US 3459189 A
Description (OCR text may contain errors)
Alig- 5 1969 n. D. ALLEY ET M- TROCAR CATHETEIR Filed July 28, 1965 INVENTORS RALPH D. ALLEY DAVID S. SHERIDAN a w v f fand 011151138.
A L' l Mu, "WF
United States Patent O Mtee 3,459,189 TROCAR CATHETER Ralph D. Alley, Loudonville, and David S. Sheridan,
Argyle, N.Y., assignors, by mesne assignments, to
Brunswick Corporation, Chicago, lll., a corporation of Delaware Filed July 28, 1965, Ser. No. 475,489 Int. Cl. Aelb 17/34 U.S. Cl. 12S-347 11 Claims ABSTRACTl F THE DISCLOSURE A trocar catheter is provided which is sterile packaged and ready for immediate use. The trocar catheter has a trocar with an abutment near its distal end which is adapted to engage an abutment extending from the internal surface of the catheter near its distal end such that the abutment on the trocar assists in placing the catheter. The trocar is suitably marked in such a way that the exact location of the catheter can be determined by reference to the trocar. The trocar and catheter have aligned end surfaces which cooperate to provide a smooth point for penetrating the area being punctured. The proximal end of the trocar is ball shaped for providing a surface which better cooperates with the physicians hand in placing the trocar. The ball shaped end of the trocar cooperates with the package for ease in storing and removing the trocar from the package. The catheter has an X-ray opaque line and drainage openings near the distal end at least one of which openings coacts With the X-ray opaque line to indicate the location of vthe end of the catheter in the patient under appropriate techniques.
The present invention relates to a strocar catheter and more particularly to a thoracic trocar catheter.
Conventional intercostal catheter kits which are utilized for the drainage of fluids, either gas or liquid, from the thoracic cavity have been available in many hospitals and in some physicians oces. However, when many emergencies arise, such kits may not be available because, even if they are maintained in a hospital or in a particular physicians oce, they must be sterilized before use, the contents of the kit must be checked and parts must be matched after the desired size is selected. Therefore, these kits are often unavailable when a physician is called in an emergency case such as an automobile accident, or, if available, much valuable time may be lost before a conventional kit may be utilized in treating a patient. The present invention makes it possible for every hospital to have on hand at all times an integrated intercostal drainage instrument which is sterile packed and ready for immediate use in the emergency room, in the operating room, for distribution from central supply, or available in the physicians oice for an emergency call to another hospital.
In the use of conventional intercostal catheter kits, the opening made by a trocar remained open until a tube was placed. If the drainage tube was not quickly inserted following trocar withdrawal, air entered or fluid was expelled from the opening. The present invention eliminates Ithe interval of time when the system is open, and thereby does not allow external or internal pressures to transfer uid through an opening made by the trocar while a tube is being placed.
Therefore, an object of the present invention is to provide a new and improved trocar and catheter.
An additional object is to provide an integrated intercostal drainage instrument, sterile packed and ready for immediate use.
3,459,189 Patented Aug. 5, 1969 Another object is to provide an integrated trocar catheter having a trocar with an abutment formed near its distal end and having a catheter with an abutment extending from its internal wall surface which is engageable by the abutment on the trocar for placing the catheter.
A further object is to provide a flexible tube having an abutment extending from its internal wall surface near its distal end and a reduced diameter distal end aperture and to provide a trocar which is slidable into the tube through its proximal end and which has an abutment engageable with the tube abutment while simultaneously allowing a point of the trocar to extend through the distal end aperture of the tube.
Yet another object is to provide a packaged trocar and catheter which has an integrated trocar catheter enclosed in a sterile container with a cap which, when removed, will alloy easy access to the handle of the trocar for withdrawing the trocar and catheter from the container as an integral unit.
