WO2002091929A1

WO2002091929A1 - Tourniquet

Info

Publication number: WO2002091929A1
Application number: PCT/GB2002/002204
Authority: WO
Inventors: John Watts; Kevin Bartlett; Stephen James Williams
Original assignee: Bibby Sterilin Limited
Priority date: 2001-05-12
Filing date: 2002-05-13
Publication date: 2002-11-21
Also published as: GB2377892A; GB2377892B; GB0111806D0; GB0210871D0; EP1392183A1

Abstract

A tourniquet for a distal end (8) of a body extremity comprising an inflatable cuff (10) to fit around said distal end and means (12) for inflating the cuff with fluid, wherein the cuff is made from a tube having an open end for inflation and a closed end, the two ends being arranged to form a ring, and a slide (24) on the ring for adjusting the size of the ring to suit the distal end of the body extremity.

Description

TITLE: TOURNIQUET

DESCRIPTION

This invention concerns a tourniquet and, in particular, concerns a digit tourniquet for use in surgery to fingers.

The provision of a convenient and high quality tourniquet for use in finger and other types of surgery has long presented difficulties.

Ideally, surgery to a digit should be carried out in a clear bloodless region with little or no ischaemia being caused at that region or in surrounding tissue.

The lack of a versatile and high quality digit tourniquet, which is easy to use, has long presented surgeons in orthopaedics and accident and emergency plastic surgery with a considerable problem, when dealing with finger surgery. As a result, it has become common practice to stop blood flow further up a patient's arm, by the use of, for example, a pneumatic tourniquet of the type commonly used to take a patient's blood pressure. However, this has its drawbacks in that it may cause ischaemia to tissues over a wider area, remote from the field of surgery, and also parasthaesia or paralysis. Moreover, accurate control of blood flow in a patient's finger is difficult to achieve in this way.

Techniques adapted specifically for use with a finger include the application of drain tubes, such as catheters, or pearl rose drains clipped around the fingers by the use of forceps. However, these exert an uneven, and relatively high pressure (600mmlHg - 800mmHg) around the finger and have resulted in neurovascular damage and tissue necrosis.

A further alternative has been the use of a finger glove tourniquet fashioned from cut rubber gloves but these also have the disadvantage of exerting great pressure to the digit (150mmHg - 500mmHg) and increase the risk of necrosis to the surrounding tissue. Worse still, such finger glove tourniquets have been known to result in the loss of a digit as a result of severe ischaemia, when a tourniquet has been forgotten about, and left on the digit concerned.

The similar colours of the glove and an exsanguinated finger exacerbate this problem.

US Patent No.4773419 disclose a pneumatic tourniquet for limiting blood flow to a distal portion of an extremity comprising a cuff for encircling the extremity and a syringe for introducing fluid into the cuff to expand it in order to constrict the extremity. The syringe has spring means associated with it for maintaining pressure on the fluid. The cuff is formed by a rubber tube that is wrapped around the extremity and secured with Velcro. This apparatus is difficult to apply initially, especially in a situation requiring rapid action to stop blood flow, and may be difficult to remove quickly again in an emergency situation because of the need to disengage the spring means.

An object of the present invention is to provide an improved tourniquet, which at least reduces some of the problems outlined above. According to this invention there is provided a tourniquet for a distal end of a body extremity comprising an inflatable cuff to fit around said distal end and means for inflating the cuff with fluid, wherein the cuff is made from a tube having an open end for inflation and a closed end, the two ends being arranged to form a ring, and a slide on the ring for adjusting the size of the ring to suit the distal end of the body extremity.

The cuff is preferably made of flexible, relatively non-elastic tube. The tube is preferably flat tube and is preferably reinforced at least on its intended outer side, such as with a strip of plastics material adhered or otherwise bonded thereto.

In a first preferred embodiment of the invention, the two ends of the tube are attached to each other to form a ring and the ring passes through a slide for adjusting the size of the ring. The tube will be inflated either side of the slide, which will help to keep the slide in position.

