US 3505988 A
Description (OCR text may contain errors)
N. DEANE April 14, 1970 PROSTHESIS FOR CHRONIC ACCESS TO THE PERITONEUM Filed April 11, 1967 INVENTOR. NORMAN DEANE United States Patent O 3,505,988 PROSTHESIS FOR CHRONIC ACCESS TO THE PERITONEUM Norman Deane, 112 E. 74th St., New York, N.Y. 10021 Filed Apr. 11, 1967, Ser. No. 629,950 Int. Cl. A61b 19/00 US. Cl. 128-1 3 Claims ABSTRACT OF THE DISCLOSURE In the technique of peritoneal dialysis, upon the removal of the catheter, a flanged, elongated, flexible member is inserted directly into the wound for chronic access to the peritoneal cavity.
BACKGROUND OF THE INVENTION The procedure of peritoneal dialysis involves the infusion of a volume of fluid of predetermined composition into the abdomen. The fluid is allowed to remain in the peritoneal cavity and is then drained out. The infusion and draining take place through a catheter and auxillary administration clamps and bottles operating through gravity flow and siphoning processes. The procedure is an exceedingly important one and forms a lifesaving procedure in many cases of kidney damage.
In order to understand the inventive technique and prosthesis, it is essential that one fully understand the manner in which the catheter is inserted in the body for the fluid exchange, and the conventional methods for maintaining peritoneal access during periods between treatments, which may run from several days to a week or more; the entire period of treatment often taking months.
Almost any site on the anterior abdomen wall may be selected for the introduction of the catheter provided that precautions are taken to avoid puncturing the underlying organs. The most convenient site is several centimeters below the umbilicus. With the patient in the supine position and the skin and subcutaneous tissues locally anesthetized, a trocar or stylet is employed in a stabbing motion to penetrate the skin, subcutaneous tissues, muscle and peritoneum. The trocar is hollow and includes an obturator designed to close the canal during its insertion. When the peritoneum has been punctured, the obturator is removed and the catheter is slipped in through the trocar as far into the peritoneal cavity as possible. Once the catheter is in place, the trocar is slipped out over it and the skin is closed snugly about the catheter with a purse string suture. Infusion and siphoning may now take place.
Upon completion of the dialysis, it is the conventional practice to remove the catheter. Because the treatment takes place redundantly during spaced intervals, it is desirable to maintain access to the peritoneal cavity. This desirability is strengthened by the fact that the creation of the stab wound for catheter insertion is not unaccompanied by hazard. While the trocar has a critically sharp point to penetrate muscle layers, they are sometimes carried back and damaged. Further, if the abdomen wall is displaced, large blood vessels may be perforated. Bowel laceration particularly in patients where the bowel is known to be matted and friable creates additional serious risks.
Consequently, a great number of prostheses have been designed to maintain peritoneal access through the original wound. These prostheses are implanted to bridge the skin and peritoneum and resemble hollow rivets through which a catheter may he slid. During periods intervening treatment, a plug is inserted which engages the rivet shaped prosthesis to close the opening.
A whole family of the foregoing type prosthesis has M 3,505,988 Ice Patente Ap 1970 been suggested and tried. While meeting with initial popularity, all incurred high incidence of infection and ultimately proved unsatisfactory. Further, these prostheses tended to web across the opening. This fibrosis effectively obviated the advantage soughtperitoneal cavity access.
OBJECT OF THE INVENTION Accordingly, it is the object of this invention to provide a technique for chronic access to the peritoneal cavity for dialysis without the disadvantages obtaining with conventional techniques.
The above mentioned and other features and objects of this invention and the manner of attaining them will become more apparent and the invention itself will best be understood by reference to the following description of an embodiment of the invention taken in conjunction with the accompanying drawing wherein the single figure illustrates a catheter replacement or prosthesis for chronic access to the peritoneum according to the invention.
With the inventive technique, the catheter is inserted in the conventional manner utilizing a trocar with an obturator to penetrate the skin, subcutaneous tissue muscle and peritoneum. The infusion and siphoning are also administered in the conventional manner. Upon completion of the dialysis treatment, the catheter tube is drawn out. In the figure, a catheter replacement or prosthesis is shown.
This device comprises a mesa-shaped head 10 and elongated body 12. The body 12 is of a diameter substantially the same as the catheter which it replaces. The head;
which is firmly secured to the body to insure against separation, is much larger in diameter than the body and serves as a flange to limit the displacement of the prosthesis into the wound. The mesa-shape of the head is convenient and not critical. The junction 14 of the head and body is mobile, and the body itself flexible to allow the prosthesis, upon insertion, to track the wound. This flexibility also permits body motion without pain or tissue damage.
Upon complete removal of the catheter, the prosthesis shown in the figure (preferably with an antibiotic ointment painted on its surface to aid insertion and insure against infection) is slipped into the wound, its rounded head end facilitating the tracking of the wound into the peritoneal cavity. The body 12 is of suflicient length to penetrate the peritoneum and preferably is available in several sizes, the proper size being selected dependent upon the judged thickness of the abdominal wall.
Upon performing subsequent peritoneal dialysis, the prosthesis is removed and the catheter is re-inserted into the wound which has been maintained open. Inadvertent withdrawal of the prosthesis during periods intervening treatment will be avoided by taping of the prosthesis head to the anterior stomach wall.
Both the prosthesis and the technique according to the invention are of extreme simplicity, vis-a-vis conventional arrangements. The prosthesis may be formed of any material which is non-irritating, non-thrombogenic, nonreactive with body tissue and reasonably flexible. Examples of such materials are pharmaceutically acceptable plastics such as tetrafluoroethylene.
With the invention, incidences of infection are negligible. Fibrosis or webbing has been eliminated, and another common disadvantage of conventional prostheses, that is, the adhesion of bowel to the interior prosthesis rim, has also been eliminated.
While the principles of the invention have been described in connection with specific apparatus, it is to be clearly understood that this description is made only by way of example and not as a limitation to the scope of the invention as set forth in the objects thereof and in the accompanying claims.
What is claimed is:
1. In the process of peritoneal dialysis including the steps of producing a stab wound in the abdomen, followed by the insertion of a catheter through the wound into the peritoneal cavity, the improvement for preserving chronic access to the peritoneal cavity comprising the step of Withdrawing the catheter and inserting an elongated fianged flexible prosthesis directly into the open wound, said flange being in sealing engagement therewith.
2. A prosthesis for providing chronic access to the peritoneal cavity consisting essentially of an elongated flexible member having a rounded end, and a length at least equal to that necessary to penetrate the peritoneum, and a head mobily secured to said body at the end opposite said rounded end for limited progression of said member into the body, said head including a planar disk shaped surface generally orthogonal to said flexible member at the point of said securing.
3. The prosthesis claimed in claim 2 wherein said head is mesa-shaped.
References Cited UNITED STATES, PATENTS 1,957,673 5/1934 Sayre 128 341 2,324,520 7/1943 Lamson 1281 2,510,766 6/1959 Surface 1281 3,241,554 3/1966 Coanda 128350 3,253,594 5/1966 Matthews 61; al. 128--348 10 3,333,588 8/1967 Schulte 128350 DALTON L. TRULUCK, Primary Examiner US. Cl. X.R.