US1955140A - Wound treatment - Google Patents

Description

April 17, 1934. E, I, MCKESSON 1,955,140

WOUND TREATMENT 2 Sheets-Sheet 1 Filed Dec. 31, 1928 glwuentoo April 17, 1934. E. l. McKEss 1,955,140

WOUND TREATMENT Filed D60. 31, 1928 2 Sheets-Sheet 2 Patented Apr. 17, 1934- UNITED STATES PATENT OFFICE 1 Claim.

This invention relates to the handling of patients for a maintained Withdrawal of liquid therefrom.

This invention has utility for post-operative drainage in surgical cases for removing natural secretions from disturbance of the wcund and for removing pus or objectionable accumulations as .well as thereby contributing materially to the speed of recovery for the patient, to the comfort of the patient, and to the economy and eificiency in the care of the patient.

"Referring to the drawings:

Fig. 1 is a view in side elevation of apparatus effective for carrying out the invention herein, as assembled for wound drainage as in the instance of an abdominal operation in the region region;

'Fig. 3 shows a connection where there is pulsation pressure disturbance as in the region enveloping the lungs;

Fig. 4 is a plan view, with parts broken away, of the apparatus of Fig. 1;

Fig. is a view on an enlarged scale of the pump of Fig. 1, with the cover plate removed; Fig. .6 .is a section on'the line VIVI, Fig. 5;

Fig. 7 is a section on the line VII-VII, Fig. and

Fig. 8 is a view of the pump fouling prevention mechanism, parts being broken away.

Plug 1 may be connected through electric conductor lines 2 extending to terminals 3, to cut in electric powerfor operating motor 4 mounted on truck 5 having ball bearing swivel casters 6 in thus providing a portable hospital unit. This motor 4 has shaft 7 extending therefrom into chamber 8. In this chamber 8, shaft 7 is provided with worm 9 in mesh with worm wheel 10 on shaft 11 mounted in bearings 12, 13. The bearing 12 is inside Wall of the chamber 8 having ports 14, 15, to well 16 having top closure or plug 17 with exhaust vent 18 as a muffle therefrom when the apparatus is herein operated as used as a suction or exhaust device.

The chamber 8 may be filled with lubricant 19 to .a level to be seen in the well 16, which well 16 may be the lubricant replenishing way. As so charged with lubricant 19, say castor oil, the worm wheel 10 may just dip therein in the operation of this speed reduction gearing. When it is desired to clear the chamber 8, plug 20 may be removed and the chamber 8 flushed with a clean ing solution or a new lubricant.

As herein disclosed, the speed reduction gearing 9 is a direct drive for a rotary pump. The chamber 8 is completed by side wall 21 carrying Jflange 22 in thus providing pump chamber 23.

In this pump chamber 23 is rotor 24 eccentrically located in the chamber 23 by its trunnions 26, 2'7. The trunnion 26 has transverse slot 28 to receive transverse projection 29 from the shaft 11 thereby providing a loose key connection for pump shaft 26, 2'7, in alignment with the speed reduction shaft 11. The rotor 24 is provided with radially and longitudinally extending slots 30. These slots 30 are herein shown as three in numher having therein bars 31 serving as the pistons in this rotary pump and riding on the inside of the chamber 23 in the counter-clockwise rotation of this rotor '24, (Fig. 5). These pistons 31 have recesses 32 therein for helical compression springs 33 guided against buckling by stems 34 (Fig. 6). Itis accordingly seen these pistons are normally outwardly projecting at all times to ride against the interior of the chamber 23 and thus cause exhaust by way of port 35 into the chamber 8.

The chamber 23 is closed by end plate 36 assembled by bolts 37 with the flange 22, while bolts 38 assemble the flange 21 with the housing for the chamber 8. In this housing for the chamber 8, screw 39 is held adjusted by lock nut 40 for providing end bearing for the shaft 7 in taking up thrust of the worm gear speed reduction. The flange 36 has boss 41 providing bearing for the shaft section 26 of the rotor 24, in alignment with the bearing 13.

