Note : Les descriptions sont présentées dans la langue officielle dans laquelle elles ont été soumises.
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BACKGROUND OF THE INVENTION
This invention relates to a method and apparatus for placement of
a suprapubic catheter, and more particularly to a method for suprapubic
cystotomy wherein the catheter initially pierces the bladder wall from
within and is drawn outwardly therefrom for final placement.
Suprapubic catheterization is the insertion into the urinary
bladder of a drainage tube through the skin in the lower abdomen above the
pubic bone, i.e., the suprapubic area. The procedure is normally carried
out by placing a regular transurethral catheter into the bladder and
instilling sterile liquid therein until the bladder is sufficiently full
that it can be palpated through the skin. This catheter is then removed and
the suprapubic catheter is placed into the bladder by one of two means - the
trocar method or the needle method.
These methods of insertion can be potentially dangerous unless
great care is taken during insertion. Complications often arise due to
over-penetration of the "cutting point" into the surrounding bowel or bladder
area, since these insertions are made blindly.
Another technique of inserting suprapubic catheters involves
inserting a rigid instrument having a curved distal portion that has a
clamp thereon into the bladder and depressing the handle of the instrument
so as to cause a protrusion on the suprapubic area. An incision is made
from without at this point down to the tip of the distal portion of the
rigid instrument, which is then brought through the incision. The clamp on
the distal end thereof is opened to accept and grasp a catheter, which is
then withdrawn backwardly into the bladder. The clamp is released and the
catheter is retained within the bladder while the rigid instrument is with-
drawn through the urethra. This method of insertion also can produce
dangerous complications. For example, whenever a separate incision must be
made there is always the attendant possibility of infection. This - -
possibility is further increased in that the distal portion of the rigid
instrument is first pushed out into the local environment and exposed to
possible contamination and is then drawn back into the bladder and out
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through the urethra.
Still another prior art suprapubic insertion technique is
described in U.S. Letters Patent 3,640,281 to Robertson. This technique can
be described as including the steps of: inserting a curved distal portion of
a rigid instrument into the bladder through the urethra, the curved distal
portion having a closure thereon; inflating the bladder with a fluid through
the instrument; engaging the distal end of the instrument with the anterior
wall of the bladder with sufficient force to provide a visible protrusion of
the suprapubic region of the abdominal wall; making an incision through the
abdominal wall and the anterior wall of the bladder in register with the
distal end of the instrument; displacing same outwardly through the incision
and removing the closure from the distal end of the instrument; inserting a
portion of a catheter into the distal end of the instrument; withdrawing
the instrument through the incision from the bladder and the urethra, leaving
a portion of the catheter within the bladder; and inflating the inflatable
portion of the catheter within the bladder to insure retention. This
technique, while it appears to be more satisfactory than the others
mentioned herein, still has an increased possibility of contamination and
infection since the distal portion of the instrument comes up through the
bladder and through the externally made incision, is handled at that position
from without, and is then withdrawn backwardly through the incision, bladder
and urethra.
Accordingly, it is an object of this invention to provide a means
of inserting suprapubic catheters that minimizes infection, or the
possibility thereof by employing a unidirectional movement of a catheter
through the bladder and through the abdomen from within to the external
environs.
Another object of this invention is to provide a means of making
an incision in the anterior wall of the bladder and the abdominal wall from
within the bladder, so as to reduce the possibility of contamination from -
without.
A further object of the present invention is to provide a method
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of inserting a suprapubic catheter into the bladder that insures that no
portion of the catheter or insarting apparatus must pass from the bladder
to ~he outside and back to the bladder.
- SUMMARY OF THE INVENTION
Apparatus for, and a method of, inserting a suprapubic catheter
into the bladder is provided in a safe, efficient and simple manner compris-
ing a hollow, curved and rigid tubing member having a shielded catheter
therewithin onto which a cutting point is attached. The tubing member is
inserted transurethrally into a bladder in such a manner as to permit the
cutting point to, when pushed through the distal end thereof, pierce the
wall of the bladder from within after the bladder has been externally
palpated. The cutting point, then emerging from the abdomen, is grasped
externally and the catheter is pulled through the bladder and abdominal wall,
via the tubing member, to a predetermined and premarked point thereon. The
curved tubing member can then be easily withdrawn therefrom, leaving the
catheter tube safely within the bladder in the proper position. This
technique provides a novel and efficient means for inserting suprapubic
catheters transurethrally while minimizing the possibility of infection.
In accordance with this invention there is provided a method of
placement for a suprapubic catheter comprising: inserting the distal end
of a rigid, hollow tubing member having an opening at both ends thereof
through the urethra and into the bladder, said distal end being curved; ~ -
locating the opening on said distal end against the anterior wall of the ~-~
bladder in the suprapubic region thereof; pushing a cutting point through
said tubing member and through said opening on said distal end so as to
pierce the anterior wall of the bladder and abdomen in the suprapubic region
and through the outer surface of the skin, said cutting point having a
catheter attached thereto; pulling said cutting point outwardly away from
said tubing member leaving a portion of said catheter within the bladder;
and withdrawing said tubing member backwardly from said bladder leaving said
catheter at the desired position within said bladder.
In accordance with another aspect of this invention there is pro-
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vided a device for inserting a suprapubic catheter comprising: a rigid,
hollow, tubing member having a curved distal end portion thereon, said
tubing member having an opening at both ends thereof; and, a rigid plunging
means disposed telescopically within said tubing member for pushing a cutting
point disposed within said tubing member outwardly through said distal end
portion, said cutting point having a catheter tube attached thereto.
