US3463159A - Instrument for drainage of the chest - Google Patents

Description

Aug. 26, 1969 H. J. HEIMLICH INSTRUMENT FOR DRAINAGE-OF THE CHEST Filed Feb. 16, 1965 M -m R mm m J my W E W I! fl/ Z M ATTORNEYS United States Patent 3,463,159 INSTRUMENT FOR DRAINAGE OF THE CHEST Henry J. Heimlich, 851 Forest Ave., Rye, N.Y. 10580 Continnation-in-part of application Ser. No. 392,073, Aug. 18, 1964. This application Feb. 16, 1965, Ser. No. 433,008

Int. Cl. A6lrn 27/00; A61f /44 US. Cl. 128-650 3 Claims ABSTRAQT OF THE DISCLOSURE One-way valve comprising tubular element of rubbery material surrounding a rigid nipple at one end to keep that end of element open. Nipple connectable to intrapleural catheter. Walls of remainder of valve flattened together to close passage between them, but yieldably separate to permit passage between them of air and masses draining from the chest. Valve is of appreciable length with respect to size of drainage masses. Nipple has smooth interior surface which diverges toward valve. Rigid chamber surrounds valve, and has outlet at end opposite nipple. Outlet may be spaced from opposite end of chamber to provide a water trap.

This application is a continuation-in-part of copending application No. 392,073, filed Aug. 18, 1964.

This invention relates generally to surgical apparatus, and has particular reference to an instrument for drainage of the chest.

In the treatment of certain chest injuries and illnesses, and often post-operatively, it is necessary to provide means for continuously draining air and fluids from the chest, i.e., from the region surrounding the lungs. The air pressure in the chest is normally slightly below atmospheric, and if there is any opening to it, either through the chest wall or thorugh a puncture in the lung itself, air will enter and create an undesirable and dangerous condition.

It has been the practice, heretofore, to insert a drainage tube or catheter into the chest and to establish connection with relatively cumbersome drainage apparatus, including one or more bottles containing water and serving as traps, the rear end of the drainage tube being arranged in submerged position. To avoid any possibility of mishap due to reversal of flow or disturbance of the connections, it has been customary to locate the apparatus at or near the floor adjacent to or beneath the patients bed. As a result, the patient is confined to bed, since the drainage procedure may not be interrupted. For similar reasons, administration of such drainage treatment under emergency conditions, e.g., to members of the military forces injured in battle, or during transportation of patients, has been quite diflicult if not wholly impractical.

One of the objects of this invention is to provide a reliable means for continuously draining the chest of a patient in desired manner without confining the patient and without the. necessity for employment of elaborate or directly-maintained apparatus. As a result, the patient can move around and be ambulatory, and can be treated under emergency conditions and transported without danger of lung collapse or other injury.

The attainment of this desirable result is predicated upon the employment of a novel instrument involving a one-way valve of structurally simple, readily portable character, light in Weight, small in size, and thoroughly reliable and practical. The term one-way valve" is intended to signify a valve adapted to allow passage of substances through it in one direction only.

One of the features of the invention resides in the circumstance that the valve unit may be readily fabricated,

3,463,159 Patented Aug. 26, 1969 if desired, of inexpensive discardable material. Sterilizing and cleaning procedures may thus be avoided, and the use of the instrument expedited, although sterilization and re-use are not necessarily precluded.

Another feature of the invention lies in the design of the instrument in such a way that its use is not inconsistent with the employment of conventional apparatus. Accordingly, such apparatus may continue to be used, if desired, while the patient is in bed, and its use may be safely temporarily discontinued whenever the patient is up and around and is relying upon the portable instrument embodying the features of this invention.

A further feature of the invention relates to the design of the valve in such a way that it is responsive to minute dilferentials in air pressure. As a result, elaborate suction apparatus is not esential to a proper functioning of the instrument. Nevertheless the use of suction apparatus is not precluded, should it become necessary or desirable.

Valves of ordinary kind are not suitable for the present purpose because they do not close reliably when masses or particles of non-liquid material pass through. A valve is entirely useless, and its malfunctioning may be fatal to the patient, if it is susceptible to being wedged or jammed by a particle of matter into a setting in which it is not completely closed. To be useful for the special purpose of chest drainage, a valve must remain reliably closed at all times against influx of air into the chest cavity.

