US 3433215 A
Description (OCR text may contain errors)
March 18, 1969 D. SILVERMAN 3,433,215
APPARATUS FOR PLACING IN AND RETRIEVING A TUBULAR PROBE FROM A BODY CONDUIT Filed oct. 2o, 1965 'r.l".'..........l 1......
United States Patent Oce Claims ABSTRACT OF THE DISCLOSURE This invention concerns an instrument for the placement of a sampling, inspecting or treating device within an extended cavity or tubular conduit, such as in a human body. The device consists of a tubular casing, a ilexible thin-walled tubular probe inside of the casing with the inside end closed, and the outside end sealed circumferentially to a :tirst end of the casing. The second end of the casing is closed with an elastomeric wall that can be pierced by and sealed to a small bore tube through which iluid can be pumped into the casing to extravert the tubing out of the 'first end of the casing, which can have a tapered nozzle, such as a hypodermic needle, to guide the extraverting tube into the body cavity.
This invention relates to the placement of a sampling, inspecting, or treating device within an extended cavity or tubular chamber that may have linear and nonlinear portions. Because of the nature of the cavity a rigid mechanical device could not be introduced into such a cavity and a thin exible member is not self-sustaining and cannot be pushed into the cavity.
More specifically, this invention relates to the art of medical apparatus including those instruments which are concerned with the sampling, inspecting, and treating of the walls of internal body cavities. Further, this invention is an improvement on that embodied in my U.S. Patent 3,168,092, issued Feb. 2, 1965, and entitled, Medical Probing Instrument Having Flexible Extrudable Tubing Adapted To Be Extraverted Under Pressure Into a Body Cavity.
Although the apparatus of my patent is useful for the purpose intended, the present invention extends the application to smaller diameter cavities and permits the manipulation of a wider variety of instrumentation. It also extends the techniques which may be followed in practicing the invention.
`Briely described, my invention utilizes an elongated, fluid confining chamber or casing having circumferential side Walls and two end closures. One end closure of the tubular casing has an opening which is adapted to be placed in communication -with the cavity. This opening also permits the introduction and/or the retrieval of a thin wall flexible tubing to be introduced into the cavity. A length of such tubing in collapsed form is placed within the casing. One end of the tubing remote from the cavity is closed. The other end of the exible tubing is open and is secured circumferentially to the opening in the end closure of the casing. 'Ihe entire length of tubing comprises the end closure for that end of the casing.
Means for introducing a uid within the casing and about the flexible tubing stored therein is provided and such fluid displaces the tubing progressively from the casing by everting the lead end which is the iirst to be extruded from the casing.
Thus, the collapsible thin wall exible tubing is progressively extraverted and progressively projected from the casing into the cavity as pressure and/or displacement fluid is applied to the annulus between the collapsed tubing and the casing wall. Means are provided for main- Patented Mar. 18, 1969 taining the displacing iiuid within the casing under the maintained pressure and this can include both control and indicator means.
As will become apparent, as the tubing is being extraverted/ extruded, the trailing end of the exible tubing moves out of the casing and into the extruded inflated tubing. The trailing end may carry a retrieval means and/or may transport into the cavity and within the extraverting tubing a Wide variety of instruments which may sample, inspect, or treat the areas within and adjacent the cavity. The collapsed tubing within the easing may contain medicating, sampling, and/ or opaquing materials which are brought in direct contact with the walls of the cavity when the liexible tubing is extraverted as described. Such materials within the collapsed tubing might also comprise adhesive, absorbent or other materials whereby samples of the cavity wall can be obtained.
These and other new and novel techniques and benetits derived from the use of my invention will become apparent as my description thereof proceeds with reference thereof from the attached drawings, wherein:
FIGURE l illustrates an embodiment of this invention adapted for the extraversion of a long small diameter probe into veins and arteries of the body. It represents a disposable embodiment of this invention.
FIGURE 2 illustrates the use of an elastomeric end closure of the casing.
FIGURES 3 and 4 show details of the end xture for a long small bore tube adapted to be drawn into a vein or artery by the probe, and a simple means for applying a vacuum to the tube.
FIGURES 5 and 6 show details of an embodiment of a simple pressure indicator for use with this invention.
FIGURES 7 and 8 show details of an embodiment of this invention with which it is possible to carry a small pumping device through a vein in the arm into the heart chamber.
There are a number of body cavities that are filled with air or other gas, such as the throat, colon, etc. However, there are some other cavities, or conduits (which may not be thought of as cavities) which are lled with liquids, into which the probe of this invention might be intruded. Such conduits in the human body might be the arteries or veins, for example. These diler from the air lled cavities, not only in the fact that they are filled with liquid under pressure, Ibut also in the fact that they are of small diameter.