Further objects and advantages will become apparent from the following detailed description taken in connection with the accompanying drawings, in which:
FIGURE 1 is an elevational view of a trocar which forms a portion of a preferred embodiment of the present invention;
FIGURE 2 is an elevational view of a tube which forms another portion of the preferred embodiment of the present invention;
FIGURE 3 is an elevational view of a container with a cap which forms yet another portion of the preferred embodiment of the present invention;
FIGURE 4 is a cross sectional view of the preferred embodiment of the present invention with the portions of embodiment, shown in FIGURES 1-3, assembled prior to utilization of the embodiment of the invention, taken along the line 4-4 in FIGURES 1-3.
FIGURE 5 is a perspective view of the embodiment of the invention, illustrated in FIGURES 1, 2 and 4, being placed through the thoracic wall of a patient before the ,-trocar, illustrated in FIGURE 1, is removed; and
FIGURE 6 is a perspective view of the placement of the catheter, illustrated in FIGURE 2, after the trocar, illustrated in FIGURE l, has been removed.
While this invention is susceptible of embodiment in many diiferent forms, there is shown in the drawings and will herein be described in detail, an embodiment of the invention with the understanding that the present disclosure is to be considered as an exemplication of the principles of the invention and is not intended to limit the invention to the embodiment illustrated. The scope of the invention will be pointed out in the appended claims.
The present invention, in addition to providing a thoracic trocar catheter available at all times for immediate use, provides a signicant improvement over the tedious manipulative procedures that were required in former methods. Since in previous methods the opening made by the trocar remained open until a tube was placed, the drainage tube had to be quickly inserted following the withdrawal of a trocar, or a fluid might be expelled through the opening left by the trocar. If external air pressure exceeded internal pressure, air would pass into the thoracic cavity through the opening. The present invention not only eliminates this race with time, but reduces the time of placement of a catheter since placement of a trocar coincides with the placement of a catheter. The catheter enters with the trocar and remains properly placed for connection to closed drainage after withdrawal of the trocar. There remains no interval of time during which the system is open.
Referring first to FIGURES 1 and 4, a trocar, generally indicated at 10, is shown which has an elongated cylindrical shaft portion 11, a reduced cylindrical portion 12 adjoining the shaft portion 11 to form an arcuate transverse abutment 15 and a conical point 16 adjoining the reduced cylindrical portion 12. The conical point 16 forms the distal end of the trocar and a spherical shaped handle 17 is secured to the opposite or proximal end of the trocar. A longitudinal slot 18 is formed down the length of the trocar 10 and extends from the conical point 16 through said reduced cylindrical portion 12 and into the shaft portion 11. As shown in FIGURE 4, the slot 18 has a stepped portion between the shaft portion 11 and the conical point 16 to ensure continuity of the slot in view of the reduced diameter conical point 16. The slot 18 is shown terminating just short of the proximal end of the catheter. It is possible that the slot can extend beyond the proximal end of the catheter without departing from our invention. An annular mark 21 is positioned in the shaft portion 11 of the trocar 10 near the proximal end of said trocar 10.
Referring now to FIGURE 2, a flexible plastic tube or catheter 30 is illustrated which has an elongated body portion 31 of substantially uniform internal and external diameters, a rigid integral distal end 32, and a flared portion 33 adjacent a proximal end 34. Referring to FIG- URE 4, the distal end 32 has a bevel surface 35 which forms a continuing conical shaped surface extending to an outer surface 36 of the body portion 31 with the conical point 16 of the trocar extending when the catheter 3i) is placed over the trocar 10, as illustrated in FIG- URE 4. An arcuate transverse abutment 37 extends from an internal wall surface 38 of the body portion 31 to form a reduced diameter distal end aperture 39. The internal surface of the body portion 31 coacts with the slot 18 in the shaft portion 11 of the trocar to form a capillary groove or slot 18 therebetween.
A line 4t) of X-ray opaque material extends the length of the catheter 30 and is interrupted by an aperture 41 through the wall of the elongated portion 31 near the distal end 32. Another aperture 42 is formed through the wall of the elongated catheter portion 31 between the aperture 41 and the distal end 32.
