US 3653388 A
A trocar for insertion of catheters into a body wall is described. The trocar comprises a bivalved type tapered tip with a handle attached to each portion of the tapered tip, a tubular member adapted to encircle the rearward portion of the tapered tip and a stylet which is adapted to fit inside both the tubular member and the bivalved tapered tip. This device permits insertion of a flexible tubing catheter into a body member wall for prolonged intermittent access to a cavity beyond the body wall. This device is particularly useful in insertion of cuffed catheters into the abdominal wall.
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Description (OCR text may contain errors)
[451 AprAJWZ Tenclthoit States Watut OTHER PUBLICATIONS Anand, J. K., A New Cannula For lntroducin Catheters Into Pleural Cavities." 65, p. 1370.
g Ballon- Heinrich A. M. Tencltlhoff, Seattle, Wash.
Battelle Development Corporation, Columbus, Ohio in The Lancet," 6- 26- Assignee:
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mits insertion of a flexible tubing catheter into a body member wall for prolonged intermittent access to a cavity beyond the body wall. This device is particularly useful in insertion of cuffed catheters into the abdominal wall.
4 Claims, 3 Drawing Figures CATHETER INSERTION TROCAR BACKGROUND OF THE INVENTION vention further relates to a method of and surgical apparatus for applying a cathetertube to a location within an animal body. More specifically this invention relates to a trocar apparatus which may be used to insert a catheter through a body wall with a minor amount of injury to the adjacent body parts and which trocar may be dismantled and removed leaving the catheter installed in the body wall.
The invention described herein was made in the course of work under a grant or award from the Department of Health, Education and Welfare.
Attempts in the prior art to provide apparatus for inserting catheter tubes into a body member have resulted in adequate emplacement of a catheter into the body wall. However, the trocar apparatus used usually remained in the body wall causing serious problems with manipulation of the patient. Heretofore, surgical implantation of catheters has frequently been required, usually necessitating the use of an operating room and application of general anesthesia to the patient. For this operation, a rather large incision is made in the body wall and the catheter tube inserted. The incision is then sewn up by the usual surgical techniques. This procedure, while adequately implanting the catheter in the body wall, is expensive to the patient and of course involves a rather high degree of morbidity due to the traumatic effects of the operation and the general anesthesia required.
OBJECTS OF THE INVENTION This invention has as one of its primary objects the provision of apparatus for insertion of a catheter into a body wall. Another object of this invention is to provide apparatus which permits insertion of a catheter into a body wall without a major surgical operation and under local anesthesia. A related object is to provide for insertion of a catheter at the patients bedside without lengthy preparation by several medical personnel. An additional primary object of this invention is to provide a trocar apparatus for insertion of cuffed peritoneal catheters into a body wall under minor surgical conditions using local anesthesia at the bedside to reduce the morbidity and cost of the emplacement of catheters.
Another object of this invention is to provide an apparatus and method for insertion of a cuffed silastic tube into a body wall for purposes of prolonged intermittent access to a body cavity such as is necessary in peritoneal dialysis. A related object is to provide apparatus and method for insertion of a catheter which reduces the incidence of bleeding and leakage. An additional related object of this invention is to provide apparatus and method for inserting cuffed catheters which positively prevent the cuff from entering the abdominal cavity.
SUMMARY OF THE INVENTION This invention provides a trocar for inserting a catheter through a body wall into a body cavity which trocar may be removed by manipulation of the component parts thereof leaving the catheter installed in the body wall. The trocar is constructed of a substantially cylindrical tip section, a retainer tube into which one end of the cylindrical tip section is inserted and a stylet which can be inserted through the bore of the retainer tube and the bore of the cylindrical tip section. The sharpened end portion of the stylet protrudes out of the cylincrical tip section. The stylet is sized so that it can be replaced by a catheter tube when the trocar is inserted through an incision in a body wall with a portion of the cylindrical tip section protruding into the body cavity defined by the body wall. The cylindrical tip section is divided axially into a pluralityiof segments each of which has a handle attached to it to facilitate individual manipulation of the segment. The segments may be individually manipulated and removed from an incision leaving the catheter emplaced in the incision.
The interior of the preferred embodiment'of this invention has a first bore section extending through a portion of the cylindrical tip and through the length of the retainer tube. A
second bore section having a smaller diameter extends through the remainder of the cylindrical tip section. The first bore section is of an adequate diameter to accommodate the felt cuff of a cuffed peritoneal dialysis catheter tube and the second bore section is of a diameter which will accommodate the catheter tube itself but not the felt cuff.
These and other objects, advantages and attributes of this invention will become more readily apparent from an evaluation of the following description of the preferred embodiments with reference to the attached drawings.
IN THE DRAWINGS FIG. 1 is an exploded top perspective view of the elements of this invention;
FIG. 2 is a top perspective view of the device of this invention assembled without the stylet inserted therein;
FIG. 3 is a longitudinal sectional view of the assembled device with the catheter installed therein shown inserted through an incision in a body cavity wall taken on a plane containing the central axis of the device of this invention.