Through this rotor 24 from the transverse slot 28 is duct 42. The boss 41 is externally threaded and has mounted thereon cap 43 provided with gasket 44 as a seal against lubricant seepage. However, this gasket 44 .is backed by compressible packing as sponge rubber 45 so that in this adjustment the snugness of this compressible portion 45 against the end of the shaft 27 may beadjusted, thereby varying the effective suction of the rotary pump for drawing lubricant as lifted by worm wheel 10 for working into the bearing 13 and thence into the duct 42. This suction of the pumppulls this lubricant past the compressible packing 45 and about the trunnion 2'? into the pump chamber 23, there effectively to lubricate the pistons 31. The high speed operation causes this lubricant excess tobe thrown centrifugally and flow by way of the exhaust port 35 back into the chamber 8.

Intake suction for this rotary pump is by way of port 46 from which there extends flexible duct 4'? to rigid duct section 48 extending to closure 49 and there having port 50 for communication into reservoir 51 herein shown as a Instead of controlling the speed of the motor 5, there is efiected herein a nicety for wide range of adjustment of the effective pull in the reservoir 51, which pull, due to the fact that there is a rotary pump of high speed, is uniform. In practice, for the drainage of wounds of a patient, the pressure desired may be but slightly below atmospheric, and it may be run to forty millimeters of mercury, or higher if desired, in unusual cases, for the capacity of the pump is one which will pull a quite high vacuum.

For this adjustment, the reservoir lid or closure 49 has in the passage 48, lateral port 58 closed by bushing 59, having ports 60 therethrough. Valve disk 61 with gasket 62 has stem 63 extending through the bushing 59 to cap nut 64. This cap nut 6 1 has depending sleeve 65, while the bushing 59 has counter-bore 66 remote from the valve disk 61, there to house compression helical spring 67 tending normally to hold the valve disk 61 in lifted position to close the ports 66. This nut 64 has externally knurled portion and carries graduations 68. This nut 6 1 has long pitch threaded connection with the stem 63 so that in rotation of this nut 64 as to the stem 63, the compression of the spring 67 is adjusted, thereby increasing the resistance to opening of the valve 61 for inbleeding of air in response to suction by way of the ports 66. In

this rotation of the nut 64, the stem 63 is held from rotation as to the bushing 59 by spline 69. Screw '70 holds indicator '71 with the stem 63, so that this indicator 71 may disclose on the scale of graduations 68, the degree of compression of the spring 67 as brought about by rotating the nut 64. These graduations 68 are advantageously in millimeters of mercury for thereby disclosing the sub-atmospheric condition as set for development and maintenance in the reservoir 51 by this adjustable control mechanism.

Spaced from this exhaust terminus port in this reservoir 51 is rigid tube '72 extending upward and from the closure 19 and away therefrom, there to have mounted thereon flexible duct 73 as the drain tube extending into wound 74 and in a region therein spaced inward from the incision or superficial out. At the wound, this duct 73 may be wrapped with gauze '75, with sheet rubber '76 thereabout to provide a porous packing surrounding this flexible duct '73. This duct 73 is of such strength in its walls to resist collapse under the elected pressure for operation of the reservoir 51. Beyond this rubber dam gauze packing at the superficial region of the wound 74, gauze envelope 77 extends about the terminus of the duct 73.

In the generation of sub-atmospheric condition in the reservoir 51, this wound, say in the region exterior of the intestines but in the abdominal region, may serve to cause odors and liquid accumulation to be withdrawn. The gauze mass 77 about the duct is sufficient to sustain the tissues for holding such against strain or drawing into or toward the terminus of the duct '73.

In practice, it is desirable that this withdrawing suction be up to the supply rate of the substances to be withdrawn and a little in excess thereof. This excess precludes or minimizes seepage through or into the dressing I5 and may even be to an extent to cause a slight inflow of air. This ventilation of the dressing may not be of an extent to detract from healing conditions within the wound.

