Title of Invention

A DEVICE FOR INSERTION OF CHEST TUBE INTO THE CHEST CAVITY.

Abstract

A device for insertion of chest tube into the chest cavity comprising a main shaft having a first end and a second end, said first end having a clamp adapted to hold the proximal end of chest tube/catheter fixed during operation, wherein said second end is provided with a sharp end mounted on a serrated collar and wherein said main shaft is axially connected to a plunger assembly adapted to advance/retreat said sharp end without rotation of said main shaft. The device facilitates easy and fast insertion of chest tube and vitiates the need for any purse - string suture which is very painful to the patient.

Full Text

Field of the Invention The present invention relates to a device for insertion of chest tube in the chest cavity. In particular, the present invention relates to a device for insertion of chest tube, particularly, Malecot Catheter, for draining of air/pus from the chest cavity. Background of the invention In conventional practice as outlined in accompanying Fig. 1, the rubber tube (Malecot Catheter) is clamped between the jaws of the forceps and locked tightly. The other end of the rubber tube is then stretched and wrapped around the forceps. An incision of 3-31/2 cm in length is made on the chest wall. The tip of the forceps holding the flower of the rubber tube is then gently thrust through the incised wound. Once inside the chest/pleural cavity, the forceps is withdrawn holding the tube in position. A purse - string suture is then applied on the chest wall encircling the tube to secure it in position. The other end of the tube is then connected to the drainage bottle to allow the air/ pus to drain out as illustrated in accompanying Fig. 2. Such conventional method of inserting chest tube has several drawbacks. Fixing the tube with the forceps is a cumbersome process. The total circumference of the tip of the forceps with the tip of the tube secured between its (forceps) jaws is about 7 cms. To accommodate this unit easily within the chest wall, the chest wound / incision has to be about 3 - 4 cms. Once the forceps is withdrawn there is considerable play between the chest wall and the tube. To secure the tube in position, a purse - string suture has to be applied on the chest wall encircling the wound which is very painful to the subject. Besides this, since the incision made is large, the amount of blood loss is also considerable. Complications as excessive haemorrhage subcutaneous emphysema, accidental expulsion of the tube and local cellulites are common with the conventional method. Another method of inserting the tube is by disposable units comprising trocar, cannula, introducer and a plastic guard as taught in Croftoin & Donglas Respiratory Diseases; Chapter 30, page 774. This device is also cumbersome as it contains 4 separate units and is rarely used because of its cost and complications. Objects of the invention Therefore the object of the present invention is to provide a device for insertion of chest tube which comprises of a single unit and is therefore less cumbersome. Another object of the present invention is to provide a device for insertion of chest tube whose circumferential dimension with rubber tube loaded is much less compared to conventional devices so that the chest incision/wound required to introduce it into the chest cavity is as small as 1- 1.5 cm only. A further object of the present invention is to provide a device for insertion of chest tube which helps in snugly fitting the chest tube within the chest wound and therefore vitiates the need for any purse - string suture which is very painful to the patient. Yet further object of the present invention is to provide a device which helps in sutureless and less painful way of inserting a chest tube into the chest cavity. Yet another object of the present invention is to provide a device which helps in insertion of chest tube into the chest cavity with minimum chance of infection. Yet further object of the present invention is to provide a device which helps in much rapid insertion of chest tube into the chest cavity because of the absence of any complicated parts and need of suture. Summary of the invention Accordingly, the present invention provides a device for insertion of chest tube into the chest cavity comprising: a main shaft having a first end and a second end, said first end having a clamp adapted to hold the proximal end of chest tube/catheter fixed during operation; wherein said second end is provided with a sharp end mounted on a serrated collar; and wherein said main shaft is axially connected to a plunger assembly adapted to advance/retreat said sharp end without rotation of said main shaft, said plunger assembly comprising: a support means partially accommodating the first end of the shaft, the support means comprising a first support and a second support separated by one or more support bars; wherein said first support has a hole through which the main shaft extends inside the support means; wherein said first end of said main shaft has a cam for supporting a spring between the cam and the said first support; and said second support has a threaded shaft running through the second support and in threaded communication with the support, wherein one end of the threaded shaft remains in contact with said cam so that when the threaded shaft is rotated clockwise, it advances the tip of the said main shaft. Detailed description of the invention The device of the present invention is useful in introducing of a malecot catheter into the chest/pleural cavity comprising of a single unit with a plunger assembly which can be rotated in a clockwise direction resulting in advancement of the tip of the shaft by an equal distance. This results in stretching of the flower of the catheter till it straightens up. When said plunger is rotated, the shaft does not rotate with it preventing the flower of the catheter from tearing off. The whole incision is less than 1-1.5 cms. The average time taken for the whole procedure i.e. from loading the catheter on the device to connecting it with the underwater seal is about 9 minutes which much less than the time required for conventional devices or forceps. Since the incision required is small the mechanism vitiates the need for any purse string suture which is a very painful step. The device is also very economical as compared to portex tube. The details of the invention, its objects and advantages are explained hereunder in greater detail in relation to non-limiting exemplary illustrations of the system in relation to the accompanying drawings: Brief description of