SU1757651A1 - Device for draining the pleural cavity - Google Patents

Abstract

This invention relates to the field of medicine. The purpose of the invention is to improve the accuracy of the installation of the drainage tube in the pleural cavity and reduce the traumatic drainage. The device for drainage of the pleural cavity is a trocar and contains a stylet 1 with a handle, a cylindrical spring 4, an elastic drainage tube 3 having drainage holes 6 on the side surface, a valve 9 of float type working in one direction (outward). The device stylet contains a longitudinal channel 10 which connects the valve cavity to the most distant port 2 at the distal end of the device. The proximal end of the device 7 is provided with a locking cap 8 which is put on the proximal end of the device during drainage after the stylet is removed. The device works as follows: after anesthesia of the drainage site, a skin incision is made on the chest and a device is inserted into the chest cavity by rotational movements. During the passage of the chest wall, the acute distal end of the stylet is displaced in the opposite direction due to tissue resistance, and the valve of the device closes. After the distal end of the device enters the pleural cavity, the stylet returns to its original position by expanding the spring located in the cavity of the stylet handle and the device valve opens. The device stiletto is removed, and a locking cap is put on the proximal end of the device, after which the device begins to operate automatically without external aspiration systems due to the energy of air or fluid in the pleural cavity, as well as due to the elastic force of the lung before completely removing the liquid or gas from the pleural cavity. 6 Il. S ™ x x | ABOUT

Description

The invention relates to the field of medicine and can be used for diagnostic and therapeutic purposes, namely for puncturing the wall of the pleural cavity, suctioning a liquid and evacuating gases, and during

the need and the introduction of liquid drugs.

A device (trocar) for drainage of the pleural cavity is known, which contains a stylet with a handle and is attached to it.

elastic drainage tube having drainage holes on the lateral surface of the distal part (1).

The device works as follows: after local anesthesia 1 of the corresponding intercostal space, a skin incision is made. The device is taken by the handle of the stylet and its chest wall is pierced with its sharp end. After the distal end of the trocar enters the pleural cavity, the stylet is removed and the proximal end of the drainage tube is connected to the aspiration device.

It is also known a device (trocar) for drainage of the pleural cavity, made in the form of a hollow metal stylet, in the cavity of which a drainage tube is installed with side openings on the distal part, the internal channel of the stylet extending at an angle of 60 ° at the distal end of the device (2). The stylet is injected into the pleural cavity under local anesthesia in the corresponding interstitium. After hitting the proximal end of the device into the cavity of the plezra, the stylet is rotated so that its lateral opening is directed to the lowest region of the pleural cavity. Then the drainage tube with side holes at the distal part. located in the stylet cavity, pushed through the side opening at the distal end of the stylet into the pleural cavity. At the same time, the stylet itself remains stationary. The distal end of the drainage tube is connected to an aspiration system.

All of these devices have common significant drawbacks:

1. When using these devices, the accuracy of installing a drainage tube in the pleural cavity during drainage is low, since the drainage procedure is performed blindly, i.e. under the control of the surgeon's DVKH, it is not clear whether the device tube fell into the pleural cavity or it is located deep in the chest or under the skin. Thus, the accuracy of drainage when using these devices depends entirely on the intuition and experience of the doctor.

2. In addition, the drainage procedure with the use of these devices is traumatic, since blind insertion of the device into the deep wall (only under control can lead to uncontrolled advancement of the sharp rigid stylet of the device into the pleural cavity and lead to damage to the lung and other organs). cells.

The closest in essence, selected as a prototype, is the pos.a. No. 1223920, cl. A 61 M 27/00. 1983, containing a tube with openings at the working end and a fixation unit, as well as a valve of one-way conductivity of the membrane type, located at the other end of the tube (3). The device works as follows; a skin incision of 10–12 mm in length is made in region VI of the intercostal space in the mid-axillary line. Through the inter-rib, a trocar stylet is inserted into the chest wall, then the trocar stylet is removed and the tube is fixed with a click to the leatherette. A one-way valve is attached to the outer end of the tube using a threaded joint.

The disadvantages of the prototype device is that.

1. The installation accuracy of the drainage tube of the device in the pleural cavity is low.

2. The procedure of drainage with a prototype device is traumatic. This is due to the fact that

-drainning by the prototype device is carried out only under the control of the surgeon's hand, and it is not clear whether the drainage tube of the device has fallen into the pleural cavity or it is located in the thickness of the breast clerk or under the skin. Precision drainage when using prototype

FULLY CALLS FROM INTUITION AND L1 / POSSIBLE

doctor's experience;

- insertion of a prototype device into the chest only under the control of the hand can lead to uncontrolled advance of the sharp stiletto into the pleural cavity and cause damage to the lung and other chest organs. Injuries to the drainage increase even more under conditions of emergency care (with tight pneumothorax).

