CA1050377A

CA1050377A - Suction tube and retrograde flushing for wounds, body cavities and the like

Info

Publication number: CA1050377A
Application number: CA235,941A
Authority: CA
Inventors: Herbert S. Loseff
Original assignee: Individual
Current assignee: Individual
Priority date: 1975-07-24
Filing date: 1975-09-22
Publication date: 1979-03-13
Also published as: US3993080A

Abstract

ABSTRACT OF THE DISCLOSURE

A drainage tubing for wounds, or body cavities, is described. The tubing is placed and retained in the wound site in an improved manner by means of an inflatable bal-loon positioned in the intact, healthy tissue adjacent the patient's skin, or in the body cavity adjacent a wall there-of. The drainage tubing may also have a second, collapsible bulb portion for aseptic back-flushing of the placement site while the tubing lumen is sealed from the exterior. The specific construction enables a technician to insert the tubing when used in a wound site either from within or with-out the placement site using an awl to penetrate the exter-ior tissue adjacent the site.

Description

~0~0377 BACKGRODND OF T~IE INVENTION

When a patient has a serious, deep wound, or a large abscess, osteomyelitis, or other collections of body fluids such as serum, blood, or pus in the body, drainage catheter 3 tubing (commonly called wound tubing) is commonly used to alleviate the situation. Commonly, the wound tubing is made of flexible plastic such as polyethylene, or inert elasto-mers such as silicone rubber or the like. Typically, the wound tubing is fabricated to have sufficient stiffness so that fluids can be removed through it by suction without collapsing the tubing, for example, by an evacuator such as is shown in U.S. Patent No. 3,115,138.
The wound tubing typically is manufactured with a large number of lateral perforations for communication be-tween the lumen or bore of the tubing and the exterior, the perforations being located in a central portion of the tub-ing, and the ends of the tubing bei.ng free of lateral per-forations.
For e~placement in the wound site, a pointed steel awl is connected to one end of the wound tubing, to pass the tubing through healthy, intact tissue adjacent the wound in such a manner that at least one end of the wound '! tubing is positioned exterior of the patient, while the-perforated portion lies at the wound site. Following this, excess portions of the wound tubing, and the awl, are re-moved by severing the tubing, and the wound site is sutured.
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3~7 Various significant problems exist in the prior art wound tubing. First, the restless patient can accidentally, or otherwise, pull on the wound tubing and cause it to withdraw outwardly along its path through the healthy tissue. This can happen when the patient is asleep, or irrational patients and children may intentionally try to withdraw the wound tubing.

Once the wound tubing has been partially or completely withdrawn, those portions of the tubing which have been exposed to the exterior will become contaminated with bacteria, and thus should not be simply reinserted into the patient again, even if this were possible. Accordingly, a wound tubing may have to be reinserted by connecting fresh sterile wound tubing to an awl, and once again punching it through the healthy tissue into the wound site. Also, the stitche,s holding the wound closed may well have to be re-opened in order to withdraw the awl and to re-position the wound tubing.

Furthermore, at the skin exit hole or holes of the wound tubing, there is a pronounced tendency for blood, lymph, or irrigation solution to leak outwardly, which is clearly undesirable. Also, there is the still more undesirable possibility of the migration of bacterial contamination inwardly toward the wound site along the wound ` ~ 10S~37~ _4 ~

tubing, and the consequen-t danyer of infection.
Also, the perforations and the bore or lumen of the wound tubing at the wound site frequently become ~lu~
with debris. To avoid changing of the wound tubing, there is frequently attempted a back flushing procedure, in which sterile flushing solution, such as normal saline, is passed through the wound tubing to flush the solution into the wound site. This disperses and breaks up the debris which blocks flow in the wound tubing. This techniqu~ has its consequent dangers of introducing bacterial contamination from the exterior into the wound site. The problems pres-ent with wound tubing will be recognized by one skilled as being present in tubing lodged in any body cavity, such as in the abdomen, chest, head, neck, or limbs.
In accordance with this invention, the above disad-vantages are eliminated or greatly reduced in effect by the improved drainage tubing of thls invention and its method of use, and an additional advantage is supplied by provid-ing a construction that more conveniently permits insertion of the wound tubing either from within the wound or cavity site or from without the site as is best for the patient.

