US 2108325 A
Description (OCR text may contain errors)
Feb. 15, 1938. C. E, ZlEGLl-:R 2,108,325
FUNI S CLAMP Filed NOV. 2, 1936 ATTORNEYS.
-Patented Feb. 15, 1938 UNITED STATES `FFICE 9 Claims.
This invention relates to funis clamps, i. e., to devices for clamping the umbilical cord of an infant at the time of birth.
The umbilical cord, as is well known, comprises :two arteries and a vein, which connect with the infants circulatory system, embedded in the socalled jelly of Wharton, all enclosed within an outer membrane, the amnion. The custom of tying off the cord of a new-born infant with a f ligature is very old, being in fact the first recorded instance of the ligature of blood vessels. Originally the purpose of this procedure was to prevent bleeding from the cord stump.
More recently, however, it has been realized "lthat control of bleeding from the stump is of by the body of the infant, affords an excellent bacterial culture medium. As the severed ends of the umbilical blood vessels are embedded in the cord stump, ideal conditions are thus provided for the inception of infection in the cord stump and its extension into the body of the infant. Many an infants death from sepsis is attributed for this reason to infection originating in the cord stump. However, bacteria do not thrive in dry media, and accordingly, it is of the utmost importance that the moisture in the stump escape or be removed as soon and as completely as possible to eliminate the possibility of infection from this source.
Although the ligaturing of the severed cord is still practiced widely, it is recognized generally that it is an unsatisfactoryprocedure. A major reason is that dehydration of the ligatured stump occurs slowly, and thus the possibility of infection, as just explained, is great no matter how carefully aseptic conditions be observed when the cord is severed and the ligature applied. Moreover, the formation of the umbilicus follows sloughing oif of the cord stump, which occurs through dehydration or mummication. Where the cord is simply tied off, mummication is a rather slow process, so that complete healing is delayed, requiring as much as a week or ten days, wherefore in addition to the possibility of infection there is present also the danger of hernia.
Accordingly, it has been known for years that rapid and complete dehydration of the stump tissues is necessary to minimize the danger of infection originating in the cord, and to cause early separation of the stump. This can not be achieved by a ligature alone, for obviously a ligature exerts no action which could favor dehydration, but rather retards it. A large number of procedures have been proposed for the achievement of rapid dehydration, such as the use of various dressings, drying powders and (Cl. 12S-346) astringent applications, caustics, the cautery, and others, but with no uniformity of results.
Dehydration of the cord stump has been hastened to some extent by using clamps instead of ligatures. These clamps have generally suffered from various disadvantages, chief among which is the fact that they have not squeezed moisture out f the stump efficiently enough to cause the very rapid drying that is desirable. And the construction of these clamps has been such that they are dilncult to apply, deteriorate and lose their eniciency with use, break readily, or do not exert uniform pressure throughout the width of the stump. And as far as I am aware, none has effected perforation of the amnion, which is desirable to hasten stump dehydration.
In my Patent No. 1,440,574, granted January 2, 1923, I have described and shown a clamp for this purpose comprising a pair of jaws having semicircular outer faces which are engaged by a rubber annulus to urge their clamping faces into engagement with the cord, That clamp constituted a substantial advance in the art, and it has been used extensively and increasingly with favorable results. It has been attended, however, by certain disadvantages. For instance, while it materially reduces the time necessary for dehydration of the stump, as compared with the classical practice of ligaturing, further improvement in this feature is desirable in View of the foregoing considerations. threaded into the clamp, and the boiling necessary for sterilization causes the rubber clamping ring to lose resiliency so that the pressure on the stump becomes less the longer the clamp is used, thus necessitating more or less frequent replacement of the rubber element.
It is among the objects of this invention to provide an umbilical cord clamp which is of simple construction, sturdy, and can be quickly and easily applied to and removed from the cord, which does not deteriorate with use, which can be readily and thorough sterilized by boiling without harm to the clamp, which thoroughly perforates the amnion and applies high crushing pressure throughout the Width of the cord stump, and which dependably assures very rapid dehydration of the stump.