Referring now to FIGURE 3, a sterile package is illustrated which consists of an elongated plastic container closed at one end 51 and open at an opposed end S2 and an enclosing elongated plastic cap 54 which is closed at one end 55, is open at an opposed end 56, and which is slidable over the open end 52 of the elongated container 50. As illustrated in FIGURE 4, the interior diameter of a wall section 57 of the cap 54 adjacent the closed end 55 is slightly less than the diameter of the spherical handle 17 and the internal diameter of a wall section 58 adjacent the open end 56 of the cap 54 is slightly greater than the diameter of the spherical handle 17 to form an abutment 60.
In order to obtain sterile packaging, the trocar is slid into the catheter 30 through its proximal end 34 until the angular abutment on the trocar 10 engages the internal abutment 37 of the catheter 30 with the conical point 16 protruding through the distal end aperture 39. The combined trocar 10 and catheter 30 are then inserted into the elongated container 50 with the spherical handle 17 which is slightly greater in diameter than the open end 52 engaging the open end 52 as illustrated in FIGURE 4. The cap 54 is then placed over spherical handle 17 until the abument 60 engages the handle 17. Thus, the trocar catheter is shown assembled and packaged in FIGURE 4. A tamper proof seal, as illustrated and described in copending application Ser. No. 225,268, tiled Sept. 2l, 1962, is utilized to seal the cap opening 56 to the container 50 to complete a sterile package.
The procedure for placing the tube or catheter 30, illustrated in FIGURE 2, by use of the integrated trocar 10, illustrated in FIGURE 1, will now be described in greater detail. Referring to FIGURE 5, an area of skin,
generally indicated at 60, is prepared for puncture. The
skin 60 and the deep structures are inliltrated with an anesthetizing agent. A suitable maneuver is performed to confirm the space, generally indicated at 61, between ribs 62 and 63. A stab wound is made through the skin 60 and subcutaneous fascia at 61.
Referring to FIGURE 3, the tamper proof tape seal (not shown) which covers the joint between the open end 56 of the cap 54 and an adjacent portion of the outer surface, of the container is removed by grasping a tab, pulling up, around and oit. The cap S4 is pinched between the fingers to grip the handle 17 of the trocar. The cap 54 and trocar are then moved away from t'ne mouth of the container 50 uncovering a sterile area on the exterior of the container adjacent the entrance to the container 50 which prevents contamination of the trocar catheter as it is withdrawn from the container. Once the integrated trocar catheter is removed from the container 5t the cap 54 is discarded. With the handle or ball 17 in the palm of one hand and using the other hand to stabilize the instrument by supporting the catheter tube 30, the trocar catheter 10-30 is introduced between the ribs 62 and 63, as shown in FIGURE 5. As the catheter is introduced, blood or other fluid which is encountered by the point 16 tiows up the capillary groove 18 and is observed by the physician. The size of the slot or groove 1S has been adjusted so that the physician will receive an immediate indication of the tluid that he is encountering, but the quantity of iiuid owing up the groove is nevertheless limited to prevent it from tiowing out of the proximal end 34 of the catheter 30.
After the trocar catheter is placed, as illustrated in FIGURE 5, the physician grasps the spherical handle 17 in one hand and holds the catheter tube 30 with the other hand at or near its tiared portion 33 adjacent the proximal end to start the withdrawal of the trocar 1t). After the trocar 15 is partially withdrawn, the tube 30 is pinched ott by the physician between the head of the trocar and the body of the patient. The trocar it) is then removed the rest of the way from the tube 3G. The ared portion 33 is connected to a tube leading to a water seal or three bottle system (not shown) in the conventional manner well known to those skilled in the art.
The mark 21 on the trocar near the proximal end thereof indicates the length of the catheter and the mark is used with the trocar to form a measuring stick. After the water seal or three bottle system is in place, the trocar 1t) is held next to the catheter tube 30 with the point of the trocar just touching the patient very near to the incision 61, the physician can mark or measure the distance from the mark 21 and the proximal end 34 of the catheter tube 30, a measurement with which to judge the depth of insertion of the catheter. A record of the depth of insertion is made for later use. The catheter is sutured in place by a loose skin stitch holding the catheter by a tight ligature. The trocar is again held next to the catheter and the depth of insertion checked against the previous recorded depth to be sure that during the fixation of the catheter to the skin, the catheter did not migrate into or out of the position in which it was placed. A large tape dressing can be applied to the skin and around the catheter tube in such a way that the tension on the tube is referred to a broad area of the skin rather than to the suture-ligature.