SUMM~RY OF THE INVENTION .

The invention in one of its broader aspects comprehends a device for treatment of a wound, body cavity, and the like which device includes a tubular member having a central lumen and ports in the wall along a portion thereof, an elastomeric retention balloon carried by the tubular member and spaced along the tubular member from the portion, and tubular means extending from the retention balloon for inflation thereto. A
squeeze bulb is provided for connection to the end of the tubular member and is further spaced in the same direction along the tubular member from the portion thereof than the retention balloon. Means are provided for selectively ~ . ., . ~
c ~0~037~
attaching an awl to either end of the tubular member whereby the tubular member may be drawn into an operative position with respect to a wound in either direction through adjacent tissue.
Preferably, a Eill tube of elastomeric material is provided for the retention balloon along it a length of the tubular member and is normally sealed along its length, but may be pierced by a hypodermic needle or the like to permit pumping in a sufficient amount of air to inflate the retention balloon, after which withdrawal of the needle permits the fine hole left thereby to be sealed by the elastomeric character of the material of the fill tube. The balloon is positioned to be inflatable under sound tissue, such as under the skin of a patient, while the drainage ports lie in the wound or cavity site.
Another aspect of the invention is the provision of an enlarged lumen, either attachable to or as an integral por-tion on the tubular drainage member, for use as a collapsi-ble squeeze bulb and storage portion, for retention of flusll-ing solution in the tubular member outside of the body when the drainage device is positioned in a patient with the drain-age ports located in the wound or body cavity site. With this arrangement, the lumen or bore of the tubular member can be sealed from the exterior by appropriate clamp means after filling with flushing solution, and the enlarged lumen por-tion of the tubular member can be squeezed and manipulated for aseptic back flushing of the drainage device, while the tubular member is sealed against possible ';

~5~377 bacterial contamination Erom the outside. Accordingly, the wound site can be bathed or back-flushed with any de-sired solution in a manner which reduces the risk of con-taminating the wound site. In the preferred form of this invention the fill tube extends from the retention balloon and terminates adjacent to but short of the enlarged lumen, whether the enlarged lumen is integral with or attachable to the tubular drainage member.
Another preferred feature of this invention is that the drainage ports are of smaller aperture size than the diameter of the central lumen of the tubular drainage mem-ber. As a result of this, the drainage ports serve to screen out tissue particles, small blood clots, and the like, preventing t~em from entering the central lumen and causing obstruction within the tubular drainage member.
It is generally desirable for the tubular drainage member and balloon member of the device of this invention to be made of silicone rubber, since such material is high~

ly non-adherent to clots and debris, and is thus easily flushed. Also, very little tissue reaction occurs in tis-sue which is in prolonged contact with silicone rubber.
Accordingly, the pàtient may experience considerahly in-creased comfort when a silicone rubber drainage device is used in accordance with this invention.
If desired, organic plastic or rubber drainage de-- vices made in accordance with this invention can be fab-ricated with a coating of room temperature vulcani~ing silicone rubber or the like for essentially equivalent effect.

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~)S0377 Other hydrophobic, flexible thermoplastic materials, such as polyethylene, can also be used with advantage to fabricate the devices of tl~is invention. Other corres- -ponding medical grade materials such as latex rubber and polyvinylchloride plastisol can also be used.
The drainage device of this invention is used to provide the drainage to a wound site or the like in a patient by inserting the tubular drainage member into the wound site in such a position that the lateral drainage ports are in flow communication with the wound site. Also, the tubular member is passed through healthy, intact tis-sue adjacent the wound site so that one end of the tubular member is exposed t'o and communicates with the exterior of the patient, and in such manner that the balloon reten-tion member is positioned within the healthy, intact tissue adjacent the skin. Generally, either of the above steps may be performed first with equivalent effect.
~fter the tubular drainage member has been properly emplaced, the balloon member is inflated, to firmly retain the drainage member in the wound site, so that it is less likely to be accidentally or otherwise removed from proper emplacement by pulling on an exposed portion of the tubul-ar member. Likewise, the pressurized balloon member pro-vides an improved seal at and just below the skin level, which greatly reduces or eliminates bleeding and fluid leakage from the skin hole through which the tubular mem-ber passes. The balloon inflation also reduces the possi-bility that bacterial contamination can enter the skin hole to cause infection.