BRIEP DESCRIPTION OF THE DRAWINGS
Figure 1 is a perspective view of the insertion device of this
invention;
Figure 2 is a partial sectional view of the device of this
invention being inserted into a patient's bladder transurethrally;
Figure 3 is a partial sectional view of the cutting point within
the device making a puncture from within the bladder;
Figure 4 is a partial sectional view of a suprapubic catheter in
place within the bladder, and the insertion device being withdrawn there-
from; and,
Figure 5 is a sectional view of the catheter assembly of this
invention.
DESCRIPTION OF THE PREFERRED EMBODIMENTS
Referring to the drawings, Figure 1 shows the device 10 used in
this invention to insert a suprapubic catheter into a patoeent's bladder
transurethrally. The device 10 includes a rigid, curved, hollow, tubing
member, being curved in such a manner as to permit the member to easily be
inserted transurethrally into a patient's bladder. The member is open at
both ends, the distal end 11 being the curved portion and having an opening
12 thereon, while the proximal end 13 has an opening 15 thereon and can have
a pair of flanging rings 14 or the like attached thereto for holding and
guiding the member into the bladder. It should be noted that the rings 14
are added for convenience, and are not necessary parts in this invention.
A catheter 16, such as a spring catheter, having a cutting point
17 thereon, is preloaded in a rigid, hollow plunger 18 having an opening on
at least the proximal end thereof. The plunger 18 can advantageously have a
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ringed configuration, such as shown by 19, situated at the proximal end
thereof. The ringed configuration 19 provides a convenient means for
handling the plunger 18 and for convolutely storing the catheter 16 there-
within. Such a ringed arrangement is, of course, preferred but is not
necessary. The distal end of the plunger 18 is telescopically placed within
the curved member so that when the plunger 18 is pushed all the way into
the member the cutting point 17 is capable of extending out through the
opening 12 of the curved member.
Referring now to Figures 2, 3 and 4, a suprapubic catheter can
easily and efficiently be inserted into a patient's bladder 30, by externally
palpating the bladder and inserting the device 20, by urethral entry, into
the bladder so that the curved distal portion 21 points toward the abdomen
and until resistance of the anterior wall of the bladder is felt against
the catheter tip 22 having the opening thereon. At this point, an interal
to external puncture can be made in the suprapubic region by pushing the
plunger 28 inwardly, thereby forcing the cutting point 27 to pierce through
the bladder wall 31 and abdominal wall 32 and exiting through the outer
surface of the skin. As can be seen from the drawings, the curved distal
portion of the insertion device 20 is shaped so that it can easily be
inserted through the urethra, and so that the plunger 18 can be handled and
operated from a convenient position. The emerging cutting point 27 can then
be grasped externally and the catheter 26 can be pulled therethrough to a
predetermined and premarked point 41 thereon. The device 20 can then be
withdrawn backwardly, as shown in Figure 4, leaving the suprapubic retention
catheter 26 safely within the patient's bladder 30 at the proper level. A
stylet can then be employed to remove the catheter when drainage is to be
terminated.
The catheter tube can advantageously have a coiled configuration
34 on the end thereof for assisting in the retention of the catheter
intracystically. This coiled portion may advantageously have a plurality of
openings 35 thereon for facilitating drainage.
Turning finally to Figure 5, a sectional view of the catheter
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assembly 10 shows the catheter 16 having a predetermined mark or shoulder
41 which serves a two-fold purpose. The shoulder 41 serves firstly as a
means of enabling the plunger 18 to push the catheter 16 out through the
opening 12 of the device 10, and secondly, as a marker to show how far the
catheter 16 should be pulled out of the patient's bladder. As shown in
Figure 4, the catheter is properly placed when the shoulder 33 becomes
visible externally The catheter assembly should have sufficient compressive
strength so that an axial force applied to it from plunger 18 by means of the
shoulder portion 41 will be transmitted axially to the cutting point 17
sufficiently to drive the point 17 through an abdominal wall. The catheter
16 is shown here as a semi-rigid vinyl tubing of a relatively heavy wall,
but it can be of a variety of materials, such as a more flexible tubing con-
taining a reinforcement such as a bead chain or tightly wound spring running
from the shoulder 41 to the cutting point 17.
The cutting point 17 is advantageously a beveled, three sided,
electropolished metal point. Other configurations of cutting points should
work as well, and excessive cutting action should be avoided which could
cause hematuria and clogging of the catheter.
This method of insertion makes a small, clean, pin-point incision
from within the bladder, and does not allow any ppssible sources of
contamination to come into contact with the incision. An obvious advantage
of this invention is, of course, that complications that often arise due to
over-penetration of the trocar or cutting point into the surrounding bowel
area or the like, are completely eliminated, since the cutting point does
not come into contact with any body parts until its exact location is
precisely known.
While it is preferred that the curved, hollow tubing member and
the hollow plunger are of a sturdy metallic material, any rigid, durable
material such as an impregnated or reinforced plastic, or the like would work
with similar results. The length and diameter of the device should be such
that it can be suitably used for human beings, and will vary according to
whether it is to be used for male or female patients. The drawings here, of
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courseJ show the device being used on fema]e patients.
Since it is obvious that many changes and modifications can be
made in the above-described details without departing from the nature and
spirit of the invention, it is to be understood that the invention is not
limited to said details except as set forth in the appended claims.
It should be apparent to those skilled in the art that many
modifications and changes can be made herein without departing from the
spirit or scope of the present invention. It is therefore intended that
this invention be limited only by the following claims.
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