The purpose of the present invention is:

1. Increasing the installation accuracy of the drainage tube of the device in the pleural cavity during drainage.

2. Decrease in traumatic ™ drainage,

This goal is achieved by the fact that a known device for drainage of the pleural cavity, comprising an elastic tube with openings at one end and a valve of one-sided conduction of membrane type at the other end, according to the invention, comprises a stylet that has a handle with a cylindrical spring in it Golosti and longitudinal channel with this

the valve is made of float type and has the ability to communicate through the longitudinal channel of the stylet with a hole at the working end of the tube, and the non-working end of the tubes and is equipped with a locking cap

Distinctive features of the device are:

1. The device has a float valve.

2. The valve cavity has a message with a drainage lumen.

3. The valve and drainage tube of the device are a single system and are inseparable.

4. The style of the device has a longitudinal channel.

5. The longitudinal channel of the stylet connects the valve cavity, through the lumen of the drainage tube, to the most distant hole of the drainage tube at the distal end of the device,

6. The style is connected to the handle with a cylindrical spring.

7. The cylindrical spring is located in the cavity of the handle

8. The proximal end of the device is equipped with a locking cap.

Distinctive features of the prototype allow:

1 To improve the accuracy of the installation of the drainage tube in the pleural cavity by eliminating the false triggering of the float valve in the chest or under the skin (if blood or gas is present) and the float valve activating when the most distant opening at the distal end of the device enters the pleural cavity.

2. To reduce the trauma of drainage due to the operation of the float valve of the device, when the farthest drainage hole at the distal end of the device enters the pleural cavity, since this does not require further advancement of the stylet of the device. This ensures the achievement of the goal. Since all of the above distinctive features are common and essential, are not identical or equivalent prototype signs, they are new signs and this device for drainage of the pleural cavity meets the criterion of novelty.

The combination of features that distinguish this device from analogs has not been identified in other technical solutions when studying this and other areas of technology and medicine, and, therefore, provide

to the claimed solution, compliance with the criterion is significant.

The technical solution of the device is illustrated in the drawings, where FIG. 1 shows 5 a general view of the device; Fig, 2 section along b-b; in fig. 3 - initial position of the device; in fig. 4, 5 and b - the scheme of the device.

The technical solution of the device for

0, the drainage of the pleural cavity is a trocar and contains the metal stylic 1, which has a sharp distal end 2 and a handle 3, with the stylet and the connecting handle connected to each other

5 by means of a cylindrical spring 4, which is located in the cavity of the handle. The stylet is fitted with an elastic drainage tube 5, which has drainage holes 6 on its lateral surface. The proximal end of the device 7 is equipped with a locking cap 8 which is put on the proximal end of the device. After removal of the stylet during drainage. The device contains a valve 9 float

5, which, together with the drainage tube of the device, is a single system and is inseparable from each other, with the float valve of the device communicating with the lumen of the drainage tube.

0 The device stylet has a longitudinal canap 10, which statically connects valve cavity 11, with the farthest (indicator) opening 12 at the distal end of the device, which serves to indicate whether the distal end of the device5 has entered the pleural cavity. The valve of the device contains a piston 13, which can freely move in the cavity of the valve. The valve piston contains a hollow suction tube 14, on the side surface of which there is an aspiration hole 15, through which when the piston is raised, the valve cavity has a connection with the atmosphere. The upper part of the valve has an opening

5 through 16, through which the valve piston is in communication with the atmosphere and the rim 17 to prevent the valve piston from falling out during its rise during operation. The lower part of the valve has a channel 18 in which

0 includes aspiration piston tube. The piston of the valve is equipped with a groove 19, sealing them, and the cavity of the valve is equipped. The protruding protrusions 20 prevent the ingress of fluid or gas 5 through the channel with the piston lowered into the valve cavity.

The device is made of plastic materials (the valve of the device is made of transparent plastic). The stylet of the device is made of stainless steel, the cylindrical spring is made of stainless steel.

The device works in a manner.

The device is held in a hand so that the 5 handle of the stylet 3 rests on the palm of the hand, and the fingers clasp the valve 9 of the device. This prevents the stylet from moving with the grip in the opposite direction (outward) during insertion of the device into the chest-10. After anesthesia of the drainage site, a small incision is made on the chest with a scalpel — a device is inserted into the chest wall. During the passage of the chest wall 15 (see FIG. 4), the sharp distal end 2 of the stylet encounters tissue resistance and is thereby displaced in the opposite direction with respect to the device. And since the handle 3 of the stylet 20 is fixed by the surgeon’s hand together with the valve 9 of the device, the movement of the stylet 1 occurs inside the handle 3 of the device and is compressed by the cylindrical spring 4, which is located inside the knuckle 25. As a result of the displacement of the stylet, the longitudinal channel 10 of the stylet also displaces, as a result of which the communication between the longitudinal channel of the stylet and the most

It rises and this confirms the fact that the device has entered the pleural cavity. All the above confirms the accuracy of the installation of the drainage tube of the device in the pleural cavity. The device stiletto 1 is removed after the valve has been actuated, since there is no need for its further advancement, and therefore the possibility of damage to the lung and other chest organs is eliminated. This ensures a reduction in traumatic ™. After removal of the stylet, the locking collar of the packs 8 is put on the proximal end 7 of the device, after which the drainage tube 5 of the device is inserted deeper into the pleural cavity to the required depth. In this case, the device takes the form shown in the drawing fit. eight.