~37~

Other advantages of this invention will be readily apparent from the specific embodiments of this invention des-cribed below.
In the drawings:
Figure 1 is an illustrative view, with some portions broken away, showing use of one form of drainage device or wound tubing, and illustrating the emplacement of the wound tubing by drawing it into the wound from without the wound;
Figure 2 is a fragmentary view showing another form of device wherein the wound tubing may be emplaced by being drawn into position from within the wound, after which an enlarged lumen may be connected thereto to serve the same function as the enlarged lumen shown'in Figure 1.
~eferring to the drawings, Figure 1 shows a drainage member or wound' tubing 10 which comprises a tubular member 11 of flexible, plastic tubing such as silicone rubber, poly-' ethylene, or medical grade polyvinyl chloride plastisol, which is typically about two or three feet in length. The tubing has a lumen or bore 12 which may be about 1/8 inch in dia-meter or other diameters as required. The tubing has a lead in end 18 and the other end is at 20.
A first, intermediate por-tion 16 of tubing 11 defines a plurality of lateral drainage ports in the wall of tubing 11 for fluid communication between lumen 12 and the exterior of tubular member 11. The portion 16 of the tube is preferably' spaced from the end 18 thereof, by a convenient length of say at least 3 inches, and preferably about 6 to 8 inches of port-free tubing for purposes which will become apparent below.
A retention balloon 22 is positioned at one side of the ;
drainage ports defined in first portion 16 of tubular member 11. Balloon 22 is generally positioned so that it can .

~05~)37~

be inflatable under the skin of a patient when th'e drainage ports lie in a wound site. Balloon 22 may be fabricated in a conventional manner by appropriately glueing or otherwise sealing an elastomeric sleeve at regions 24 and 25 to the tub-ing 11. The balloon 22 has an elongated extension portion 26 sealed along its length to the exterior wall of tube 11 and defining either within itself or with the exterior of tube 11 a second tubular fill passageway or lumen 27 for balloon 22.
The balloon 22 may be inflated by passing saline solution, air, or the like through the fill passageway, or tube, 27 which is carried along a portion of the length of tubing 11. Fill tube 27 is of relatively small dimension and does not appreciably enlarge the total diameter of the combined t~be 11 and fill tube 27. The distal end 28 of extension portion 26 is sealed to tube 11, but is, pierceable, as is well known in the art, by a hypodermic needle 30 or the like for purposes of pump-ing through tube 27 air or liquid for purposes of inflating balloon 22. Balloon 22 is preferably made of an elastomer such as silicone rubber, or alternatively, natural latex.' A distal portion of tubing 11 beyond the distal end 28 of fill tube 27 and spaced therefrom forms an enlarged lumen portion 32, which may be used as a collapsible squeeze bulb, as well as a storage portion for retention of a flushing sol- ' ution (such as physiological saline, containing an antibiotia) in a position outside of the body when the wound tubing is positioned in a patient. The end portion 20 of tubing 11 may be sealed by a conventional screw clamp 34, or the like that slips over the end 20,`so that the entire lumen 12 of'the wound tubing may be filled with 1ushing solution, including en-larged lumen portion 32, and then the clamp 34 may be closed to seal the lumen from communication with the exterior.