Shown in FIGURE 1 is an embodiment which might be considered a fully disposable instrument, cheap to construct, simple to sterilize and easy to use. Since the conduit in which the probe is to be used is of small diameter, the probe must be of small diameter. The casing of the instrument can be constructed of a length 10 of small diameter, thick-walled fairly rigid plastic tubing, preferably transparent. The probe or exible thin-walled tubing 11 is inserted into the casing 10 and iitted over one end of the casing. A combination nozzle or nose piece and needle 14 is molded into a fixture 13 which tits over and locks the cui'l 12 of the probe 11 to the casing 10. A sanitary cover 15 is provided to seal the needle against contamination. The opposite end of the casing 10 is closed by a plug, wall, or closure of perforatable, self-sealing material such as an elastomer 18. Before the probe 11 is inserted into the casing 10 it is attached by some such means as clamp 17 in pressure tight relation to a length of capillary tubing 16. This can be fitted with a sharp metal point 19 so that it can penetrate the closure 18 and permit the sliding of the capillary tube 16 therethrough. A dust cover 20 is provided to seal oit the closure 18, tubing 16, and termination 19. Thus, between the covers 15, 20, and portions 13 and 10, the entire instrument is sealed and can be sterilized and safely stored in a sterile `condition.
In use, the cap is removed, and the needle 14 inserted into the vein or artery. Next the cover 20 is removed, the end fixture or termination 19 is removed and suction applied to the exposed end of the tube 16 to remove all traces of air from the inside of the probe 11 and tube 16 so as to ensure that no air will be introduced into the vein or artery. To make this more positive, some blood will be withdrawn through the needle 14, probe 11 and tube 16. This will be explained more fully in connection with FIGURES 3 and 4.
In FIGURE 3 is shown how the termination 19 might be constructed. It comprises a double ended hypoderrnic needle with a central hub 33, the diameter of which is substantially the same as that of the tubing 16. If desired, a shoulder 32 can be provided for the end lof the tubing 16 to seat against. One end 34 of the needle goes into the tubing 16. The other end 35 serves to perforate the closure 18. When it is desired to apply a suction to the end Iof the tubing 16, a previously evacuated container 37, FIGURE 4, with a perforatable closure 38 is pressed against the end of the needle 35. When this perforates the closure, the evacuated space 39 is presented to the interior 36 of the tube 16 and the tubing 11, evacuating that space and withdrawing blood from the conduit into which the needle 14 is inserted. If the perforatable closure 38 has a substantial thickness, and is self-sealing, then by partially withdrawing the needle 35 so that its open end is completely enclosed in 38 (as will be shown in connection with FIGURES 5 and 6) the capillary tube 16 will be closed oif. Thus, the simple apparatus of FIGURE 4 serves as a perforating termination for tube 16, a pressure shut yolf, and an adjustable source of suction, and a container to hold liuids withdrawn by the suction.
In FIGURE 2 is shown to a larger scale the closure 18 with the capillary tube 16 passing therethrough. Shown also is a needle 23 penetrating the closure 18 with a small pressure indicator 24. Also, a hypoderrnic syringe 26, or equivalent, with needle 25 perforating the closure 18 has a side needle 28 perforating a closure 29 over a container 30 containing sterile liquid 31. By operating the plunger 27, liquid (by suitable valves, etc., not shown but well known in the art) is carried from the container 30 into casing 10. Means such as a needle (described in connection with FIGURES 5 and 6), pressed through the closure 18 vwill serve to bleed out the air in the casing 10 as it is filled with the liquid 31. Additional liquid transferred from 30 to 10 will cause the probe to be extraverted and carry with it the capillary tube 16. The tube 16 can by this process be carried through a vein in the arm, into the heart chamber, to there sample the fluid, measure pressure, etc. When the test is completed, the probe is withdrawn back into the casing 10 by maintaining pressure in the casing 10 and withdrawing tube 16, and the instrument removed from the vein.
In FIGURES 5 and 6 are shown an embodiment cornprising a simple assembly 49 that can be used to bleed air out of the casing 10, act as a controllable needle valve, and as a pressure indicator. This device consists of a double ended hypodermic needle with one exposed end 40, which would be inserted through the closure 18. There is molded, or otherwise provided, a hu=b 41 and housing 42, by which the device can be held. The other end of the needle 43 is exposed inside the housing 42. A second tubular housing 44, open -on one end, and closed on the other end with a thick perforatable, self-sealing closure 45. There is a loose t between the housings 42 and 44 so that in the position shown in FIGURE 5, air passing through the needle from to 43 can be vented through the annular space between 42 and 44.
