US 2630803 A
Description (OCR text may contain errors)
Filed May 12, 1950 INVENTOR fUST/ICH/(AS 0.5/I/P4N BY 7 ATTOFNEY l atented Mar. 10, 1953 UNITED STATES PATENT OFFICE DOUBLE PNEUMOTHORACIC NEEDLE Eustachius 0. Baran, Staten Island, N. Y.
Application May 12, 1950, Serial No. 161,564
This invention relates to a double pneumothoracic needle.
This needle has been invented and developed primarily for initial pneumothorax induction. Nonetheless the very same needle may very advantageously be employed in lumbar, suboccipital, peritoneal and pericardial punctures. The problem which surgeons have encountered in the use of needles in the areas and tissues above indicated, is the problem of puncturing certain tissues only without at the same time puncturing other tissues which are disposed in spaced relation thereto. Thus in initial pneumothorax, the problem is to puncture the tissues of the chest wall without causing injury to the lung tissues. The pleural cavity lies between the chest wall and the lungs as a capillary space and in certain lung conditions it becomes necessary to gain access to said pleural cavity by means of a needle of the general character herein described, without, of course, accidentally puncturing and thereby injuring the lung tissues.
It is the principal object of this invention to provide a surgical needle of the character described which includes automatic means for limiting the thrust of the needle in passing from one medium to another or in passing through spaced strata of different tissues. More specifically, by performing initial pneumothorax, induction of the whole blade of the needle between the chest wall and the lung, presents a danger of puncturing the lung and, after aspiration of the air into the blood vessel, often causes the death-of the patient. The described needle is of such a construction, that after induction of a small part only of the sharp blade into the pleural cavity the wedge-shaped plunger automatically slides into the small hole and thrusts over the sharp point of the needle, and due to the pushing of the lung aside from the sharp point, prevents puncturing of the lung. The surgical needle under discussion is a hollow needle in which a spring-urged, blunt ended plunger is slidably mounted.
The modus operandi relating to the surgical needle herein described and claimed is as follows: The blunt plunger is manually retracted to its nonoperative position in the hollow needle against its springs action. A mechanical catch or latch may be provided to retain the plunger in its said inoperative position to free the surgeons hands for the Work of actually inserting the needle and for the other aspects of the procedure. .The needle is then inserted into the chest wall and the lunger is released to thrust forward under its spring action. The operative position of the plunger is in advance of the pointed end of the needle. It is prevented, however, from thrusting forward to its operative, advanced position by the resistance of the tissues of the chest wall to such forward movement. But when a small part of the pointed end of the needle enters the pleural cavity, there is no longer sufficient resistance to the forward movement of the plunger and it is thereby enabled, under the influence of its spring, to thrust forwardly to a position well in advance of the pointed end of the needle, and thereby to push the lung away from the sharp point of the needle.
An important feature of the present invention is the wedge shape of the blunt end of the plunger. The needle is diagonally out to expose the blunt end of the plunger even in its retracted position. When the pointed end of the needle punctures the parietal pleura lining the inside of the chest Wall, and passes through said membrane only to the extent of a small part of its length, the wedge-shaped blunt end of the plunger will Wedge or cam its way through the puncture in said membrane and enable said plunger to thrust its way forwardly in advance of the sharp point of the needle. The blunt end of the plunger will thereby be enabled to serve as an advance guard, so to speak, preventing contact between the pointed end of the needle and the lung.
Another important feature of this invention is its penetration indicating factor. When the plunger thrusts forwardly to its advanced or operative position, the surgeon is fairly certain that the pleural cavity has been reached. But there are times and conditions when the forward thrust of the plunger is not a sure guide or indication that the pleural cavity ha been reached. For example, the plunger wil1 thrust forwardly when the pointed end of the needle enters soft fatty tissue. A surgical needle made in accordance with the present invention is provided with a longitudinally extending channel or groove in I its plunger which communicates at all times with a side opening in the needle. This side opening is connected to a manometer which registers pressure in the pleural cavity. When the plunger thrusts forwardly into the pleural cavity, the channel or groove with which it is provided, communicates with said pleural cavity and enables th manometer to register the pressure in said cavity. Thus the manometer reading is a sure indication that the pleural cavity has been reached.
Still another important feature of this invention is the removability of the plunger from the needle at the very time the needle is in use without disconnecting the manometer or extracting 3 the needle from the chest wall. A corollary feature is the movability of the plunger on its longitudinal axis to provide greater or lesser communication between its channel or groove and the pleural cavity. During perforation of the chest wall the needle is closed to guard against obstruction of the needle with fatty tissue or blood. After perforation, the plunger may be turned on its longitudinal axis to expose more or less of its channel or groove to the pleural cavity. This can be done by virtue of the fact that the pointed end of the needle is cut diagonally of its length. It may be found desirable, during the course of an operation of the character under discussion, to enlargethe air passage to the pleural cavity. This may be done in the present device by simply withdrawing the plunger from the needle. The plunger is normally held in place in the needle solely by the spring or pair of springs which urge it forwardly. The springs may be disengaged from the plmiger by simply slipping them off the bifurcated bracket on said plunger which supports them. A valve is provided in the needle above the side opening therein, so that said needle may be sealed off at its top end following withdrawal of the plunger.