The rigid distal end 32 is molded to tit closely around the reduced cylindrical section 12 of the trocar 10 so that it blends smoothly into a non-traumatic tip with the point 16 of the trocar 10. Since the point 16 and the bevel surface 35 of the catheter 30 form a cone shaped tip which smoothly parts chest wall tissue, the tip formed by the trocar and the catheter is a Safeguard against trauma to intercostal nerves and vessels. For intercostal penetrations, the trocar 10 is preferably constructed of a single integral shaft portion 11, reduced section 12, and point 16 of resilient semi-iiexible aluminum. The trocar 10 can be made of materials ranging from rigid stainless steel to semi-rigid plastics provided the material is suiciently rigid to transmit the necessary force from the spherical ball 17 to the point 16. The trocar could be made of a ductile or malleable material that can be bent or shaped to a desired contour, such as a long sweeping arch, which will remain in that shape throughout the subsequent use of the trocar. Such other materials may be preferable in varying the rigidity and resilience of the trocar `for other applications of the trocar catheter. For example, it might be desirable to use a stainless steel shaft portion on a particularly difficult intercostal penetration while a small size catheter utilizing a semi-rigid plastic trocar might be utilized in penetrating other portions of a patients body. The utilization of a smooth conical point, such as point 16, is a departure from conventional angular trocar points. The conical point 16 has the advantage over past trocar points in that an intercostal penetration may be made with a minimum 4danger of injury to ntercostal nerves and vessels.
The tube 30 is preferably constructed of a medical grade polyvinyl chloride which is inert in prolonged contact with body tissues. Medical grade polyvinyl chloride is also non-wettable and has thermal sensitive properties conforming readily to tissue contours without tension or compression. The X-ray opaque line 40, which is interrupted by the aperture 41, provides under X-ray the means for not only ascertaining the path which the tube has taken in being placed but also provides a means for determining the position of its distal end with a reasonably high degree of accuracy. Thus, the X-ray opaque line and its interruption by the aperture 41 delineates on X-ray film, the tubes position relative to the chest Wall in the pleural space.
Those skilled in the art will recognize that although a thoracic trocar catheter has been illustrated and described as a preferred embodiment of the present invention, the present invention applies to placing tubes or catheters in other parts of the body. The appended claims are intended to be of such scope as to cover integrated trocar catheters regardless of their size and the part of a patients body to which they are to be applied.
A significant feature of this invention is the fact that the trocar engages, for the purpose of transmitting the necessary force, the distal end of the catheter. In the parts, intravenous needle structures have been utilized which consisted of a rigid internal needle covered by a exible plastic tube which lits snugly over the needle throughout its length and which had the necessary penetrating force transmitted from an abutment adjacent the proximal end of the flexible plastic tube sheath. Such structure is not practical for the placement of thoracic catheters nor is it practical for placing tubes in other parts of a patients tbody other than for conventional intravenous procedures. Therefore, for the rst time, a structure for placing the tube is provided which can be utilized in almost any desired medical procedure Which requires the placing of a tube through body tissue. Since the present invention transmits force from the trocar to the catheter at the distal end, there is no possibility that the tube or catheter will be forced back along the trocar, nor does the tube or catheter have to t snugly upon a trocar or needle shaft.