DESCRIPTION OF THE PREFERRED EMBODIMENT Referring more particularly to the drawings wherein like nu merals indicate like parts, there is seen in FIG. 1 a trocar comprising a bivalve tapered tip made up of two elements numbered 10 and 11. Manipulator handles 12 and 13 are attached to elements 10 and 11 respectively. The forward portion 14 of element 10 and the forward portion 15 of element 11 are tapered to form a sharp annular surface. The rearward portion 16 of element 10 and the rearward portion 17 of element 11 have cylindrical outer surfaces adapted to be inserted within the cylindricalbore of a tubular member 20. When thus inserted into tubular member 20, the interior of elements 10 and 11 form a cylindrical bore 40 of such a diameter as to permit insertion of the tip section 22 of stylet 24. The end of tip section 22 of stylet 24 is sharpened for insertion through an incision in the wall of a body member. The body portion 26 of stylet 24 has an outer diameter that will fit into the interior bore of cylindrical member 20.
The trocar may be assembled as shown in FIG. 2 with the cylindrical portion 16 and 17 of the two elements 10 and 11 inserted into the interior of tubular member 20 to firmly but releasably hold the elements of the trocar together. Stylet 24 is then inserted inside tubular member 20 with the tip section 22 of stylet 24 extending out of the forward portion of elements 10 and 1 1.
In FIG. 3 the trocar is shown assembled and inserted into an incision in a body membrane. The stylet 24 has been removed and replaced by catheter tube 31. The exposed end 32 of catheter tube 31 extends out of the tip of the trocar and into the body cavity shown generally as 33. The small incision necessary to insert the trocar extends through epidermis 34, sub-cutaneous fat 35, the fascia 36, and through the peritoneal membrane 37 into body cavity 33.
The catheter shown in FIG. 3 is of the cuffed peritoneal catheter type which is extensively used in dialysis procedures when partial or complete kidney failure requires the external removal of wastes from a body. The catheter is usually a flexible tubing made of an elastomeric material which has a cuff constructed of dacron felt or similar material. The dacron felt cuff serves to seal the incision and must be positioned near the epidermis in an extra-peritoneal position. The felt must not be permitted to enter the body cavity.
Use of such cuffed peritoneal catheters installed through the use of this invention permits frequent intermittent access to the peritoneal cavity without the severe operation previously required. The catheter may be inserted at the patients bedside by a single doctor with the use of local anesthesia, thus eliminating the greater portion of the morbidity formerly associated with implanting the catheter in a body wall.
When the catheter is installed as shown in FIG. 3, it is inserted as far as it will go into tubular member 20 such that the felt cuff 30 engages the constriction 41 in the bore of elements 10 and 11 which prevents passage of the felt cuff material 30 into the body cavity 33. The trocar may then be dismantled by removing tubular member 20 from its engagement with elements 10 and 11 and manipulating elements 10 and 11 by use of handles 12 and 13 respectively to remove the trocar from the incision leaving only the catheter tube 31 with its attached felt cuff 30 inserted into the incision. The felt cuff 30 substantially eliminates bleeding problems and leakage from the incision, usually without need of further surgical repair techniques.
The catheter tube 31 is securely implanted into the body membrane wall for purposes of irrigation of the interior body cavity, removal of fluids, administration of fluids or drugs or similar operations. One specific use for the device is insertion of the catheter into the abdominal cavity for dialysis procedure in acute and chronic renal failure.
The apparatus taught by this invention may be constructed of any one of a number of structural materials, such as metal, plastics and the like. Metals are frequently preferred because of their desirable strength characteristics and ability to be repeatedly used yet thoroughly sterilized by autoclaving or similar laboratory techniques. A disposable trocar could be constructed ofinjection molded plastic material.
From the foregoing detailed description, it will be evident that there are a number of changes, adaptions, modifications and the like to the present invention which are within the ability of those skilled in the art. The inventor has described his invention by way of specific examples. However, simple modifications to these specific examples will be readily apparent to those skilled in the art and are considered to be within the scope and spirit of this invention.
I claim as my invention:
1. A trocar for insertion of cuffed catheters into a body wall incision comprising:
a tapered tip segmented axially into at least two elements, said tip having a first axial bore therethrough to receive a forward tubular portion of a cufied catheter and a cylindrical rearward portion having a second larger bore axially aligned with the first bore to receive the cuffed portion of said cuffed catheter;
a tubular member adapted to encircle said cylindrical rearward portion of said tapered tip and to releasably hold the elements ofsaid tip in cylindrical relationship; and,
a stylet adapted to slidably engage both bores of said tip, said stylet having a sharpened forward portion extending beyond said tapered tip when said stylet is inserted therein.
2. The apparatus of claim 1 having a manipulator handle extending rearwardly from each of said elements to facilitate removal of said elements.
3. A trocar for insertion of a cuffed catheter tube into a body wall incision comprising:
a hollow, rigid insertion tip, said tip being divided axially into at least two parts and having a first axial bore to receive a forward tubular portion of a cuffed catheter and a cylindrical rearward portion having a second larger bore axially aligned with the first bore to receive the cuff of said cuffed catheter and adapted to prevent passage of said cuff into said first axial bore;
grasping means attached to each ofsaid parts, and;
means to maintain each of said parts in cylindrical relationship, said means permitting separation and removal of said parts.
4. The apparatus of claim 3 having a removable pointed stylet slidably engaging both bores of said tip.