In another preferred embodiment of the invention at one end of the tube is a collar through which the other end of the tube can be passed to form a ring. The size of the ring can be adjusted by feeding more or less of the other end of the tube through the collar. Preferably the collar is at the closed end of the tube. Because the tube passes through the collar, there will be inflated tube on both sides of the collar, which can help to prevent the tube slipping through the collar.-

The means for inflating the cuff preferably comprises a syringe and the inflating fluid is preferably air. Between the inflating means and the cuff there is preferably provided a one-way valve for maintaining the cuff inflated. Deflation of the cuff can be by reverse operation of the inflating means, opening of the oneway valve or even by rupturing a connection between the cuff and the inflating means in some way. For example, a surgical knife could be used to cut through plastics tubing connecting the inflating means to the cuff.

The tourniquet of the invention may further include a fluid pressure monitoring device, to enable a user to ensure that unduly high pressure is not applied to the distal part of the body extremity.

This invention will now be further described, by way of example only, with reference to the accompanying drawings, in which:

Figure 1 shows apparatus according to the invention for limiting blood flow to a digit; and

Figures 2 and 3 show stages in the use of the apparatus of Figure 1. Figure 4 shows an alternative form of apparatus according to the invention; and

Figures 5 and 6 show stages in the use of the apparatus of Figure 4. Referring to Figures 1 , 2 and 3 of the accompanying drawings, apparatus for limiting blood flow to a digit 8, such as for use in carrying out surgery on the digit comprises an inflatable cuff 10 connected to a syringe 12 for inflating the cuff. It is to be understood that the term digit includes not only fingers and toes but other body parts for which limiting of blood flow therethrough is required, for example for the carrying out of surgery thereon. Such other body parts include the penis. The cuff 10 is made from relatively non-elastic, flexible, flat plastics tube, which may be reinforced on one or both sides, such as by means of plastics strips adhered to one or both sides of the flat tube, to prevent the tube stretching outwards during inflation. The term non-elastic is intended to include materials that when inflated will not stretch to any appreciable extent, whereby the cuff can maintain pressure on the digit around which it has been placed. The cuff tube is closed at one end and its two ends joined together to form a ring. The open end of the cuff tube is connected by tube 14 to a T-piece 16, which is in turn connected to the syringe 12. Also connected to the T-piece 16 is a pressure gauge 18 or a pressure relief valve.

Between the tube 14 and the T-piece 16 is a non-return valve 20 and between the T-piece and the syringe 12 is a second non-return valve 22.

On the cuff is a slide 24 that can be used to adjust the size of the cuff ring to suit the particular body part. The slide has a slot through which the cuff fits that is sufficiently wide to allow inflation of the cuff beyond the slide.

In use, the cuff 10 is fitted over the body part to be treated and the slide moved to reduce the size of the cuff to suit the body part (see Figure 2). Then the syringe is used to inflate the cuff 10 by forcing air into it (see Figure 3). The inflated cuff exerts pressure on the body part to reduce blood flow therethrough allowing surgery to be carried out on the body part with reduced interference from blood flow. Because the line from the syringe to the cuff includes one-way valves, the cuff remains inflated until the syringe plunger is withdrawn to draw the air from the inflated cuff. Alternatively, as an emergency measure, the tube 14 can simply be cut with a surgical knife or blade to release the cuff pressure immediately. Furthermore, because the slide effectively separates the cuff into two parts that are both inflated either side of the slide, the slide maintains its position on the cuff and hence the pressure on the body part is maintained.

The pressure gauge 18, which is for practical purposes optional, may be used to monitor the pressure applied to the body part or to ensure that a desired pressure is applied for a particular purpose.

Turning to Figures 4, 5 and 6 of the accompanying drawings, apparatus for limiting blood flow to a digit 30, such as for use in carrying out surgery on the digit comprises an inflatable cuff 32 connected to a syringe 34 for inflating the cuff.