This feature is extremely important because it very frequently becomes necessary to clean the needle during the course of its use and the cleaning problem is greatly facilitated, and even solved, by the very fact of removal of the plunger.
A preferred form of this invention is shown by way of illustration in the accompanying drawing in which:
Fig. 1 is a front view of a pneumothoracic needle made in accordance with the present invention, the pointed end of the needle being partly broken away and in section to expose the blunt end of the plunger.
Fig. 2 is a side view of the same surgical needle.
Fig. 3 is a view somewhat similar to that of Fig. 2, but showing the major part of the needle and its plunger in longitudinal section, and also showing the plunger in its forwardmost, operative position, in engagement with the lung.
Fig. 4 is a similar view showing the plunger turned an angular distance of 180 from its position in Fig. 3.
Fig-. 5 is a fragmentary section on the line 55 of Fig. 3.
Fig, 6 is another fragmentary section on the line 6-6 of Fig. 4.
Fig. '7 a fragmentary vertical section through the needle structure, showing the valve which closes oif the top end of the needle when the plunger is withdrawn therefrom.
Fig. 8 is a top view of the upper portion of the instrument, showing the bracket which supports the plunger springs.
Fig. 9 is a fragmentary section through the lower end of the needle, showing its use where the membrane lining the chest wall and the membrane enclosing the lung are adjacent each other.
The surgical needle which is shown in the drawing comprises the following component parts: a hollow needle H), a plunger H slidably mounted in said hollow needle, a channel or groove l2 formed in said plunger, longitudinally thereof, a tubular member l3 formed on the side of the hollow needle and communicating with the inside of said needle and with said channel in the plunger, a bracket l4 mounted on the outside of the hollow needle, a second bracket mounted at the top end of the plunger, a pair moms of tension springs I B and I1 respectively connecting the two brackets, and urging the plunger to thrust forwardly in the hollow needle, a stop member I8 connected to the upper end of the plunger, a shoulder 19 formed at the upper end of the needle to engage said stop member I8 and to limit the forward thrust of the plunger, and a valve or stop cook 20 through which the plunger extends when the plunger is mounted in the hollow needle, and which may be employed to close off the hollow needle when the plunger is removed therefrom.
The hollow needle in is cut diagonally at its lower end to form a sharp point 30. The wall of the hollow needle opposite the diagonal cut is tapered toward the point as Fig. 9 clearly shows. The inner wall of the hollow needle is perfectly cylindrical throughout the greater part of its length. The tubular inlet member l3 communicates with the inside of the hollow needle as Figs. 3 and 4 clearly show. It may b seen in Figs. 5 and 6 that the opening in said tubular member l3 bulges out at 3! to a diameter which exceeds the inside diameter of the hollow needle. Hence communication is always provided between said tubular inlet member l3 and the channel in the plunger, irrespective of the angular position of said plunger in said hollow needle.
For purposes of convenience, the upper part of the needle 10a may be designated as the bedsing or handle for said needle. The lower part lllb may be designated as the needle proper. The lower part of the needle housing is provided with a pair of finger pieces 32 and 33 respectively by which the needle may be held and manipulated. Bracket M is fixed to the needle housing between said finger pieces and the tubular inlet member 13. Bracket M carries a pair of doublelooped or pigtail shaped hooks 34 and 35 respectively. The lower ends of springs l6 and 11 are connected to said hooks in such manner that whether they project upwardly as shown in 1 or hang downwardly,.the connection between said springs and said hooks remains. 45
Adjusting screws 36 and 3'l respectively are 'connected to the upper ends of said springs l8 and [1. These adjusting screws are accommodated by slots or notches 38 and 39 which are formed in bracket l5. Adjustably mounted on said screws are nuts 40 and 4| respectively which have rounded bottom surfaces as clearly appears in Fig. 1. Corresponding recesses or seats are formed in bracket 15 to accommodate the rounded bottom surfaces of said nuts. For purposes 0f convenience these nuts may be referred to as ball-shaped nuts which may be seated in the recesses formed in bracket 15. When it is desired to withdraw the plunger from the hollow needle, nuts 46 and 41 are 'u'nseated from their respective recesses and screws 36 and 31 are then ejected from their respective slots 38 and 39. See the dotted lines in Fig. 1. It will of course be understood that these nuts and screws are intended for adjusting purposes to adjust the tension of the springs.
sto member I8 is firmly attached to the upper end of the plunger and it moves integrally therewith. Bracket 15 on the other hand is swivelly connected to the upper end of the plunger. Hence the plunger may be turned without affecting the position of bracket 15 relative to bracket 14 and the needle housing. Shoulder l9 isalso fixedly or integrally connected to the needle housing. It is formed at the front of the needle housing and extends around to the sides thereof but to the back. Thus the plunger may be turned to bring its stop member i8 into or out of engagement with shoulder 19 without disturbing the arrangement of the springs. To facilitate turn ing the plunger and also withdrawing it from the hollow needle, a knob 45 is provided at the top end of the plunger.