An important feature of the present invention resides in the employment of a specially configurated valve having this capability. The valve is of the type which comprises a tubular element of rubbery material open at its inlet end but having its walls thereafter flattened together and yieldably urged by their inherent resilience into this condition to close the passage between them. The valve is so designed that the flattened part is of appreciable length whereby the passage through the valve is of considerable extent relative to the size of gobs or masses likely to pass through. The passage through the valve is thus defined by a substantial area of rubbery material which provides a sure closure against reverse flow and yet allows free forward passage of stulf through the valve by a resilient progressive separation and reclosing of the walls. Of primary significance is the fact that blood clots, tissue masses, particles, etc., are powerless to jam the valve into a dangerous open condition which would be fatal to the patient. Substances emanating from the chest work their way through the valve passage gradually, by a kind of peristaltic movement of the tube walls, i.e. the passage widens temporarily in advance of each mass of substance and closes itself automatically directly behind it as the mass moves toward the outlet. Even if a solid particle or gob were to become stuck, there is always a broad surface of the passage firmly and reliably izlosegl against the undesired and perilous influx of air or A still further feature of the invention resides in the provision of a special chamber, composed of rigid protective material, surrounding the valve and shielding it from external contact. The fluids and other substances passing through the valve are discharged into this chamber, and the chamber is provided with an outlet which allows optional connection of the instrument to a collection receptacle or to a suction tube. The chamber outlet may under certain circumstances be advantageously located above the level of a body of water within which the outlet end of the valve is immersed, so that the presence or absence or bubbling can serve as an indication of how the chest drainage is progressing.

One way of achieving these objectives and advantages, and such other advantages as may hereafter be pointed 3 out, is depicted in the accompanying drawings, in which FIGURE 1 is a cross-sectional view of the improved instrument;

FIGURE 2 is an enlarged cross-sectional view along line 22 of FIG. 1;

FIGURE 3 is a view of the valve during the passage through it of an illustrative mass or particle;

FIGURE 4 is an enlarged cross-sectional view along the line 44 of FIG. 3;

FIGURE 5 is a view similar to FIG. 3 as the mass leaves from the outlet end; and

FIGURE 6 is a fragmentary cross-sectional view of the lower part of the valve and enclosing chamber, showing a modification.

The chest wall is diagrammatically represented at 10. Inserted through it, by usual surgical techniques, is a drainage tube 11 whose inner end is provided with one or two apertures 12 through which air and fluid and other matter may enter the tube 11.

The outer end 13 of the catheter 11 is connected in leakproof fashion to a connection nipple 14 extending outwardly from, and preferably formed as an integral part of, the end wall 15 of a chamber 16 composed of rigid plastic or the like. The chamber 16 has been shown in the form of a substantially cylindrical body. Its other end wall 17 carries a connector tube 18 to which flexible discharge tubing 19 may be joined. The tube 19 leads, optionally, to a collection receptacle such as a flexible plastic bag or the like, or to a suction apparatus such as that customarily employed for chest drainage purposes. The end walls 15 and 17 may be permanently bonded or sealed to the body of the chamber 16, or one or both of them may be separately attached, if desired, as by screw threads or the like. The body of the chamber 16 is preferably transparent so that the valve within it may be readily observed.

The end wall 15 of the chamber 16 has an inwardly projecting connection nipple 20 which is also preferably formed as an integral part of the Wall 15. This nipple is aligned with the outer connection nipple 14, and it is connected in leakproof fashion to the rear or inlet end 21 of a tubular one-way valve element. This element consists of a substantially tubular body having opposed walls 22 of resilient rubbery material. The walls are separated at the inlet end 21 of the tube where they encircle and engage with the part 20, but thereafter the walls 22 lie in flattened-together condition (see FIG. 2) all the way to the lower or outlet end 23. By their inherent resilience the walls 22 are urged yieldably into this overlying relationship, thus establishing a normally closed passage through the valve. The walls 22 are in contact over a broad surface and keep the valve reliably closed against reverse flow. Under a slight pressure differential, the walls 22 spread apart momentarily, along an area dictated by the magnitude of the substance passing through, as indicated in FIGS. 3 and 4, thus allowing passage of air and fluid and other matter through the valve and out of the outlet end 23 into the lower part of the chamber 16 surrounding it. It will be noted that the inner walls of the nipples 14 and 20 diverge toward the valve 22. This structure inherently permits any clot that enters the nipple 14 to pass through the nipple 20 and valve 22. Furthermore, the cross-sectional shape of each wall of nipple 14 tapers in a direction away from valve 22 so that almost no ledge at all is present within the catheter upon which a clot might become lodged.

The valve is of adequate width to allow passage of the drainage material to be anticipated. This width may be approximately one inch. The valve is also of appreciable length, viz., of the order of three inches. This length is considerably greater than that of any particle or mass likely to pass through the valve.

