US 2140113 A
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Dec. 13, 1938. c. J. FILLING ET AL SURGICAL DEGOMPRESSION' APPARATUS 2 Sheets-Sheet; 1
Filed April 8, 1936 1;: I J k nvmvroxs P illm a 57655 L Gar n,J1:
latentecl Dec. 13, 1938 I g UNITED STATES PATENT OFFICE SURGICAL DECOMPRESSION APPARATUS Charles J. Pilling, Lansdowne, and Burgess L. Gordon, Jr., Philadelphia, Pa, assignors to The George P. Pilling & Son Company, Philadelphia, Pa., a corporation of Pennsylvania Application April 8, 1936, Serial No. 73,292
3 Claims. (Cl. 128275) This invention relates to improvements in surmay be removed when desired. The upper end gical decompression apparatus for the displaceof the jar is removably held in place by and ment of air from within the pleural cavity in between the side arms of a spring clip l2. The the treatment of persons afflicted with pneumoclip 52 is secured to and projects forwardly from thorax and such other disorders of the lungs the panel 9, and the side'arms of the clip are 5 which permit the passage of air therefrom into fitted to and embrace the neck l3 of the jar. the pleural cavity. The jar H3 is provided with a cover l4 com- An object of the invention is to provide a prising ametal body l5 having a rubber cushionnovel and advantageous apparatus for permiting washer l6 interposed between it and the top 10 ting and controlling the displacement or expulof the jar, and having a downwardly-extendl0 sion of air from within the pleural cavity. ing annular flange H which surrounds an out- Another objectis to provide adjustable dewardly-extending an u r fla e 3 011 t e neck vices for regulating the extent to which air is 13 3 position the Cover t n The cove permitted to pass from within the pleural cav- M has a post 59 rising fixedly from the central l5 ity. part of the body 55 thereof. Slidable Vertically 15 Another object is to provide a manometer in on the post i9 is a yoke 2i! having arms 2| association with other parts of the apparatus, which embrace and extend under op Sides whereby the pressure of air within the pleural of the flange N3 of the neck of the jar. The cavity will be indicated at all times when the D 51 9 a d t y 26 a alined Slots 22 and apparatus is in service. 23 respectively, for the reception of a clamp 20 The invention resides in the elements and arm level 24 Which s p v ted 01 fulc umed the combinations of them hereinafter described on a pin 25 which extends throu h Sides of the and claimed. yoke 28 and through the lever 24 and through In the accompanying drawings, illustrating vertical slots 26 in sides of the post l9. The 25 the invention, lever 24 is provided with a cam Zl which is con- 25 Figure 1 is a front view of a decompression structed to engage the bottom wall of the slot apparatus illustrating one form of embodiment 22 and raise the yo 25 e a y t0 the y of the invention. of the cover M and thus cause the yoke to firmly Figure 2 is a side view thereof. clamp the cover upon-the jar when the clamp 30 Figure 3 is a sectional detail, on line 33 of lever 24 is moved to the right hand side of the 30 Fig. 2, showing the means for clamping the 010- post l9, as shown in Figs. 1 and 3. When the sure on the jar. clamp lever 24 is moved to the left hand side of Figure 4 is a detail in section showing a porthe post Hi, the yoke 23 is lowered relatively to tion of the jar, the closure thereon, and the air the body of the cover M the pressure of the tube extending through the closure and into cover upon the jar is removed permitting the 35 the jar, the section through the clamping means removal of the cover from the jar it].
for the closure being taken on line 4-4 of The l wer p r n f the container r j r 0 Fig. 1. provides a Water receiving and containing space Figure 5 is a sectional detail of a part of the 28 below the line 29 and the upper portion of manometer, on line 55 of Fig. 1. the jar it, above the line 29, provides an air re- 40 Figure 6 is a vertical section through the air ceiving space Bil. This space SE] is open to the controlling valve and portions of the flexible atmosphere through an aperture 3| in the body tubes connected thereto. of the cover M.
Figure '7 is a longitudinal section through the Extending vertically through the cover [4 is a means for detachably connecting the needle and metal tube 32 which also extends through a sup- 45 its flexible tube. porting and guiding bracket or post 33 rising Referring to the drawings, the supporting fixedly from the body l5 of the cover [4. The frame or structure of the apparatus comprises a lower end portion of the tube 32 extends into base board 8 and an upright panel 9 rising fixthe water space 28 of the jar l3, and the tube edly therefrom. 32 is slidable vertically within the cover I4 50 Mounted upon the base board 8 is a suitable and post 33 to different positions of adjustment closed container which, as herein illustrated is to raise and lower the lower end of the tube in the form of a transparent glass jar Ill. The within water contained within the space 28. jar l0 rests within a metal cup H which is se- The upper portion of the tube 32 is provided cured upon the board 8 and from which the jar with a gear rack 34 whose teeth are engaged by 55 the teeth of a small gear wheel 35 fixed on a shaft 36 and located between plate-like arms 31 which are formed on or secured to the upper end portion of the post l9 and project forwardly therefrom on the respective sides of the gear rack 34. One end of the shaft 36 extends outwardly and has a suitable head or wheel 38 fixed on the outer end thereof, by means of which the shaft 36 may be turned to cause the gear wheel 35 in co-operation with the rack 34, to either raise or lower the tube 32 in accordance with the direction in which the head or wheel 38 is turned.
