US3752158A - Apparatus and method for suprapubic drainage of the urinary bladder - Google Patents

Abstract

Apparatus and method for suprapubic drainage of the urinary bladder comprises a small trocar for puncturing the bladder wall following which a flexible drainage tube is inserted through the lumen of the trocar and into the bladder. The trocar is then retracted from the patient and withdrawn from the tubing over the proximal end thereof. The proximal end of the tubing is then connected through a three way stopcock which is in turn connected to an additional piece of flexible tubing, the latter running to a portable suction-producing device which may be secured to the patient''s garment. A fully closed evacuating system is provided. The stopcock has an auxiliary passageway into which a hypodermic needle may be inserted to irrigate or flush the system, or to introduce medication into the bladder.

Description

United States Patent [191 Kariher Aug. 14, 1973 Inventor: 9. 1am. H- rihsrt- 199$.

An i ua. Br tish. We t indie [73] Assignee: Snyder Manufacturing Company,

Inc., New Philadelphia, Ohio 22 Filed: Nov. 23, 1970 21 Appl. No.: 91,885

OTHER PUBLICATIONS Hodgkinson et al.-Amer. Jour. Obstet. & Gynec. Vol.

96, No. 6, Nov. 15, 1966, pp. 773-783. Medical-Surgical Review-April, 1970-pg. 16. Surgical Procedures-Phamplet Zimmer Manufact. Co., pgs. 6 relied on.

Lancet September 1963-pg. 607.

Primary Examiner-Dalton L. Truluck Attorney-Olson, Trexler, Wolters & Bushnell ABSTRACT Apparatus and method for suprapubic drainage of the urinary bladder comprises a small trocar for puncturing the bladder wall following which a flexible drainage tube is inserted through the lumen of the trocar and into the bladder. The trocar is then retracted from the patient and withdrawn from the tubing over the proximal end thereof. The proximal end of the tubing is then connected through a three way stopcock which is in turn connected to an additional piece of flexible tubing, the latter running to a portable suction-producing device which may be secured to the patient's garment. A fully closed evacuating system is provided. The stopcock has an auxiliary passageway into which a hypodermic needle may be inserted to irrigate or flush the system, or to introduce medication into the bladder.

2 Claims, 13 Drawing Figures PMENIED 3.752.158

sum 1 or 2 APPARATUS AND METHOD FOR SUPRAPUBIC DRAINAGE OF THE URINARY BLADDER This invention relates to methods and systems for body drainage, and more particularly to a suprapubic urinary drainage system and method.

BACKGROUND OF THE INVENTION eter may have to be frequently removed and reinserted...

This further traumatizes the bladder and contributes to the discomfort of the patient. Furthermore, the repeated insertions of the catheter is frequently a source of infection, which complicates the postoperative care.

OBJECTS AND SUMMARY OF THE INVENTION An object of the present invention is to provide a method and system for suprapubic drainage from the bladder which eliminates the need for repeated insertions and withdrawals of a catheter through the urethra. The system of the present invention reduces the possibility of infection, increases patient comfort, encourages the patient to begin voiding naturally, and is easily disconnected and removed from the patient when no longer needed.

A further object of the present invention is to provide a method and system of the type stated which is fully closed and wherein the urine is gently sucked out of the bladder in such a manner as to preclude bladder collapse. The evacuator unit of the apparatus can be attached to the patient so that the latter can be made ambulatory as soon as otherwise possible. The apparatus includes a small drainage tube that is inserted into the bladder suprapubically. The suction is effected by means of a portable device which applies the suction over a limited period of time after which the suction ceases until the device is reactivated. In the interim, the patient is encouraged to begin voiding naturally. Gravity drainage of the bladder is avoided and the system prevents back flow of urine into the bladder, which might cause infection.

In accordance with the foregoing objects, there is provided an apparatus, which may be in kit form, that includes a small diameter trocar or like cannulated needle for puncturing the bladder wall, and a small diameter flexible drainage tube insertable at one end through the lumen of the cannula and into the bladder. After the small diameter tube has been inserted into the bladder, the trocar is slid off of the tube through the proximal end thereof and discarded. The aforesaid proximal end of the tube is connected to a three way stopcock that forms part of the kit. Also connected at one end to the stopcock is a length of large drainage tubing which, at its other end, is connected to a suctionimposing device capable of being secured to the patients garment or otherwise attached to or carried by the patient so that the latter may be ambulatory. The stopcock has an auxiliary passageway in communication with the tubing through the stopcock valve. The auxiliary passageway is kept sterile by a removable seal cap. However, the cap may be removed for insertion of a hypodermic needle into the auxiliary passageway to withdraw fluid, to irrigate the system, or to introduce medication, such as antibiotics, into the bladder.