The chamber which surrounds the valve is only slightly larger in diameter, as shown in FIG. 2. It extends longitudinally for a distance slightly greater than the. length of the rubbery tube as shown in FIG. 1.

The catheter 11 may be of rubber or plastic and of conventional size and character, and the discharge tubing 19 is similarly of conventional kind appropriate to the function it is to perform. It is not essential that the connection of the tubing 19 to the outlet on the chamber 16 be leakproof.

A slight modification is illustrated in FIG. 6, in which the valve element happens to be shown as it appears from a direction at from that of FIGS. 1, 3 and 5. The modification resides in the fact that the outlet connector pipe or tube 18 is located at the side of the protective chamber rather than at the end. The chamber 16' has a closed end wall 17 so that a small body of water may be accommodated, into which the lower or outlet end of the valve extends. The outlet pipe 18 is located, as shown, above the level 24 of this water.

The operation is as follows: the upper end of the intrapleural catheter 11 is of course connected to the chest cavity in leakproof manner. The valve walls 22 are normally in fully contacting relation so that the passage through the valve is closed, hence no air can enter the chest cavity through the tube 11. During the patients normal breathing procedure, the lung moves periodically toward the chest wall 10, thus developing a temporary buildup of air pressure in the tube 11. As each pulse rises above atmospheric pressure, the walls 22 of the valve are forced open momentarily, and air and fluid are expelled through it. As substances pass through the valve, the walls 22 partake of a kind of peristaltic movement as indicated in FIGS. 2, 3 and 5. A gob or particle of matter 25 (which may be liquid or solid or in-between) exerts a mild pressure upon the convergent region of the valve walls 22 as shown in FIG. 2; the walls separate momentarily in advance of the substance, then come together again directly behind it. The substance thus works its way gradually and progressively through the valve until it is discharged as shown in FIG. 5.

The representation of FIGS. 3 and 4 depicts an intermediate stage during the progressive movement of the mass or body 25. It will be observed that the instrument can be employed with absolute safety to the patient. Because of the substantial length of the valve relative to the size of solid or semi-solid masses likely to pass through it, no body such as that indicated at 25 can ever cause a malfunctioning in which the valve is in a dangerous open condition. Even if a mass such as that shown at 25 were to become stuck, there are always surrounding areas of substantial size in which the walls 22 are pressed together and thus seal off the valve against perilous reverse flow of air or liquid.

Thus the chest is continuously drained, while re-entry of air is assuredly precluded. Whether the patient is lying, sitting, or moving about, the valve is protectively shielded by the chamber 16 that surrounds it, and the expelled material may be accumulated in an appropriate bag or receptacle connected to the tube 19. Should it become necessary or desirable to establish connection with conventional suction apparatus, the tube 19 can be simply disconnected from the portable collecting bag and connected, instead, to the suction apparatus.

The construction shown in FIG. 6 is useful in indicating, by the occurrence or absence of bubbling, the extent to which the chest drainage is progressing. In postoperative periods it is desirable to observe this.

It is to be understood that minor structural changes may be made without necessarily departing from the spirit and scope of the invention as expressed in the appended claims.

What is claimed is:

1. An instrument for drainage of the chest, comprising a one-way valve composed of a tubular element of rubbery material one end of which is an inlet and the other an outlet, the inlet being adapted to be connected in leakproof fashion to the outlet end of an intrapleural catheter, the walls of the tubular element lying apart at its inlet but being otherwise flattened in contact with each I other and held in flattened condition by their inherent resilience said walls being of constant thickness throughout their length, said tubular element being of appreciable length relative to the size of masses of drainage matter passing through, said walls separating momentarily in ad- Vance of such matter and automatically closing directly behind it as a pressure differential moves such matter progressively through said element from inlet to outlet, said walls nevertheless remaining always in contact along broad areas thereby preventing reverse flow through said valve, and a protective chamber of rigid material surrounding and enclosing said valve, said chamber having an end wall provided with aligned connection nipples extending outwardly and inwardly therefrom, said nipples being integral with each other, the outer nipple being attachable to said catheter and the inner nipple to the inlet end of said valve, and the inner walls of said nipples being substantially annular and diverging toward said valve so that any clot entering said outer nipple will 20 surely pass into and through said valve.

2. An instrument for drainage of the chest as defined in claim 1 wherein said inner walls are smooth and unbroken.

3. An instrument for drainage of the chest as defined in claim 1 wherein the cross-sectional shape of each wall of said outer nipple tapers in a direction away from said valve so that the inlet edge of said nipple has a minimum thickness.

References Cited UNITED STATES PATENTS DALTON L. TRULUCK, Primary Examiner US. Cl. X.R.

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