The fact that the engaging abutments of the trocar and catheter are at their distal ends provides another very important feature of the integrated trocar catheter. In the event of improper placement, the structure of the trocar catheter illustrated in FIGURES 1, 2 and 4 can be reassembled and the procedure repeated. To repeat the procedure, the physician withdraws the catheter, grasps the spherical handle 17 of the trocar in one hand and inserts the tip 16 into the proxi-mal end 34 of the catheter 30 and with the other hand guides the catheter towards the handle of the trocar in increments always grasping the catheter 30 in front of the tip 16 to push it rather than to pull it onto the trocar. Thus, the illustrated and described trocar catheter structure represents a particularly significant step forward in the medical instrument art in that it provides a structure which is readily available to the physician for emergency procedure, is applicable in various sizes for penetration into most portions of a patients body, and unlike presently known intravenous needle structures can have the trocar reinserted into a tube or catheter for a repeat penetration.
1. A trocar catheter for use in penetration of body cavities through normal and pathological tissue, including thick, densely calcied scar tissue, comprising:
a catheter tube having a rigid, non-distensible ldistal end portion, flexible mid and proximal end portions, and an internal wall surface throughout said tube,
the distal end portion having a cylindrical portion and a truncated conical tip portion, an abutment projecting inwardly from the internal wall surface of the cylindrical portion of said distal end portion, and forming an opening of reduced cross-sectional area throughout the remaining portion of the distal end portion, and
a rigid trocar slideably and removably received within said tube through said proximal end portion, said trocar having a shaft portion, and a reduced por- -tion terminating in a conical point, said reduced portion forming a shoulder engageable with the abutment in the cylindrical portion of said tube when said conical point is extending from said distal end opening of the tube, said point having its conical shape matching the slope of the truncated cone tip of the distal end portion of the tube to provide a conical penetrating point for said trocar catheter,
whereby pressure applied to the shaft portion of the trocar transmits force through the trocar to the coacting shoulder and the abutment to the rigdi nondistensible distal end portion for leading the catheter through body tissue into position whereupon the trocar is removed and the catheter left in situ.
2. In a trocar catheter as claimed in claim 1 wherein said catheter tube tapers gradually outward from said mid-portion to the outer proximal end of said tube.
3. In a trocar catheter as claimed in claim 1 wherein a longitudinal slot is formed in said trocar extending from said conical point and having a depth substantially slightly short of reaching said trocar center line through said point, through said reduced trocar portion and into the shaft portion so that uid may flow in said slot along the length of the trocar and catheter to indicate pene-tration of the trocar and catheter into the body cavity.
4. In a trocar catheter as claimed in claim 2 wherein a measuring mark is provided on said trocar opposite the tube proximal end when said tube is assembled on said trocar with the shoulder on the trocar and the abutment on the tube in engagement with each other so that the deptg of placement of the tube in the body cavity can be note 5. In a trocar catheter as claimed in claim 1 wherein a spherically shaped-handle is provided on a proximal end of the shaft portion of the trocar whereby the pressure applied to the trocar is applied against said handle for facilitating placement of the catheter.
6. In a trocar catheter as claimed in claim 1 wherein said catheter tube has an X-ray opaque line extending longitudinally the length of said catheter tube.
7. In a trocar catheter as claimed in claim 6 wherein said catheter has openings near the distal end thereof at least one of which interrupts said X-ray opaque line.
8. A trocar catheter as claimed in claim 1 wherein said trocar being formed of a ductile material can be adapted to be shaped to a given predetermined contour prior to use.
9. A trocar catheter as claimed in claim 1 wherein said trocar being formed of a semi-rigid material can be adapted to be shaped to a given predetermined contour prior to use.
10. A trocar catheter as claimed in claim 1 wherein said trocar being formed of a malleable material can be adapted to be shaped to a given predetermined contour prior to use.
11. A trocar catheter as claimed in claim 5 which is enclosed in an elongated container having a closed end and an open end, said open end receiving said assembled trocar and catheter with a diameter of said open end being less than the maximum diameter of said handle in a plane References Cited UNITED STATES PATENTS Strauss 12S-214.4 Jones 206-63.2 Koehn 12S-214.4 Scislowicz 12S- 214.4 Eisenberg 12S-214.4 Spademan 12S-214.4
perpendicular to said trocar center line to limit insertion 10 DALTON L TRULUCK, Primary Examiner of said trocar into said container, and an encasing cap for said container which is closed at one end and is slidable over said handle and said open end of said container.