According to this invention a cord clampl is provided having a pair of cooperating jaws the engaging faces of which are provided with a plurality of sharp teeth for puncturing the amnion, preferably interengaging each other so that the jaws can move close' together. Most suitably the individual teeth are relatively small and of pyramidal form to present a large number of sharp points. A looped strong metal spring has its ends secured to the jaws for pressing them together so strongly as to completely crush and perforate an umbilical cord stump disposed be- Also, the cord must be tween them. Most suitably the spring is of a particular form presently to be described and which with the sharp-toothed jaws cooperates to convert the stump. in, for example, eight hours or less, to a translucent parchment-like lm from which every trace of moisture has been removed.
The invention will be described with reference to the accompanying drawing in which Fig. l is a plan view of one embodiment of the clamp; Fig. 2 a plan View of the clamp spring shown in Fig. i before association with the clamp jaws; Fig. 3 an enlarged pian view of the jaws of the clamp; Fig. l an end view of Fig. 3; Fig. 5 a side view of one of the jaws; Fig. 6 a face view showing the jaw teeth; Fig. 7 a View showing the clamp opened by retractor forceps; Fig. 8 a section taken on the line VIII-VIII of Fig. 7; Fig. 9 a side View of the closed clamp and forceps; Fig. 10 a fragmentary view showing a cord stump crushed between the jaws of the clamp; and Figs. 11 and 12 views similar to Figs. 'l and 2, respectively, showing another embodiment.
Having reference now to the drawing, the clamp comprises a pair of jaws I, suitably of stainless steel to prevent corrosion and permit sterilization by boiling, provided, as shown in Fig. 6, withv rectangular clamping faces for receiving a cord stump between them. The jaws are engaged by a sp-ring S which urges them together. These jaws are of a length such as to completely crush the stump, and wide enough to crush a length ap propriate to cause rapid loss of moisture upon perforation of the amnion and crushing of the portion received between the jaws. Experience has shown that with the spring now to be described satisfactory results are had with jaws having clamping faces l inch long and 0.25 inch wide, although other dimensions may be used, of course.
An important feature of the invention resides in so constructing the jaw faces as to cause rapid and complete dehydration of the cord stump by providing for free escape of the moisture therein when the stump is crushed by the jaws. To this end the faces of the jaws are provided with sharp teeth adapted to puncture, or perforate, the tough aninion at a large number of places so that moisture can quickly escape from the jelly of Wharton and other cord tissues. Most suitably the faces of the jaws are diamond cut to produce a relatively large number' of small teeth in the form of pyramids having sharp points, with the two sets or" teeth adapted to interengage or mesh with each other when nothing is disposed between the jaws, as shown in Figs. 3 and 4. For example, I have found that desirable results are had with pyramidal teeth of an inch square at their bases. With jaws of the dimensions given the jaws will have, as shown, four rows of teeth extending lengthwise of each jaw, as shown in Figs. 4 and 6, and fifteen rows of whole teeth 2 extending transversely of each jaw, with a row of half teeth '2a at one end (Figs. 3 and 6) By arranging the two jaws so that their rows of half teeth are at opposite ends, as seen in Fig. 3, all of the teeth mesh with each other when the jaws are placed together, so that there is no gap between the jaws (Fig. 1).
The jaws must exert high pressure upon the stump to cause penetration of the teeth through the amnion and strong crushing to facilitate expulsion of moisture from the stump. Although Various types of spring may be used, the compression requisite for that purpose is such that ordinary loop springs must usually be rather large or massive, whereas devices of this nature should be compact. A more serious disadvantage, however, is the fact that ordinary loop springs break readily and before being used many times if they are made strong enough to exert the desired crushing strength.
The form of spring shown in the drawing has been proved by experience to combine entirely adequate crushing eiort, compactness, and minimizing of tendency to break under repeated flexing as the clamp is opened and closed. This is accomplished by forming spring S to provide a plurality of reverse bends, thus supplying, in effect, a plurality of springs.
More particularly, a length of spring wire is so bent about a short radius near its ends as to provide end portions 3 of approximately the length of, but somewhat shorter than, the jaws. This provides a pair of spring elements between ends 3 and arms t, which latter are preferably parallel to each other. The wire is bent likewise on a relatively short radius relative to arms 4 to form further spring elements between arms 4 and a large radius outer loop having outwardly bowed side arms 5.