The upper end of the tube 32 terminates in a laterally extending head or arm 39 to which a nipple 46 on the forward end of a flexible rubber tube 4| is detachably connected. The tube 4| is in communication with the tube '32 through a passage formed in the head or arm 39 and extending through the nipple 40.
The rearward end of the tube 4| is connected to a lateral projection 42 on the upper end of a metal fitting 43 which is secured to the panel 9. The flexibility of the tube 4| and its disposition with relation to the tube 32 and fittings 43 are such as to permit the easy up and down adjustment of the tube 32 relatively to the fixed fitting 43. The fitting 43 has a horizontal passage 44 in the lower portion thereof which extends through projections 45 and 46 on the respective sides thereof, and the fitting also has a vertical passage 41 therein whose lower end communicates with the passage 44 and whose upper end communicates with the tube 4| through the lateral projection 42 on the fitting. The vertical passage 41 is interrupted by a valve 48 which is constructed to be turned within the fitting 43 and which is provided with a suitable operating head or handle 49, by means of which the valve 48 may be turned to open or close the passage 41 as desired.
One end of a long flexible rubber tube 50 is connected to the projection 46 of the fitting 43 and communicates with the passage 44 therein. The other end of the tube carries a metal fitting 5| having a projecting nipple 52 provided with a threaded base 53 and a ground tapered free end portion 54. The nipple 52 extends into a head which forms the base of a tubular needle 56, and which is constructed to be detachably connected to the nipple 52. The interior of the head 55 is threaded for the reception of the thread 53 of the nipple, and the interior of the head has a ground tapered seat 5! for the reception of the tapered portion 54 of the nipple. The parts of the nipple 52 and head 55 are so related that when the head 55 is screwed tight upon the nipple. 52, the tapered end portion of the nipple will be forced into contact with the seat to form a tight joint between the nipple and the head. The parts just described provide a construction which prevents the accidental withdrawal of the head 55 from the nipple 52 when the apparatus is in service, and in which the needle may be readily detached from the nipple, when desired, by unscrewing the head 55 from the thread of the nipple.
The needle 56 has a pointed free end and it is constructed to be forced into the body of the person or patient to be treated until the open pointed end of the needle is in communication with the pleural cavity of the patient.
The needle 56 is surrounded by a guard disc 58 carried by a sleeve 59 which surrounds and is slidable on the needle and is provided with a set screw 60 to secure it and its disc 58 to the needle in positions of longitudinal adjustment thereon. The disc 58 serves as a guard to engage the body of the patient and prevent the insertion of the needle beyond the desired point for communication with the pleural cavity.
The projection 45 of the fitting 43 is connected by a flexible tube 6| to a projection 62 on the expanded upper end portion 63 of one limb 64 of a U-shaped manometer tube 65 containing a suitable pressure indicating liquid, such as colored water 66. The tube 65 is formed of transparent glass and it is mounted on a backing plate 67 by means of brackets 68, and the plate 61 is secured to the panel 9 of the apparatus. The passage 44 of the fittings 43 communicates with the expanded portion 63 through the tube 6| and projection 62 and a small curled glass tube 69 which extends from a wall 16 which closes communication between the projection 62 and expanded portion 63 around the tube 69. The expanded portion 63 and the small curled tube 69 serve to prevent the indicating liquid 66 of the manometer from accidentally entering the tubes 6| and 56 during the handling or tilting of the entire apparatus.