The cuff 32 is made from relatively non-elastic, flexible, flat plastics tube, which is reinforced on one side, such as by means of plastics strips adhered to the intended outer side of the flat tube, to prevent the tube stretching outwards during inflation. The cuff tube is closed at one end and has a collar 36 at that end. The open end of the cuff tube has a connecting tube 38 extending therefrom. The cuff is formed into a ring by passing the tube 38 and part of the cuff through the collar 36. The tube 38 is connected to a T-piece 40, which is in turn connected to the syringe 34. Also connected to the T-piece 40 is a pressure gauge 42 or a pressure relief valve.

Between the tube 38 and the T-piece 40 is a non-return valve 44 and between the T-piece and the syringe 34 is a second non-return valve 46. The size of the cuff ring is adjusted by passing more or less of the cuff tube through the collar. The collar is of a strip of plastics material and allows the cuff to inflate on both sides of the collar.

In use, the cuff 32 is fitted over the body part to be treated and the size of the cuff ring adjusted to suit the body part (see Figure 5). Then the syringe is used to inflate the cuff 32 by forcing air into it (see Figure 6). The inflated cuff exerts pressure on the body part to reduce blood flow therethrough allowing surgery to be carried out on the body part with reduced interference from blood flow. Because the line from the syringe to the cuff includes one-way valves, the cuff remains inflated until the syringe plunger is withdrawn to draw the air from the inflated cuff. Alternatively, as an emergency measure, the tube 38 can simply be cut with a surgical knife or blade to release the cuff pressure immediately. Furthermore, because the collar 36 effectively separates the cuff into two parts that are both inflated either side thereof, the cuff tube is less likely to slip through the collar, so that the pressure on the body part is maintained.

The pressure gauge 42, which is for practical purposes optional, may be used to monitor the pressure applied to the body part or to ensure that a desired pressure is applied for a particular purpose.

Apparatus of the invention can be made from relatively inexpensive materials and, hence, can be treated as a disposable item. All of the components apart from possibly the pressure gauge can be made from plastics materials that are readily sterilisable, so that the apparatus can be provided in a sterile pack.

Claims

1. A tourniquet for a distal end of a body extremity comprising an inflatable cuff to fit around said distal end and means for inflating the cuff with fluid, wherein the cuff is made from a tube having an open end for inflation and a closed end, the two ends being arranged to form a ring, and a slide on the ring for adjusting the size of the ring to suit the distal end of the body extremity.

2. A tourniquet as claimed in claim 1 , wherein the cuff is made of flexible, relatively non-elastic tube.

3. A tourniquet as claimed in claim 1 or 2, wherein the tube is flat tube.

4. A tourniquet as claimed in claim 3, wherein the tube is reinforced at least on its intended outer side.

5. A tourniquet as claimed in claim 4, wherein the reinforcement is provided by a strip of plastics material adhered or otherwise bonded to the outer side of the tube.

6. A tourniquet as claimed in any one of claims 1 to 5, wherein the two ends of the tube are attached to each other to form a ring and the ring passes through a slide for adjusting the size of the ring.

7. A tourniquet as claimed in any one of claims 1 to 5, wherein at one end of the tube is a collar through which the other end of the tube can be passed to form a ring.

8. A tourniquet as claimed in claim 7, wherein the collar is at the closed end of the tube.

9. A tourniquet as claimed in any one of claims 1 to 8, wherein the means for inflating the cuff comprises a syringe.

10. A tourniquet as claimed in any one of claims 1 to 9, wherein the inflating fluid is air.

11. A tourniquet as claimed in any one of claims 1 to 10 wherein between the inflating means and the cuff there is provided a one-way valve for maintaining the cuff inflated.

12. A tourniquet as claimed in any one of claims 1 to 11 , further including a fluid pressure monitoring device.

13. A tourniquet substantially as hereinbefore described with reference to and as illustrated in Figures 1 , 2 and 3 or Figures 4, 5 and 6 of the accompanying drawings