A spring as thus described is capable of applying sufficient crushing effort to jaws l. However, experience has shown that where the spring is strong enough to do that it will break more or less quickly centrally of the loop, i. e., midway of arms A feature of major importance to this invention resides in my discovery that breakage can be overcome by bending the outer loop, formed by arms 5, inwardly, toward the bends between ends 3 and arms 4, midway of the bends between arms 4 and 5, as shown at 6. This provides still another spring element.
With such a spring each jaw is in effect acted upon by three springs, i. e., one between arm il and end 3, one between arms 4 and 5, and one between arm 5 and the adjacent arm of bend 5. As a result of this construction very high spring pressures can be had with wire of relatively small diameter and with a spring of small compass. A more important advantage, however, resides in the fact that the distribution of stress over the various spring elements reduces fatigue failure vat bend 6 and thus provides long spring life. For instance, to open the jaws to provide a 1/2 inch opening, each jaw moves but 1A; inch through three spring elements, from which it can be seen that the stresses are distributed and reduced in the various elements. To further minimize fatigue failure the wire may be rolled to render its section non-circular, in the manner known in the spring art, e. g., to ovalize the wire.
As shown in the drawing, ends 3 of the spring are received in bores 'l disposed longitudinally in the jaws i near their outer sides. if the arms 3 merely extend into such bores it is possible for the jaws to rotate on 'the spring. Accordingly, a further feature resides in avoidance of that undesirable result. This is accomplished by forming a slot 8, Fig. 5, in the side wall of each bore 7 at its upper end, the slot being long enough that the bend between spring end 3 and arm i lies below the end plane of the jaw when the spring is inserted in bore 'i'. When the spring has been thus inserted the sides of slot 8 beyond the spring bend are crimped inwardly, as seen at 9, Fig. l, thereby simply locking the spring on the jaw and preventing relative rotation of these two members. Such insertion of the spring to permit locking in the jaws as just described is made possible by forming bend 6 at a distance from the bends 34, as shown in Fig. 2, this distance being such as to permit insertion of ends 3 deeply enough in bores l, for closing the slots at 9, and to bring bend 6 close to the ends of the jaws, as seen in Fig. 1.
Using jaws of the dimensions stated, such a spring may be made satisfactorily from vanadium steel spring wire 6.112 to 0.125 inch in diameter. To insure nigh pressure, ends 3 initially converge toward each other, as seen in Fig. 2, but when the clamp is assembled they are brought into parallel relation, as may be seen from Fig. 1, so that strong pressure is exerted upon the jaws. This together with extension of ends 3 substantially the full length of the jaws causes the jawsA to exert satisfactorily uniform pressure over their length on a cord stump engaged by the jaws.
Suitably, the ends 3 contact at their tips before the spring is assembled, and they are spaced apart of an inch at their rear ends. When the spring .is assembled with the jaws, ends 3 become parallel, about 1/2 inch apart. Also, the spring may satisfactorily have an over-all length of linch-es, while it may be 1,1/2 inches wide before assembly, and when constructed as shown it then becomes l; inches wide when assembled with the Jaws.
To permit the jaws to be spread apart for receiving an umbilical cord, or for removing the clamp from a dried cord stump, a retractor tool is used. Each jaw of the clamp is provided with a plurality of transverse cylindrical bores I0 for. receiving pins II of a retractor forceps I2, Figs. 7 and 9. By utilizing a pair of openings and two forceps pins in connection with each jaw, the jaws are prevented from pivoting relative to the retractor tool while the jaws are being separated. The forceps jaws arepreferably provided adjacent the pivot pin I2a with recesses I3 for receiving a pin I4 having a head I5, or any other convenient means, to keep the clamp jaws separated while they are being sterilized or scrubbed (Figs. '7 and 8). The spring is preferably chromium plated, and as the clamp is made entirely of metal it can be sterilized in any manner without adversely affecting it in any way.
The embodiment shown in Figs. 1l and 12 comprises a pair of jaws Ia like those described above, associated in similar manner with a spring generally similar to that shown in Figs. 1 and 2. This spring comprises end portions 3a` extending into bores formed in the jaws Ia, arms da, generally parallel to the ends 3a when the spring and jaws are assembled, and an outer loop- 5a having an inwardly projecting bend 6a midway of the bends between arms 4 and 5. In. this instance, however, bend 6a. takes the form of a coil II. This type of spring is advantageous because bend is severely stressed. By making this in the form of coil I'I (Figs. 11--12) instead of a simple bend (Figs. 1--2) the stresses are distributed over a greater length of wire and the unit stress is thus. reduced, thus further minimizing danger of spring breakage.