The duct terminus may be of a special reduced form as to the intake end, or have a plurality of ports laterally or terminally, it being desired at all times that any pull action shall not be of a character to irritate the tissue, but that the tissue shall be supported.

In the instances wherein the removal be of a secretion as in a bladder, rubber darn '78 may be inserted from exterior of the body to the interior of the bladder 79. This dam, as in the instance of the dam 76, holds the duct 73 from adherence at th wound. In this instance, the omission of the gauze permits a more ready ventilation and likewise the inflow to the bladder 79 of air in response to the suction in the reservoir 51 may be of relatively greater volume. The location of the terminus of the duct 73 may be for more or less complete drainage of the bladder '79 and of course primarily is to keep the secretions away from the wound or diseased portion which it is desired to have free of the disturbance in the healing process.

Where the bladder has been opened and the prostate gland removed and where the wound is then completely closed with sutures, mine is removed by way of an indwelling tube or catheter through the urethra and attached to the pump to efiect removal of urine preventing pressure of urine against the sutures thus permitting more certain and rapid healing.

In the abdominal as well as bladder region treatments, the pressure handlirr is conducted solely for the drainage and is undisturbed by fluctuating pressure factors such as are present in the instance where respiration expansion and contraction is present. Accordingly, in the treatment of a wound, say for drainage of the pleural cavity, this pressure problem must be taken into account, for any inflow of external air might be seriously objectionable in collapsing the lung. To this end, rib 80 may be removed, and rubber tube or dam 81 extend into the cavity and there have sealing portion 82 with wall 83 of the pleural cavity. This rubber dam 81 has additional pressure seal 84 at the wound exterior. Duct '73 as assembled therewith limits all air flow into and out of the wound to this duct 73. Regulation of the nut 64: may be such as to hold the lung against collapse in the inhalation and still allow the exuding on the exhalation, for the effective drainage as desired.

It is accordingly seen that in the conduct of the treatment as hereunder rendered possible, post-operative conditions of a patient are eiTectively handled in the promotion of healing conditions for the wound as to the removal of secretions which might deter the healing; as to the removal of the diseased emanations, whether odors or liquids. These conditions can take care of a volume of drainage while still keeping the dressings clean and thereby avoiding tendencies of external irritation as well as annoyance to the I patient from frequency of dressings otherwise quite necessary. With this wide range of wounds to be handled, there can be definitely detected changes in the character of drainage substance. This is an advantage to those having the patient in charge, enabling them to detect changes in the patient from such source.

In the event the attendant may not empty the vessel 51 before there is considerable accumulation therein, safe-guarding of the apparatus is had herein against such accumulation being drawn into the pump to foul the pump.

To this end in the exhaust port 50 there is introduced nipple 85 carrying depending fitting 86. This fitting 86 has shoulder 87 at chamber 88 lfrom which there are lateral ports 89. The nipple 85 has port 90 therethrough. This port is a seat for needle valve 91 on stem 92 guided by the depending portion of the fitting 86. This stem 92 terminates in float 93 normally holding the needle valve 91 in drop position against the shou1- der 8'7 so that the suction from the port 90 is effective in this vessel 51 through the ports 89. As the accumulated liquid rises to reach the float 93, such float is lifted to have the valve 91 close the port 90. This occurs before the liquid has been lifted to the region of the ports 89 and accordingly precludes any suction of such liquid flow to foul the pump.

What is claimed and. it is desired to secure by Letters Patent is:

In apparatus for the drainage of wounds, a reservoir, a duct from the reservoir adapted to enter a wound, continuously operating atmospheric pull means for the reservoir of a capacity above the drainage action to be applied to the Wound, a duct from the means to the reservoir, said duct providing a passageway, there being an air port in communication with said passageway, a closure disk between said port and said passageway, a mounting for the disk exterior of the passageway, and adjustable spring means exterior of the passageway effective through the mounting to vary poising clearance of the disk as to the port.

ELMER ISAAC McKESSON.

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