~05C~37~
Figure 1 shows one technique for emplacement of the wound tubing of this invention in a wound. It should be noted that, for purposes of this invention, the term i'wound"
is also intended to include other areas of use of the de-vice of this invention as mentioned above, such as body cav-ities, abscesses, and other sites for accumulations of body fluid.
As shown in Figure 1, a conventional awl 36 having a threaded connector member 38, o~ appropriate size, is threaded into end 18 o the wound tubing. The wound tubing can then be emplaced in an open wound 40 on the body portion 42 of a pa tient. The surgeon penetrates the skin, or tissue, at a point 44 spaced rom wound 40, to pass the awl through intact, healthy tissue, manipulating the awl so that it enters the wound site at a point 46. Tubing 11 can then be drawn through the punctured path 48 through the intact, healthy tissue un-til the portion 16 of the tubing defining the drainage ports 17 lies in the wound site and balloon member 22 has entered skin opening 44. Some surgeons may prefer to allow a portion of balloon member 22 to remain outside of skin openiny 44.
Also, for best sealing, it is generally preferable for bal-loon member 22 to reside in essential contact with skin open-ing 44 and not to be significantly spaced therefrom.
Following this, section 16 of the tubing is positioned as desired by the surgeon in the wound 40, and tubing 11 is severed at a location indicated generally at 49, in accordance with the discretion of the surgeon, so that the awl 36 and usually most of the port-free end portion 18 of the tubing can be removed. Accordingly, first tubing portion 16 is positioned, without the need to handle or touch it, since manipulations of the tubing for mounting and using the awl 36 can be confined to imperforate end 18 of the tubing. Accordingly, section 16 1~51[~37~
of tubing ll can more likely remain in asceptic condition.
The wound 40 may then be sutured, with drainage port-defining portion 16 of tubing ll remaining positioned within the wound site.
At the discretion of the surgeon, when he believes the wound tubing to be satisfactorily positioned, balloon 22 can be inflated, typically by pumping in through fill tube 27 physiological saline solution, gas or air by means of a hypo-dermic needle 28 to which may be connected a conventional syringe or pump, to inflate balloon 22 to the degree desired, to provide firm anchoring of wound tubing ll coupled with seal-ing of puncture site 44 in the skin.
Enlarged lumen portion 32 can be collapsed, generally by hand, to force flushing solution through drainage ports 17, as well as the severed end of tubing 11 within wound site 40, to flush the wo,und tubing in an aseptic manner as desired by the physician.
If the wound site is not open to the exterior, then the surgeon must use the awl to define another exit path through intact tissue in order to ~osition the wound tubing properly.
In this event, both ends of the wound tubing protrude from the patient, and can be used for drainage and flushing, but the retention and sealing of one end is still provided by balloon 22. For such special use, a second balloon could be provided for sealing and retaining the second end of the wound tubing.
Optionally, clamp 34 can be opened to replace the flush-ing solution, or ~o subject the wound site with an alternat-ing suction-irrigation treatment with an-tibiotics and other medicinals, for bathing the wound continuously with therapeutic ~11- .

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~50377 agents.
Figure 2 shows an alternative embodiment of the wound tubing of this invention, which comprises a similar tubular drainage member lla which defines a plurality of drainage -ports 17a defined through a first portion 16a o~ the tubular member which is spaced from the ends thereof in a manner sim-ilar to the embodiment of Figure 1. A similar balloon sleeve 22a is also provided, with an inflation or fill tube ~7a. In this form the elongated wall portion 26a that seals to the outer wall of tube member lla to define fill tube 27a is shown separate from but sealed to balloon 22a and providing a pierce-able end wall 28a. It is contemplated that adjacent tubes 27a and lla having a common wall therebetween might be formed by an extrusion and then sealed where desirable to provide a confined fill tube that communicates only with balloon 22.
S The material of the wall of tubular fill means 27a is collap-sible under lateral pressure, and the cross-section of fill means 27a is small relative to the cross-section of tubular member lla.
It will be noted that, in this embodiment, a tubular portion 50, which is separate from tubing lla is provided.
Tubular portion 50 has an enlarged collapsible lumen portion 52, and a connector means 54 for connection in aseptic, leak-proof manner with an end 19 of tubing lla when desired. The~
collapsible lumen 52 has a nipple end 20a that may slidably receive thereonto a clamp 34a. Connector 54 may be a hollow tubular member with threads on the outside, proportioned to screw into the lumen of tube lla for connection therewith.
Connector 54 may also be a simple nipple or luer for liquid tight fit into the lumen or bore of tubing lla.
An advantage of the embodiment of Figure 2 is that it may be either emplaced in a wound 40 in the manner described above with respect to Figure 1, or may be emplaced in the wound in reverse manner. An awl may be emplaced in the bore of the opposite end 19 of tube lla, when compared with the emplacement of the awl as shown in Figure 2, so that the awl may enter the intact, healthy tissue at point 46 and pass through the tissue until it exits at point 44, should the surgeon find it desirable to do so. The relatively small cross-sectional size of the additional fill tube 26a - 27a compared to the cross-section of the tubular member lla, and its collapsible nature readily permits such an operation. Tubing lla can then be positioned in a manner comparable to that shown in ~igure 1 and the awl may be removed. Then, tubular portion 50 may, if desired, be aseptically connected to end 19, and the wound tubing arrangement used in the manner previously describad. The ends of tubular member lla extending beyond the tubular fill means and the perforate first portion 16a permit selective connection to one or the other, as desired, without contaminating the drainage ports or damaging the tubular inflating means.