The spring shown in Figs. 11 and 12 may tend to cause the jaws to become offset laterally when they are closed after being opened by the retractor forceps IZ. This is disadvantageous because thereby the effective clamping area is reduced. I have discovered, however, that this may be overcome simply by providing one jaw at its inner end with a pin IE which enters a bore I9 provided in the other jaw. When the jaws close from their retracted position pin I8 moving in bore IS maintains the jaws in alignment and thus prevents the undesired offsetting.
As shown in Fig. 12, the spring is initially formed with the side members inclined toward each other, and when assembled in the jaws the sides become substantially parallel with the jaws. In this manner the desired high jaw pressure is assured.
In use the clamp is opened by the retractor forceps and its open end is then moved astride the severed umbilical cord of the infant as close to the skin margin as practicable to receive all of the amnion and Whartons jelly, whichend at that level. Marked traction should be put on the cord, as by artery forceps, to permit the clamp jaws to get as low a grasp as possible on the umbilical vessels to make them taut, whereupon the clamp is allowed to close and grip the cord between its jaws. The retractor forceps are then removed from the clamp and the cord is ycut close to the clamp jaws, leaving a cord stump whose length corresponds substantially to the face width of the clamp jaws, i. e., about 1/4 inch using a clamp of the dimensions stated. The great pressure exerted on the jaws by the looped spring continuously urges the jaws together and causes them to perforate the amnion and crush the cord stump I, Fig. 10, between them with acceptably uniform pressure throughout its length and width. The great pressure applied and the perforation of the amnion in many places by the sharp teeth cooperate to squeeze the moisture from the cord through the perforations in the amnion and through the cut end of the cord. The cord-engaging surfaces of the jaws are materially increased in area by their teeth, resulting in the stump being spread over relatively large surfaces as the teeth mesh so that it is reduced to a thin ribbon in a few minutes by the compression of the jaws. In eight hours or less it is reduced to a parchment-like translucent lm of tissue from which every trace of moisture has been expelled.
To absorb the moisture squeezed from the cord it is desirable to place a thin piece of gauze be` tween the clamp and the abdomen. A binder should not be used, but a length of gauze bandage may be tied to one arm of the spring, passed around the body, and tied to the arm of the other side of the clamp spring, thus preventing traction on the clamp and stump in handling the baby. Free exposure to the air hastens dehydration of the stump.
The lmy stump remnant is composed largely of dried amnion and blood vessel walls. The latter are so intimately fused together as to be indistinguishable one from another upon examination through a magnifying glass. Consequently, secondary hemorrhage from the vessels is ordinarily impossible. As soon as possible, say after eight to twelve hours, the clamp should be removed and one-half of the lm trimmed, leaving a dry and clean remnant of adherent. dried, pressure-necrosed tissue which hermetically and aseptically seals both the umbilical vessels and the umbilical ring. This residual film rapidly crumbles and separates as healing beneath it is completed, and generally in less than a week there is nothing left of it. There is no visible scar such as follows healing of the granulating wound left when the stump is allowed to Slough oif: all that can be seen at the bottom of the umbilicus are small punctuate areas,-the sites of the obliterated umbilical vessels. At no time after the clamp is removed is there an open, granulating wound, and at no time is there any discharge, or even moisture, from the forming umbilicus.
With the removal of the clamp the traction placed on the umbilical ring through the umbilical vessels, together with their rapid involution, inverts the skin margin of the new umbilicus so rapidly that within at most three or four days after birth the umbilicus has the appearance of those healed under the usual methods of treatment at the end of ten or fifteen days. With the use of my clamp the entire cord stump is disposed of in eight hours, or less, and the danger of infection is past. As there is at no time an open wound after clamp removal, there is no further need for an umbilical dressing or binder, and the umbilicus needs little further attention beyond keeping the umbilicus dry until healing is completed.