BRIEF DESCRIPTION OF THE FIGURES In the drawing:

FIG. 1 is a front view of a portion of the body and showing the apparatus of the present invention in use as a suprapubic urinary drainage device;

FIG. 2 is a view of a step in the surgical procedure which forms part of the present invention and is carried out in conjunction with the use of the apparatus of the invention;

FIGS. 3 and 4 are fragmentary elevational views, on an enlarged scale, of a portion of FIG. 2 and showing further successive steps in connection with the surgical procedure;

FIG. 5 is a fragmentary sectional view, on an enlarged scale, taken along line 5-5 of FIG. 4;

FIG. 6 is a fragmentary perspective view showing the proximal end of the smalldrainage tube and a portion of the stopcock housing into which it is insertable;

FIG. 7 is a fragmentary perspective view of the stopcock shown attached to the small drainage tubing and to an end of the larger drainage tubing;

FIG. 8 is a fragmentary longitudinal sectional view taken substantially along line 88 of FIG. 7;

FIG. 9 is a fragmentary sectional view taken along line 9-9 of FIG. 8;

FIG. 10 is a fragmentary elevational view, on a reduced scale, of the structure of FIG. 8, but showing the use of a hypodermic needle for injection of fluid into the system or removal offluid from the system;

FIG. 11 is a fragmentary perspective view of the evacuator or suction-imposing device that forms part of the present invention, thedevice being shown in its normal expanded position;

FIG. 12 is a sectional view taken approximately along line 12-12 of FIG. 11; and

FIG. 13 is a sectional view similar to FIG. 12 and showing the evacuator collapsed preparatory to imposing suction on the drainage tubing of the system.

Referring in more detail to the drawing, the apparatus is shown as a means for evacuating urine from a human bladder. Accordingly, 2 designates an evacuator unit, hereinafter "more fully described, for creating a suction or negative pressure in aflexible conduit 4 which includes a largediameter drainage tube 6, a threewaystopcock 8, and a smalldiameter drainage tube 10 which projects through anopening 12 in the lower abdomen of the patient and into thebladder 14. Thetubes 6, 10 may be of a vinyl resin or other material compatible with human tissue. Theevacuator 2 may be suitably secured to thegarment 15 of the patient as by asafety pin 16.Suitable bandages 18, 20 may be wrapped around the patient to retain thetubes 6, 10.

In the surgical procedure, a catheter may be inserted through the urethra to empty thebladder 14, after which the bladder may be distended by introduction of a sterile saline solution or distilled water through the catheter. If desired, methylene blue may be added to the solution as a color indicator. In emergency treatment evacuation and filling of the bladder may be dispensed with, it being considered that the bladder is sufficiently distended.

After sterile preparation of the lower abdomen, atrocar 22 is used to perforate the bladder wall. Thetrocar 22 comprises acannula 24 that has a pointedpuncturing end 26 and a lumen 28 (FIG. The cannula may have an outside diameter of about 0.109 inches while the lumen may have a diameter of about 0.085 inches. Opposite to the piercingend 26 thetrocar 22 has aplastic hub 30 rigidly secured and including aradial flange 32. As shown in FIG. 2 thetrocar 22 is inserted into the skin and into thebladder 14, thehub 32 serving as an abutment against which manual force may be applied to thetrocar 22. Perforation of the bladder wall will be indicated by fluid fountaining through the hubcontaining end of thetrocar 22. The precise location of the puncture will vary with the surgical procedure. However, in a typical procedure, thetrocar 22 should be inserted just off the midline of the bladder approximately 3 centimeters above the top of the symphysis and at an angle of about 30 from the vertical (the patient being horizontal as shown in FIG. 2) and directed toward the pubis. The puncture is rather small and so bleeding is minimal.