The normal level of the water or other liquid 66 in the manometer tube '65 is at the zero line 1|, and the forward surface of the backing plate 6'! is provided with a vertical series of markings l2 uniformly spaced above and below'the zero line H and also with suitable indicia in the form of numerals progressively increasing in value both upwardly and downwardly from the zero line 7| and designating the liquid level in either the limb 64 or the limb E3 of the manometer tube 65 the egree of air pressure above atmospheric pressure that is present in the tubes 6| and 50' and needle 56, and also in the pleural cavity of the patient, when the apparatusis in service. The limb 13 of the manometer tube 65 is pro vided with an expanded upper end portion 14 whose upper end has a yieldable rubber stopper E5 inserted therein. Extending centrally through the stopper 15 is a tube 76 having a slightly contracted lower end and having a plug 11 inserted into the upper end thereof. The plug TI has an axial opening 18 therein through which a small rod or shaft 19 extends. The diameter of the opening 18 is greater than the diameter of the rod 19 to permit the free passage of air through the opening. The lower end of the rod 19 has a head 86 secured thereto and resting normally on the contracted lower end of the tube 16 and closing the same save for slight air passages formed by indentations 8| in the head 86. The rod '|9 carries a valve body 82 which rests normally below the bottom of the plug 17 and which is adapted to seat against the bottom of the plug and close the opening 78 when the rod '59 is raised.
The purpose of providing the valve 82 and its associated parts is to prevent a sudden increase in air pressure above the manometer liquid in the limb 13 of the tube 65, such as would be pro- 'duced by the coughing of a patient being treated.
Such sudden increase in air pressure would cause the manometer liquid 66 to drive air above the same in the limb 13 out through the tube 16 and passage 18 and cause such air to impinge against the bottom of the head 80 and raises the rod 13 and closes the valve 82 and thus immediately closes the opening 18 and prevents further discharge of air from the limb I3, and, consequently prevents the discharge of any of the liquid 66 from the manometer. The expanded upper end 7 portion 14 of the limb 13 of the manometer also serves to receive and prevent the accidental discharge of the indicating liquid 66 from the manometer during the handling or tilting of the apparatus.
The operation of the apparatus when it is in service is as follows:
The head 33 is turned to lower the tube 32 well into the water within the jar l0, valve 48 is closed, the guard 58 is adjusted to the desired position on the needle 56, and the needle is projected into the body of the patient to be treated until the pointed open end of the needle is in communication with the pleural cavity. Air within the cavity then passes through the needle 56 and tubes 50 and BI into the manometer 65 and acts upon the liquid 66 and causes it to indicate the degree of the intrapleural pressure. The physician in charge now opens the valve 48 to open communication between the tubes 50 and El and the tubes M and 32, and the intrapleural pressure then acts upon the water within the tube 32, the level of the water within the tube being normally at the line 29. If the degree of pressure indicated by the manometer is such that it is desired to reduce the same, the head 38 is turned to raise the tube 32 until the air can overcome the water pressure within the tube 32 and pass from the lower end thereof up through the body of water within the jar l exteriorly of the tube. The extent to which the tube 32 projects into the body of water within the jar l0 determines the air pressure that is necessary to overcome the water pressure within the tube 32 to permit the air to escape from the lower end of the tube; and, therefore, it will be understood that by raising the tube the quantity of air that is permitted to pass from the pleural cavity may be nicely regulated.
By raising the tube 32 and observing the air bubbles discharged from its lower end and observing the changing degrees of pressure indicated by the manometer, the discharge of air from the pleural cavity may be regulated and controlled until the pressure has been reduced to the desired extent, whereupon the needle 56 is removed from the body of the patient.
At any time during the operation of the apparatus, the valve 48 may be closed to close communication of the tubes 5|] and 6| with the tube 32 for an accurate reading of the manometer, or for observing the rising and falling operations of the manometer in accordance with the changes in pressure in the pleural cavity occasioned by the breathing operations of the patient, or for any other purpose.
1. In a surgical decompression apparatus, the combination of a container providing a water receiving space, a rigid tube provided with a gear rack, means for slidably supporting said tube with its lower end portion extending into said space, a gear wheel in mesh with said rack, means operable to turn said wheel to raise and lower said tube, a body penetrating tubular needle, and a flexible tube associated with the needle and the first named tube and establishing communication between them.
2. In a surgical decompression apparatus, the combination of a jar providing a water receiving space in the lower portion thereof, a cover upon the jar, means for detachably securing the cover to the jar, a rigid tube extending through the cover and into said space, means carried by the cover for slidably supporting said tube, means operable to raise and lower said tube, a body penetrating tubular needle, and a flexible tube associated with the needle and the first named tube and establishing communication between them.
3. In a surgical decompression apparatus, the combination of a jar providing a water receiving space in the lower portion thereof, a cover upon the jar, means for detachably securing the cover to the jar, a rigid tube provided with a gear rack and extending through the cover and into said space, means carried by the cover for slidably supporting said tube, a gear wheel in mesh with said rack, means operable to turn said wheel to raise and lower said tube, a body penetrating tubular needle, and a flexible tube associated with the needle and the first named tube and establishing communication between them.
CHARLES J. FILLING. BURGESS L. GORDON, JR.