The sooner the clamp is removed after dehydration is complete, the better and quicker the results for the vessels can not retract until the cord stump is removed. If left on unnecessarily long the vessels lose their elasticity and the forming of the umbilicus is delayed or is irnperfectly done since the inrolling of the skin margin of the umbilical ring is necessary to accomplish it. Furthermore, if traction on the dehydrated stump is continued unnecessarily, the film remnant separates before healing beneath it is completed with the result that an open wound is left.
Among the major advantages of the clamp provided by the invention, the following may be mentioned. The stump is dehydrated in eight hours or less, and umbilical infection and secondary hemorrhage from the umbilical vessels are substantially eliminated. The open, granulating wound heretofore encountered commonly is eliminated together with binder and cord dressings. The results attained are uniform irrespective of the thickness of' the cord stump and the condition of its component'parts.
This application is a continuation-in-part of my copending application Serial No. '78.600, iiled May 8, 1936.
According to the provisions of the patent statutes, I have explained the principle and mode of use of my invention and have illustrated and `described what I now consider to represent its best embodiments. However, I desire to have it understood that, within the scope of the appended claims, the invention may be practiced otherwise than as specifically illustrated and described.
1. An umbilical cord clamp comprising a pair of cooperating cord-engaging jaws each provided with a bore extending longitudinally of the jaw from the rear end thereof, and a looped metal spring having its end portions secured in said bores and urging the jaws towardeach other, the intermediate portion of said spring being disposed at the rear end of said jaws, and the portions of said spring between said intermediate and end portions being in the form of loops extending toward the other end of the jaws.
2. An umbilical cord clamp comprising` a pair of cooperating cord-engaging jaws each provided with a bore extending longitudinally of the jaw from the rear end thereof,rand a looped metal spring having its end portions occupying and secured in said bores and urging the jaws toward each other, the intermediate portion of said spring being disposed at the rear end of said jaws and looped inwardly toward them, and the portions of said spring between said intermediate and end portions being in the form of loops extending toward the other end of the jaws.
3. An umbilical cord clamp according to claim 2, said inwardly looped portion of said spring being formed by a coil in the spring.
4. An umbilical cord clamp comprising a pair of cooperating cord-engaging jaws each provided with a bore extending longitudinally of the jaw from the rear end thereof, the outer wall at the rear end of each bore having a slot therein, and a looped metal spring having its end portions occupying said bores and urging the jaws toward each other, the intermediate portion of said spring being disposed at the rear end of said jaws, and the walls of said slots beyond said end portions of the spring being pressed inwardly to secure the springs in the jaws.
5. An umbilical cord clamp according to claim 4, said bores extending substantially the length of said jaws.
6. An umbilical cord clamp comprising a pair ci cooperating cord-engaging jaws each provided with a bore extending longitudinally of the jaw from the rear end thereof, said bores being substantially parallel when said jaws are in engagement with each other, a looped metal spring having substantially straight end portions rigidly mounted in said jaw bores, the free ends of said end portions being deformed away from each other by said jaws whereby said end portions exert effectively uniform pressure on said jaws throughout their length, the intermediate portion of said spring being disposed at the rear end of said jaws and looped inwardly toward them, and the portions of said spring between said intermediate and end portions being looped forwardly on both sides of the clamp, said jaws being provided with interengaging pyramidal teeth, and each jaw having at least two transverse openings for receiving jaw-separating forceps.
'7. An umbilical cord clamp comprising a pair of cooperating cord-engaging jaws each provided with a bore extending longitudinally of the jaw from the rear end thereof, said bores eing substantially parallel when said jaws are in engagement with each other, a looped metal spring having substantially straight end portions rigidly mounted in said bores, the spring being bent at the outer ends of said end portions to provide side portions lying adjacent and substantially parallel to said jaws, and being further bent rearwardly at the forward ends of said side portions to form a loop surrounding the sides and rear of the jaws, and said loop being provided centrally at its rear end with a reverse bend projecting inwardly toward said jaws.
8. An umbilical cord clamp according to claim "l, said reverse bend being formed by a coil of the spring.
9. An umbilical cord clamp according to claim l, one of said jaws being provided adjacent its rear end with a pin extending toward the other jaw, and said other jaw being provided with a bore to receive said pin for maintaining the jaws in lateral alignment,
CHARLES E. ZIEGLER.