From this point on, the device starts to work automatically. A5; in excess, due to overpressure. fluid or gas in the pleural cavity and the elastic tube of the lung. The work is as follows (see the drawing of figure 5). air or fluid from the pleural cavity through the drainage holes 6 of the elastic drainage tube 5 of the device enters the cavity 1.1 of the valve and due to excessive pressure

the far (indicator) port 12 30 raises 13 valves. As a result, it rises and this confirms the fact that the device has entered the pleural cavity. All the above confirms the accuracy of the installation of the drainage tube of the device in the pleural cavity. The device stiletto 1 is removed after the valve has been actuated, since there is no need for its further advancement, and therefore the possibility of damage to the lung and other chest organs is eliminated. This ensures a reduction in traumatic ™. After removal of the stylet, the locking collar of the packs 8 is put on the proximal end 7 of the device, after which the drainage tube 5 of the device is inserted deeper into the pleural cavity to the required depth. In this case, the device takes the form shown in the drawing fit. eight.

From this point on, the device starts to work automatically. A5; in excess, due to overpressure. fluid or gas in the pleural cavity and the elastic tube of the lung. The work is as follows (see the drawing of figure 5). air or fluid from the pleural cavity through the drainage holes 6 of the elastic drainage tube 5 of the device enters the cavity 1.1 of the valve and due to excessive pressure

drainage tube located at the distal end of the device. With this, blood or air that may be in the thick of the chest wall (for example, with hemothorax or subcutaneous emphysema) will not get 35 into the valve cavity 11, and therefore, the device 9 will not be falsely triggered. Upon further advancement of the device, the acute dmstalny end of the 2 stylet enters the pleural cavity (see drawing 40, fig. 5). At the same time, due to the disappearance of the tissue resistance and due to the cylindrical spring, which at the same time expands and pushes the stylet 1 of the device, the latter (i.e. the stylet) occupies the initial position it had in statics. As a result, communication between the stylet longitudinal channel 10 and the farthest (indicator) hole of the drainage tube 12 located at the distal end of the device again occurs. Blood, liquid or gas from the pleural cavity enters through the indicator hole into the longitudinal channel of the stylet

The valve piston lift opens the aspiration port 5, located on the side surface of the aspiration tube 4 of the valve piston, and the liquid or gas from the pleural cavity through the drain holes of the device’s drain tube 5 enters the valve cavity 11 and, due to overpressure, raises the piston 13 valves. As a result of lifting the piston valve, an aspiration opening 5 is located on the side surface of the valve piston tube aspraction tube 4, and the liquid or gas from the pleural cavity through the drain holes G of the drain tube 5 of the device enters the valve cavity 11 and then through the opening aspirate The opening 5 of the valve piston aspiration tube enters the channel located in the lower part of the valve and further into the atmosphere.

The process of removing a liquid or gas occurs until the pressure in the cavity 11 of the valve, and then, and in the polo, further into the cavity 11 of the valve. Since 55 of the pleura, above atmospheric. Once

the valve piston 13 presses the atmospheric pressure through the opening in the valve upper part 16, and if there is liquid or gas above the atmospheric pressure in the pleural cavity, then the valve piston 13 starts lifting the valve piston, an aspiration opening 5 located on the side surface of the suction tube opens 4 valve pistons, while fluid or gas from the pleural cavity through the drainage holes b of the drainage tube 5 of the device enters the valve cavity 11 and, due to excessive pressure, raises the valve piston 13. As a result of lifting the piston valve, an aspiration opening 5 is located on the side surface of the valve piston tube aspraction tube 4, and the liquid or gas from the pleural cavity through the drain holes G of the drain tube 5 of the device enters the valve cavity 11 and then through the opening aspirate The opening 5 of the valve piston aspiration tube enters the channel located in the lower part of the valve and further into the atmosphere.