With thetrocar 22 in place, thedistal end 34 of the small diameter drainage tube is inserted into the lumen of thecannula 24, as shown in FIG. 4. Thetube 10 is slidably advanced through thetrocar 22 and into the bladder. This is easily accomplished since thetube 10 may have an outside diameter of about 0.060 inches and an inside diameter of about 0.040 inches. If desired thetube 10 may have a suitable indicator mark (not shown) a known distance from thedistal end 34 which aids in indicating that a predetermined length of thetube 10 has been inserted. Adjacent to thedistal end 34, the wall of thetube 10 may have a series ofapertures 36 spaced along the length of the tube and through which the urine will pass. A small piece of tape may be used to retain thetube 10 against the abdomen adjacent to the puncture. It should be noted that the angularly directed puncture wound of the trocar-22 pierces the muscle tissue of the abdomen over a sufficiently large region that the muscle tissue aids in retention of thetubing 10.

Thetrocar 22 may then be withdrawn from the patient by pulling on thehub 32 while at the same time pushing slightly on thetube 10 so that the latteris not also withdrawn. Thetrocar 22 is slid off of the exposed orproximal end 38 of thetube 10 and discarded. If a catheter has been inserted into the urethra to distend the bladder, as earlier described, it may now be used to evacuate the bladder after which the catheter will be removed. At itsproximal end 38 thetube 10 is internally fitted with a rigid tubular extension orconnector 40, which may be of metal, and by which thetube 10 may be connected to thestopcock 8 so that when theevacuator 2 is activated to produce suction, the urine will be withdrawn from the bladder through thetube 10,connector 40,stopcock 8 and largediameter drainage tube 6 for discharge into theevacuator 2, as more fully hereinafter described. For convenience and sterility, theevacuator 2, thelarge tube 6 and the stopcock 7 may be pre-assembled so that theconnector 40 may simply be joined to thestopcock 8.

Thestopcock 8 comprises avalve housing 42 of a suitable molded plastic and integrally having a central portion 441 and opposed tubular stems orfittings 46, 48

with axially aligned bores 50, 52. An end of thetube 6 is telescoped over the fitting 46, and a rubber-liketubular reducer 54 is telescoped over the fitting 48. Therigid connector 40 is pressed into the smalldiameter bore portion 56 of thereducer 54, such connection being generally made immediately after thetrocar 22 has been withdrawn, as previously described. Extending from thecentral portion 44 at substantially right angles to thefittings 46, 48 is an auxiliary stem or fitting 58 having apassageway 60 which may be closed by aremovable seal cap 62 that fits over the free end of the fitting 58.

A rotary threeway valve 64 is disposed in thecentral portion 64 of thevalve housing 42 and is provided with a manipulatinghandle 65. Thevalve 64 is rotatable from the positions shown in FIGS. 7-10 through an angle of 180. In the position illustrated, thevalve 64 is positioned so that fluid may flow through the main passageway in the valve housing, namely from thebore 52 through the valve orifice and to thebore 50. In the position 180 from that shown, thebores 50, 52 are in communication and in addition theauxiliary passage way 60 is in communication with thebores 50, 52. In the position ninety degrees counterclockwise from that shown in FIG. 8 thevalve 64 shuts off fluid flow from between thebores 50, 52 but provides communication between the auxiliarypassageway 60 and thebore 52. If desired, the valve and central part of the valve housing may have a conventional axial overlapping stop arrangement 61 (FIG. 7) so that the valve may be rotated through only a single half circle.

Theevacuator 2 may be ofa known type, for instance one similar to that shown in McElvenny et al. U. S. Pat. No. 3,115,138, issued Dec. 24, I963. Suffice it to say that such device comprises opposd parallelcircular walls 66, 68 that are joined by an annular connectingside wall 69 to define'achamber 70. The side and annular walls may be of pliable plastic sheets and may be joined by annular heat seals 71, 72. Theannular wall 69 may be transparent, and may include graduations (not shown) for indication of the volume of fluid therein. Eachwall 66, 68 is internally provided with a somewhat rigidplastic backings 73, 74 havingflanges 76, 77 that are substantially adjacent to thewall 69 to enhance the rigidity of thebackings 73, 74. Formed on thebackings 73, 74 are inwardly projectingtubular spring retainers 76, there being four on each backing and axially aligned in pairs for retaining foursprings 78. Thesprings 78 normally bias thebackings 73, 74 and their associatedwalls 66, 68 to the normal expanded positions shown in FIGS. 11 and 12. On exterior of thewall 66 in alignment with two of theretainers 76 are tubularplastic nipples 80, 82 with radial flanges 83, 84 that are heat-sealed to thewall 66. One of thenipples 82 integrally includes on its flange 84 ashort strap 85 that carries a removable closure plug 86 for thenipple 82.

