 0.5 cm in diameter tapered at the free end, the second end of this tube is soldered into the body.

The valve is connected to the catheter using an adapter made of plastic and having a large thread, through which the valve is screwed into the catheter, which prevents the spontaneous disconnection of the catheter-valve system.

The drainage kit is sterilized in a disposable package and is ready for use. The use algorithm is as follows: the package is opened, a skin incision is performed, a catheter is inserted into the pleural cavity with a trocar, the trocar is removed, a valve is screwed into the catheter opening.

The possibility of practical application of the claimed kit is illustrated by examples of its specific implementation in a clinical setting. Also, for example, the case of using the traditional method of drainage of the pleural cavity with pneumothorax is given. Example 1

Patient L., 23 years old, medical history No. 12368, was admitted to the surgery department on 09/06/05 with complaints of sharp pains in the left half of the chest, cough, shortness of breath. Sick for 6 hours when the above symptoms suddenly appeared. Radiography of the chest was performed: there is pneumothorax on the left. Performed drainage of the pleural cavity with a drainage kit, including a trocar, a catheter, and a valve fixed in the cannula by thread. The patient is active, mobile, walks freely around the department. 09/07/05 X-ray control - the lung is completely straightened. After 4 days, the X-ray control of the lung is completely straightened. The pleural cavity drainage is removed, the patient was discharged home. The duration of hospitalization was 8 days.

Diagnosis: Spontaneous pneumothorax on the left.

The use of their own drainage set with a valve fixed on the thread allowed the patient to be in free motor mode, to prevent possible complications associated with accidental depressurization of the pleural cavity and to reduce the time spent in the hospital.

Example 2

Patient V., 34 years old, medical history No. 12037, was admitted to the Department of Surgery 08/30/05 with complaints of pain behind the sternum aggravated by physical exertion. Sick for 2 years, was treated independently. Computed tomography revealed signs of complex cysts in the upper and middle floors of the anterior mediastinum. It was decided to perform the prompt deletion of education. 09/06/05. performed anterior-lateral thoracotomy on the left. The mediastinal cyst was removed, the pleural cavity was drained on the left. For drainage, a drainage kit was used, including a trocar, a catheter, and a valve fixed on the thread in the catheter. The patient in the early postoperative period is active, mobile, freely walks around the department from the first day after the operation. 09/07/05 X-ray control - the lung is completely straightened. After 3 days, the X-ray control of the lung is completely straightened. The pleural cavity drainage was removed, the patient was discharged home on the 10th day after the operation.

Diagnosis: Thymus cyst (surgery 06.09.05 anterolateral thoracotomy on the left, removal of the cyst, drainage of the pleural cavity).

Example 3

Patient O., 29 years old, medical history No. 12013, was admitted to the surgery department on 08.29.05 with complaints of pain in the left half of the chest, was hit by a car and taken to hospital. On examination, the presence of pneumothorax on the left is suspected. Radiography of the chest was performed, the diagnosis of post-traumatic pneumothorax on the left, subcutaneous emphysema was established. It was decided to drain the pleural cavity on the left. Under local anesthesia, drainage of the left pleural cavity was performed. For drains, tubes from blood transfusion systems and a water lock of the Bulau type were used. 2 hours after drainage, the auscultatory lung is straightened, breathing is carried out in all departments. On the 3rd day after drainage at

examination of the patient revealed that the drainage tubes acting as drainage of the pleural cavity and the water valve tube spontaneously disconnected due to the patient's movements, which led to the development of recurrent pneumothorax. The tubes are connected again by inserting one into the lumen of the other and, in addition, the connection is strengthened by a strip of adhesive tape. X-ray control parietal pneumothorax. For three days, active aspiration was carried out to drain the pleural cavity, the patient was always in bed. X-ray control of the lung is straightened. On the 12th day from the moment of drainage, pleural drainage was removed. 09/12/05. the patient was discharged home. The duration of hospitalization was 14 days.

Diagnosis: Dull chest injury on the left, post-traumatic pneumothorax on the left.

Due to depressurization of the drain-valve system due to the patient’s movements, the length of hospitalization was increased, the patient was forced to remain in bed around the clock on active aspiration.

Thus, the use of the proposed drainage kit allows you to easily and quickly perform drainage of the pleural cavity with pneumothorax of any genesis, enables the patient to be as active as possible in the postoperative period, and does not “confine him” to bed with fixed active aspiration or a water valve and prevents possible complications related with spontaneous depressurization of the drainage system.

Claims (1)

Set for drainage of the pleural cavity, including a catheter, trocar, valve, adapter, characterized by the connection of the catheter with the valve, the valve being fixed in the catheter on the thread.