If desired, tubing 11 or lla may be connected at its respective end 20 or 20a to a parenteral solution container which is hung above the arrangement, to provide a supply of pressurized flushing solution as desired. Clamp 34, 34a can be used to control the access of such solution to the tubing 11, lla.

When it is determined that the wound tubing should be removed, balloon 2~2, 22a may be deflated through withdrawal of the inflating gas or fluid by use of a hypodermic or merely by rupturing fill tube 27, 27a. Tubing 11, lla can then simply be withdrawn through skin hole 44 without opening of the stitches of wound 40.

1~5(~377 While in the preferred use of the invention, the bal-loon 22 is positioned to be inElatable in the patient's flesh under the skin, if the doctor feels that it is desirable or advisable, the balloon may also be located anywhere along the length of the puncture path 48 made by the awl, or even within the wound itself, and be inflated therein.
It is contemplated that two (or more) of the drainage devices of this invention may be simultaneously emplaced in a wo~nd site. Accordingly, one of the drainage devices may be used as a flushing fluid inlet, while the other drainage device serves as an outlet for the fluid and other drainage.
Also, while the drainage portions 16 and 16a of the tube have been disclosed as perforate, it will be understood that other drainage terminal constructions could be used and attached to a perforate or imperforate drainage tube after emplacement, s,lch as by use of Y or T connections between other drain tube sections and the main drainage tube.

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Claims

The embodiments of the invention in which an exclusive property or privilege is claimed are defined as follows:

1. A device for treatment of a wound, body cavity, and the like comprising a tubular member having a central lumen and ports in the wall along a portion thereof; an elastomeric retention balloon carried by the tubular member and spaced along the tubular member from said portion, and tubular means extending from the retention balloon for inflation thereof; a squeeze bulb for connection to the end of the tubular member further spaced in the same direction along the tubular member from said portion thereof than the retention balloon; and means for selectively attaching an awl to either end of the tubular member whereby the tubular member may be drawn into an operative position with respect to a wound in either direc-tion through adjacent tissue.

2. A device according to Claim 1 wherein the retention balloon is located on the tubular member spaced from said portion with ports therein such that the retention member may be inflated under the skin when said portion with ports is located in the wound or body cavity.

3. A device according to Claim 1 or Claim 2 wherein the ports are smaller in size than the cross-section of the central lumen of the tubular member.

4. A device according to Claim 1 or Claim 2 wherein the tubular member and retention balloon are each made of silicone rubber.

5. A device according to Claim 1 wherein the tubular means extends adjacent the tubular member.

6. A device according to Claim 5 wherein the tubular means comprises a sealed passageway, the wall of which is integral with that of the tubular member.

7. A device according to Claim 1 wherein the tubular means is of pierceable but self-sealing material capable of maintaining fluid pressure in the retention balloon.

8. A device according to Claim 1 wherein said portion of the tubular member is located between the retention balloon and an imperforate end length of the tubular member.

9. A device according to Claim 8 wherein the length of said end length is at least three inches.

10. A device according to Claim 1, 5, or 7 wherein the squeeze bulb is formed with a passageway extending therefrom, the device including means for selectively closing said passage-way.

11. A modification of a device according to Claim 1, 5 or 7 wherein the squeeze bulb is permanently connected to said end of the tubular member, said selectively attaching means being provided only for attaching a said awl to the other end thereof.