In FIGURE 6 the case is shown where the closure 45 is pressed against the needle 43 such that the entire open end of the needle is sealed inside the closure 45. This shuts oif the iiow of air through the needle. Attached across the open end of the housing 44 is a small elastic (rubber) balloon 47, sealed by the clamp '48. When the housing is 44 is pressed farther over the needle so that the needle is in position 43', then the air passing through the needles 40, 43 from the space inside the casing 10, acts against the elastic closure or diaphragm 47, which then acts as an indicator of pressure in the casing 10.
In FIGURES 7 and 8 there is shown another embodiment of this invention, describing a special type of instrument to be drawn into the vein by the probe 11. In FIG- URE 1 this is shown as a simple capillary tube adapted to measure the pressure in the heart chamber. In FIGURE 7 there is shown a small extensible balloon type element 50 fastened in pressure seal over the end of the capillary tube 16 by means such as clamp 51. During the process of extroversion of the probe and instrument from the casing into the vein or artery, this balloon is enclosed within the probe tubing 11. Once in the heart chamber, the probe tubing 11 is peeled back from the end of the capillary tube, exposing the balloon 50, as in FIGURE 8. Now, by applying a pulsating hydraulic or pneumatic pressure to the interior of the balloon 50, by means such as the cylinder 54 and piston 55, the balloon will undergo cycles of expansion and reduction such as 50 to 50 to 50, etc. This alternation of size in conjunction with the heart valves will cause fluids to be alternately expelled and drawn into the heart chamber. Thus, this medical instrument makes it possible, in the event of heart stoppage, to
enter the heart, without surgery, and initiate pumping action very quickly.
Another way in which the instrument of FIGURE l may be used is to have a radiopaque fluid 31 inside the inflated, extruded probe 11. Now, if the probe is inserted into an artery, in the manner described above, it should be possible by means of X-rays taken while the inflated probe is in place, to determine, either by means of the average density of the shadow in the X-ray photograph cast by the probe liquid, or by the width of the shadow (perhaps taken along two orthogonal directions) to determine the average internal diameter of the artery along the full extent of the probe. Of course, if the material of which the probe is made is itself radiopaque, or if it contains a iine metallic powder or other radiopaque material, then the same information can be obtained as if the extroverting liquid is radiopaque.
This invention is susceptible to a wide variety of embodiments, some of which have been described, and many more of which will be obvious to one trained in the art, and is not to be construed as being limited to the specific apparatus and processes described above. The scope of this invention is limited only by the scope of the appended claims.
1. A medical instrument for placing a exible tubular probe into a tubular body cavity comprising a tubular casing, a collapsed thin-walled flexible tubing placed inside said casing, the inner end of said tubing closed, the outer end of said tubing sealed circumferentially over the first end of said casing, a closure extending entirely across the second end of said casing consisting of a transverse wall of elastomeric material adapted to be perforated by and sealed around a smooth cylindrical small-diameter element, conduit means extending through said closure for introducing fluid into said casing through said closure, and tapered nozzle means fitted over the first end of said casing, and adapted to be placed adjacent the mouth of a body cavity, whereby when fluid is inserted into said casing under pressure, said tubing is extraverted from said casing through said nozzle means into said cavity.
2. A medical instrument for placing a flexible tubular probe into a tubular body cavity comprising a tubular casing, a collapsed thin-walled liexible tubing placed inside said casing, the inner end of said tubing closed, the outer end of said tubing sealed circumferentially over the first end of said casing, a closure extending entirely across the second end of said casing consisting of a transverse wall of elastomeric material adapted to be perforated by and sealed around a smooth cylindrical small-diameter element, conduit means extending through said closure for introducing fluid into said casing through said closure, the inner end of said tubing is closed by being sealed over the end of a long small-bore tube, said tube also extending through and being sealed by said elastomeric closure, whereby when fluid is inserted into said casing under pressure, said tubing is extraverted from said casing carrying with it said tube.
3. The medical instrument of claim 2 including vacuum means connected to the outer end of said tube.
4. A medical instrument for placing a flexible tubular probe into a tubular body conduit comprising a tubular casing, a collapsed, thin-Walled, exible tubing placed inside said casing, the inner end of said tubing closed, the outer end of said tubing sealed circumferentially over the irst end of said casing, closure means sealing 01T the second end of said casing, means for introducing uid into said casing, the inner end of said tubing closed by being sealed over the end of a long small bore tube, said tube extending through and being sealed by said closure means, vacuum means connected to the outer end of said tube, said vacuum means comprising evacuated chamber means, a portion of the wall of said chamber comprising a wall of elastomeric material adapted to be perforated by and sealed around a smooth, cylindrical, small-diameter element, and means on the outer end of said tube to pierce said elastomeric material and enter said evacuated chamber means.