The process of removing a liquid or gas takes place until the pressure in the valve cavity 11, and after that, and in the pressure in the pleural cavity becomes equal to or less than atmospheric (as the liquid or gas is removed), the valve piston 13 is lowered and the aspiration hole 15 suction tube 14 pgrshn

the valve closes. At the same time, the removal of liquid or gas from the pleural cavity is stopped, and the return of liquid or gas into the pleural cavity is prevented. This is due to the fact that the return of liquid or gas into the cavity of the pleura is possible only if the atmospheric pressure is greater than in the pleural cavity, and under these conditions the valve 9 of the device is closed. The process of raising and lowering the valve piston 13, i.e. the actual operation of the device continues as mentioned above until the pressure is equalized by the atmosphere and the pleural cavity. At the same time, almost all liquid or gas is removed from the pleural cavity. Residual small amounts of liquid or gas, which sometimes remain in the pleural cavity when pressure is equalized between the atmosphere and the pleural cavity, are removed from the pulmonary lumen, which creates an excess pressure in the pleural cavity, and thereby valve 9 device and removal of residual liquid or gas. Thus, the device valve only works in one direction (outward).

If necessary, operation of the device from an external aspiration system (pump), the locking cap 8 is removed from the proximal end 7 of the device, and a pump is connected to this end. The valve of the E device does not work and air or fluid is removed from the pleural cavity of the direct drainage tube 5 device through the cavity 1 of the valve and then through the proximal end of the device to the pump.

An analysis of the distinguishing features of this device and the prototype device has given the following advantages of the invention.

1. The use of the device makes it possible to very accurately install a drainage tube in the pleural cavity and completely eliminates the installation of a drainage tube in the thickness of the chest or under the skin.

2. The use of the device allows to drastically reduce the trauma of the drainage procedure, since it eliminates the uncontrolled movement of the sharp rigid stylet of the device into the pleural cavity.

3. The device operates in automatic mode, without any additional devices, due to the overpressure of the fluid or gas in the pleural cavity and the elastic pull of the lung.

4. The device does not require a set of surgical instruments for its installation in the pleural cavity, which usually

it is used for such procedures, which allows it to be used in various extreme situations, in the centers of mass casualties and in military field conditions, especially in transporting the wounded during medical evacuation stages

5 The valve in the device is float-type and more reliably prevents the backflow of fluid or

0 gas into the cavity petevry in the process of drainage than the valve type valve in the prototype device known to us (a, No. 1222920, 1983). This is associated with heme in the process of evacuating a fluid or a gzz from

5 of the pleural cavity, a situation arises when the pressure in the pleural cavity becomes equal to the atmospheric pressure (such as pressure on the pleural cavity). In this case, the membrane type valve ceases to function, since for its operation a necessary condition is the pressure difference on both sides of the valve membrane. With equal pressures on both sides of the membrane, an equilibrium state of the membrane arises in which liquid or gas can freely fall back into the cavity. Such a situation is excluded in the valve of the float type (as part of the devices claimed by the authors), since with equal

0 pressure inside and outside the pleura, the valve piston 13 is always in its lower (initial) position due to its own weight, as shown in FIGS. 3, 4 and fmg, 5, and at this position the valve of the device is closed,

5 In addition, the valve in the device has a valve cavity 11, which plays the role of a buffer between the tube and the piston 13, and there blood clots or fibrin can enter the MOP / t and without disrupting the operation of device B

In the known device (a. No. 1223920), the valve is directly connected to the drainage tube, with the liquid or gas flowing directly through the valve membrane, which reduces its reliability,

5 The device is easily transported by patients, allows them to move freely, and the operation of the device does not stop.

The combination of distinctive features of the device causes the number of receptions when using them a positive effect.

When using a prototype device complications are not marked. Techno5 logs of an industrial device can be brought to maximum simplicity with possible production on conveyor rotary lines or by the method of punching from plastics in a one-off design.

The device was developed and tested in the Thoracic Surgery Department of the Tallinn Emergency Hospital. a1i The act of clinical testing from 25.05.89. The use of the invention is scheduled for 1990-1991.

Claims (1)

DETAILED DESCRIPTION OF THE INVENTION A device for drainage of the pleural cavity, comprising an elastic tube with openings at one end and a one-way valve at the other end. and the stylet, characterized in that, in order to increase the accuracy of the installation of the elastic tube in the pleural cavity and reduce the morbidity, the stylet has a handle with a cylindrical spring in its cavity and a longitudinal channel, while the valve is made of float type and has the ability to communicate through the longitudinal channel of the stylet with a hole at the working end tube, and the non-working end of the tube is equipped with a locking cap, 12 fig / 20 3 & 7 / Ј / 7 eight J 4 & 72 3 f (/ 7 / U 13 J 5 10 S2 // 9 I f 5- S 12 g fl / reЈpa / Mffff // / {I S3 / 5 40 7/3 ДС D  c / sang BHZ ЖУ & ОСЛПЈ Aozu KSSSSZSSS f7 / 7e / no. 6f / u & rtOSJGC- / r & 5 GRUDMA №M (e & cn & 03 & Y FIG. 6