the accompanying drawings Figure 1 shows a conventional method of inserting Malecot Catheter. Figure 1 (a) shows a rubber malecot catheter and l(b) shows a Malecot Catheter fixed within the forceps. Figure 2 shows the conventional process being used to drain air / pus from the pleural cavity Figure 3 shows the device of the present invention Description of preferred embodiment The device of present invention as illustrated in figure 3 comprises a main shaft (4) with its one end in contact with a plunger (1) which moves up and down when rotated. Attached to the plunger is a cylindrical piece (3) with a clamp (2). The main shaft (4) is in assembly with the clamp. The distal end of the shaft has a precisionally designed pencil sharp end mounted on a serrated collar (5). The instrument is made out of stainless steel and can be sterilised by autoclaving prior to use on patients. The plunger (1) comprises a support means (6) having a first support (7) and second support (8) separated by two support bars (13). The main shaft (5) extends inside the support means through a hole. The end of the main shaft has a cam (9) to support a spring (10). The second support (11) has a threaded shaft (12), one end of which is in contact with the cam (9). The shaft (12) is in threaded communication with the support (11) so that when the shaft (12) is rotated it advances the main shaft (4) forward. The tip of the instrument is so designed that it keeps the tip of the catheter well secured in position even during manoeuvring. The clamp holds the proximal end of the catheter fixed in position. When the plunger is rotated in clockwise direction it advances the tip of the shaft by an equal distance. This manoeuvre stretches the flower of the catheter till it straightens up. When the plunger is rotated, the shaft does not rotate with it, thus, preventing the flower of the catheter from tearing off. The present invention has been tried upon age groups comprising of 12 years onwards. A total of 17 patients: 8 with empyema thoracis, 5 patients with hydropneumothorax and 4 patients with pneumothorax of which one had bilateral pneumothorax have been successfully managed with this device. This device is most suited in conditions where the procedure has to be performed swiftly in emergency conditions. Malecot catheters ranging from 24 F to 34 F have been used with this device. The malecot catheter is rolled and advanced over the shaft of the instrument like a sleeve. During this manoeuvre it is ensured that the tip of the malecot catheter sits exactly on the tip of the shaft, or else it may slip during manoeuvring through the muscle planes. The proximal end of the catheter is then clamped tightly. The plunger in then rotated in clockwise direction as explained earlier till the flower of the catheter is fully stretched. An incision as small as 1-1 1/2 cms is then made at a suitable site on the chest wall. The track is cleared with an artery forceps and the malecot catheter loaded on the instrument is then gently navigated through the wound. Once inside the chest / pleural cavity, the proximal end of the malecot is released from the clamp and connected to the underwater seal. Complications such as excessive haemorrhage subcutaneous emphysema, accidental expulsion of the tube and local cellulites are not uncommon with the conventional method. However, with the present device apart from minor bleeding none of the above problems are encountered. This can be explained by the fact that since the tube fits tightly within the wound there is hardly any space for air, blood or pus to spread and cause the above complications. The average time taken for the whole procedure, i.e., from loading the catheter on the device to connecting it with the underwater seal is about 9 min., as compared to 20-25 min. in case of the conventional device. As evident, the wound/incision is much smaller with the introducer - almost l/3rd the size of that with the conventional device. The diameter of the fully stretched catheter is small and when it assumes the normal shape after releasing from the clamp it fits snugly within the wound. This mechanism vitiates the need for any purse - string suture which is one of the most painful steps in the conventional procedure. The present device is also very economical as compared to the portex tube. WE CLAIM 1. A device for insertion of chest tube into the chest cavity comprising: a main shaft having a first end and a second end, said first end having a clamp adapted to hold the proximal end of chest tube/catheter fixed during operation; wherein said second end is provided with a sharp end mounted on a serrated collar; and wherein said main shaft is axially connected to a plunger assembly adapted to advance/retreat said sharp end without rotation of said main shaft, said plunger assembly comprising: a support means partially accommodating the first end of the shaft, the support means comprising a first support and a second support separated by one or more support bars; wherein said first support has a hole through which the main shaft extends inside the support means; wherein said first end of said main shaft has a cam for supporting a spring between the cam and the said first support; and said second support has a threaded shaft running through the second support and in threaded communication with the support, wherein one end of the threaded shaft remains in contact with said cam so that when the threaded shaft is rotated clockwise, it advances the tip of the said main shaft. 2. The device as claimed in claim 1, wherein said device is made of stainless steel and capable of being sterilised. A device for insertion of chest tube into the chest cavity comprising a main shaft having a first end and a second end, said first end having a clamp adapted to hold the proximal end of chest tube/catheter fixed during operation, wherein said second end is provided with a sharp end mounted on a serrated collar and wherein said main shaft is axially connected to a plunger assembly adapted to advance/retreat said sharp end without rotation of said main shaft. The device facilitates easy and fast insertion of chest tube and vitiates the need for any purse - string suture which is very painful to the patient.

Documents:

00388-kol-2004-abstract.pdf

00388-kol-2004-claims.pdf

00388-kol-2004-correspondence.pdf

00388-kol-2004-description (complete).pdf

00388-kol-2004-drawings.pdf

00388-kol-2004-form 1.pdf

00388-kol-2004-form 18.pdf

00388-kol-2004-form 2.pdf

00388-kol-2004-form 3.pdf

00388-kol-2004-letter patent.pdf

00388-kol-2004-pa.pdf

00388-kol-2004-reply f.e.r.pdf

388-KOL-2004-FORM 27.pdf

388-KOL-2004-FORM-27.pdf