5. A medical instrument for placing a flexible tubular probe into a tubular body conduit comprising a tubular casing, a collapsed thin-walled exible tubing placed inside said casing, the inner end of said tubing closed, the outer end of said tubing sealed circumferentially over the first end of said casing, closure means sealing the second end of said casing, means for introducing fluid into said casing and hypodermic needle means fitted over the irst end of said casing, said needle means adapted to pierce the wall of said body conduit, whereby when iluid is introduced into said casing, said tubing will be extraverted out of said rst end of said casing, through said needle means into said conduit.
6. The apparatus of claim 5 in which said closure means sealing the second end of said casing comprises a transverse wall of elastomeric material adapted to be perforated by and sealed around a smooth, cylindrical, smalldiameter element.
7. Apparatus as in claim 5 in which said thin-walled flexible tubing is at least partly radiopaque.
8. The apparatus of claim 6 including means to close the inner end of said tubing by sealing it over the end of a long, small-bore tube, said tube extending through and sealed by said elastomeric closure means.
9. The apparatus of claim 8 including vacuum means connected to the end of said tube outside of said casing.
10. A medical instrument as in claim 8 in which said small bore tube has sealed over its end inside of said casing a small expansible balloon, and the end of said tube and said balloon inserted into the inner end of said tubing and the said tubing sealed to said tube.
11. A medical instrument as in claim 10 in which the end of said small bore tube outside said casing is attached to a fluid pump adapted to provide an oscillatory uid pressure to said balloon.
12. A medical instrument for placing a flexible tubular probe into a tubular body conduit comprising a tubular casing, a collapsed, thin-walled, flexible tubing placed inside said casing the inner end of said tubing closed, the outer end of said tubing sealed circumferentially over the first end of said casing, closure means sealing the second end of said casing, hypodermic needle means fitted over said rst end of said casing, said needle means adapted to pierce the wall of said body conduit, container means holding a volume of radiopaque liquid, liquid transfer means for transferring said radiopaque liquid from said container means into said casing, whereby when said liquid is introduced into said casing, said tubing will be extraverted out of said iirst end of said casing, into and through said needle means into said conduit, carrying with it said radiopaque liquid.
13. A medical instrument for placing a flexible tubular probe into a tubular body cavity comprising a tubular casing, a collapsed thin-walled tiexible tubing placed inside said casing, the inner end of said tubing closed, the outer end of said tubing sealed circumferentially over the tirst end of said casing, a closure across the second end of said casing comprising a transverse wall of elastomeric material adapted to be perforated by and sealed around a smooth cylindrical small-diameter element, means for introducing fluid into said casing through said closure, and means for indication of the pressure of said uid inside said casing comprising a small diameter tube inserted and sealed through said elastomeric closure with a small expansible balloon sealed over the outer end of said tube, whereby when uid is inserted into said casing under pressure said tubing is extraverted from said casing.
14. A medical instrument for removably extraverting a long thin-Walled tiexible tubing into a small diameter body conduit, comprising a length of thick-walled substantially rigid tube forming a casing for said instrument, a transverse closure across one end of said tube comprising a wall of elastomeric material, nozzle means comprising a hypodermic needle attached to the other end of said tube, a long collapsed thin-walled tiexible tubing in said casing, the inner end of said tubing remote from said nozzle closed, the outer end of said tubing circumferentially sealed to the open end of said casing, and means adapted to pierce said closure to control the volume of uid in said casing and to indicate the pressure of said fluid.
15. A medical instrument as in claim 14 in which said iiuid control means comprises a small diameter tube passing through said elastomeric closure and attached to a fluid pump on its outer end.
16. A medical instrument as in claim 14 in which said fluid indicating means comprises a small diameter tube passing through said closure and at its outer end sealed into an expansible balloon.
17. Apparatus as in claim 14 including retrieval means attached to the closed end of said tubing.
18. A medical instrument as in claim 17 in which said retrieval means comprises a long slender cylindrical element sealed through said elastomeric closure.
19. A medical instrument as in claim 18 in which said cylindrical element is a long small-bore thick-walled tube sealed into the closed end of said tubing.
20. A medical instrument as in claim 19 in which the exposed hypodermic needle on one end and the tube on the other end of said casing are protected by sealed covers.
References Cited UNITED STATES PATENTS 2,493,326 1/1950 Trinder 12S-344 X 3,055,361 9/1962 Ballard 12s-214.4 3,168,092 2/1965 Silverman 12S-1.2 3,178,732 4/1965 Stibitz 5-81 DALTON L. TRULUCK, Primary Examiner.
U.S. Cl. X.R.