A third bracket $5 is firmly attached to the upper part of the needle housing and it will be noted that it is provided with a pair of vertically extending holes 47 and 48 respectively. These holes accommodate rods 49 and 50 which are attached at their upper ends to bracket l5. It is this arrangement which helps prevent bracket H: from swivelling when the plunger is turned in the hollow needle. These rods do not, however, prevent the plunger from being pulled out of the hollow needle.
Valve 20 aforementioned, is provided with a hole 55 whose diameter corresponds to the diameter of plunger H. This hole accommodates the plunger and allows said plunger to move either axially or rotatably therein. After the plunger is withdrawn from the hollow needle, the valve may be turned to closed position to close off the top of the needle.
The shape of the leading end of the plunger and the grooving in said plunger are extremely important aspects of the invention. It will be noted that channel or groove 52 is formed along only one side of the plunger. Hence when the plunger is in its retracted position and the plunger is turned. so that its channel faces away from tubular inlet member it, the channel is closed off at its lower end. See Fig. 2. It is the blunt, wedge-shaped end portion I la which serves to seal off the channel at its lower end, it will. be noted that when the plunger is in its lastmentioned position, the slope of the wedge or cam face of said blunt end corresponds generally, although not necessarily precisely, to the diagonal face of the needle. Thus when the plunger is released for forward movement in the needle, it will be free to cam its way through the punctured tissues, in response to the spring action upon it, without catching said tissues between it and the needle wall, due to the outside taper of the wall of the needle and the close adherence of the lowest sharp point to the wedge-shaped end of the plunger. It is also important to note that the channel extends upwardly a suificient distance to communicate with the tubular inlet member l3 at all times.
Figs. 1, 2, 3, i and 9 show some of the steps or stages in the use of the instrument and also two of its applications. In Figs. 1 and 2 the needle is shown passing through the chest wall 66. Although. the needle proper has not as yet fully cleared the chest wall, but only with a small part of its sharp point (see Fig. 9) the plunger has nonetheless been able to cam its way into the pleural cavity in advance of the sharp blade. In Figs. 3 and 4, the plunger is shown in engagement with the lung 62, well in advance of the needle proper. Fig. 3 also shows that when the plunger is in its advanced position, its channel enters into communication with the pleural cavity through a capillary connection between the plunger and the needle. A manometer may now be connected to the tubular inlet member [3 in order to provide communication between the manonv eter and the pleural cavity. The manometer. which is'not shown in the drawing because it is of conventional design, is thus enabled to register the fact of complete penetration. Fig. 9 shows how the plunger serves to protect the lung against punctures where the parietal pleura 63 lining the chest wall and another visceral pleura lining 64 and the lung are in close proximity to each other. This is done in the manner above described.
It will be understood that the instrument above described and illustrated in the drawing is but a preferred form of the invetnion and that it may be modified in many ways within the broad scope and spirit of the invention as defined in the claims in this application.
1. A. surgical needle comprising a hollow needle, a spring-urged plunger in said needle, a camshaped end portion on said plunger, a channel formed in one side of said plunger and a side opening in the needle which communicates with said channel.
2. A surgical needle comprising a hollow needle which is provided with a diagonally cut end portion tapered on the outside to a point, a springurged plunger movably mounted. in said needle, a cam shaped end portion on said plunger, 2. channel formed in one side of said plunger, and a side opening formed in the needle for communication with said channel.
3. A surgical needle comprising a hollow needle, a spring-urged plunger having a cam faced end portion. movably mounted in said needle, a channel formed longitudinally in one side :of the plunger, and a side opening formed in the needle for communication with said channel.
A surgical needle comprising a hollow needle, 2. wedgaended plunger movably mounted in said needle, a pair of springs connected to said plunger and urging it forwardly in said needle, a channel formed in the side of said plunger, longitudinally thereof, and an opening formed in the side of the needle and communicating with said channel.
5. In a surgicalneedle of the character described, a hollow needle which is open at "both ends, one of said ends being diagonally cut to a point, said point being beveled in the opposite direction from said diagonal cut and merging, substantially, with the inside wall of said needle, a sprin -urged plunger in said hollow needle, said plunger having a cam-faced end which projects through the diagonally cut end of the needle, the opposite end of the plunger projecting through the opposite end of said needle and having a knob mounted on said oppositely projecting end which may be engaged manually to pull the plunger out of the needle, an opening formed in the side of the needle, and a longitudinally extending channel formed in the side of the plunger for communication with said opening in the side of the needle.
EUSTACHIUS O. BARAN.
REFERENCES CITED The following references are of record in the file of this patent:
UNITED STATES PATENTS Germany June 1'7, 1937