As will be seen in FIG. 6, thelarge tube 6 fits into and seals within theelement 80. Consequently, when theunit 2 is activated for applying suction the urine will be withdrawn through theconduit 4 and be discharged into the chamber from thetube 6 through the opening provided by thenipple 80. To activate theunit 2 for suction, theplug 86 is withdrawn from thenipple 82 and the twowalls 66, 68 are pressed relatively toward each other, compressing thespring 78 as shown in FIG. 13, thewall 70 collapsing. It will be apparent that movement of thewalls 66, 68 relatively toward each other may be effected by supporting thewall 68 on a suitable surface flat and manually pressing against thewall 66. With thesprings 78 compressed, theplug 86 is replaced to seal the unit. The system is now fully closed and can begin evacuating urine slowly from the bladder. To this end, the expansion of thesprings 78 results in progressive enlargement of thechamber 70 causing a gradual suction to be applied to theconduit 4 to gently withdraw urine from the patients bladder. When thechamber 70 has expanded fully back to the size shown in FIG. 12, theplug 86 may be removed to empty the unit through the exhaust opening formed by thenipple 82. In the meantime, the patient can be encouraged to void naturally.

in some instances it may be desired to irrigate the system, obtain samples of urine, or to introduce medication into the bladder. For these purposes, theseal cap 62 may be removed from the fitting 58 and the cannula of ahypodermic syringe 90 may be inserted into thepassageway 60 as shown in FIG. 10. The handle may then be rotated ninety degrees to expose thepassageway 60 to thebore 52 and close off access from thepassageway 60 and bore 52 to thebore 50. Thereafter, thehypodermic syringe 90 may be used, as required.

When the system is no longer needed, the small tubing may be gently withdrawn from the bladder through the puncture in the abdomen wall and the puncture taped with a bandage.

I claim:

1. Apparatus for suprapubic drainage of the human urinary bladder comprising a drainage tube of flexible material and of relatively small transverse dimension and compatible with human tissue and arranged for insertion through a puncture in the abdomen and in the wall of the bladder, a self-contained, independently operable evacuator for ambulatory use comprising a container of flexible material, said container being resiliently compressible when subjected to manual pressure and upon release of said manual pressure being resiliently expansible to a normal expanded position, a conduit connecting said drainage tube to said container, an auxiliary fluid passageway arranged for connection to a receptacle, and valve means interconnecting said conduit, drainage tube and auxiliary passageway, said valve means having a first position interconnecting said conduit and drainage tube, a second position interconnecting said auxiliary passageway and said conduit, and a third position interconnecting said auxiliary passageway and said drainage tube, whereby fluid may be transmitted from the drainage tube into said container upon the expansion thereof, and fluid may be transmitted from the container into said receptacle, and treatment fluid may be transmitted from the receptacle into the drainage tube.

2. Apparatus for suprapubic drainage as set forth in claim 1 wherein said container is provided with an exhaust opening, and a closure valve for the exhaust opening.

Claims (2)

1. Apparatus for suprapubic drainage of the human urinary bladder comprising a drainage tube of flexible material and of relatively small transverse dimension and compatible with human tissue and arranged for insertion through a puncture in the abdomen and in the wall of the bladder, a self-contained, independently operable evacuator for ambulatory use comprising a container of flexible material, said container being resiliently compressible when subjected to manual pressure and upon release of said manual pressure being resiliently expansible to a normal expanded position, a conduit connecting said drainage tube to said container, an auxiliary fluid passageway arranged for connection to a receptacle, and valve means interconnecting said conduit, drainage tube and auxiliary passageway, said valve means having a first position interconnecting said conduit and drainage tube, a second position interconnecting said auxiliary passageway and said conduit, and a third position interconnecting said auxiliary passageway and said drainage tube, whereby fluid may be transmitted from the drainage tube into said container upon the expansion thereof, and fluid may be transmitted from the container into said receptacle, and treatment fluid may be transmitted from the receptacle into the drainage tube.

2. Apparatus for suprapubic drainage as set forth in claim 1 wherein said container is provided with an exhaust opening, and a closure valve for the exhaust opening.

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