CA1190828A - Apparatus and method for catheterization permitting use of a smaller gage needle - Google Patents
Apparatus and method for catheterization permitting use of a smaller gage needleInfo
- Publication number
- CA1190828A CA1190828A CA000426067A CA426067A CA1190828A CA 1190828 A CA1190828 A CA 1190828A CA 000426067 A CA000426067 A CA 000426067A CA 426067 A CA426067 A CA 426067A CA 1190828 A CA1190828 A CA 1190828A
- Authority
- CA
- Canada
- Prior art keywords
- tube
- wire guide
- catheter
- distal end
- lumen
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Expired
Links
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M25/00—Catheters; Hollow probes
- A61M25/01—Introducing, guiding, advancing, emplacing or holding catheters
- A61M25/06—Body-piercing guide needles or the like
- A61M25/0662—Guide tubes
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M25/00—Catheters; Hollow probes
- A61M25/01—Introducing, guiding, advancing, emplacing or holding catheters
- A61M25/09—Guide wires
- A61M25/09016—Guide wires with mandrils
- A61M25/09025—Guide wires with mandrils with sliding mandrils
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M25/00—Catheters; Hollow probes
- A61M25/01—Introducing, guiding, advancing, emplacing or holding catheters
- A61M2025/018—Catheters having a lateral opening for guiding elongated means lateral to the catheter
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M25/00—Catheters; Hollow probes
- A61M25/01—Introducing, guiding, advancing, emplacing or holding catheters
- A61M25/0105—Steering means as part of the catheter or advancing means; Markers for positioning
- A61M25/0108—Steering means as part of the catheter or advancing means; Markers for positioning using radio-opaque or ultrasound markers
Abstract
Abstract of the Disclosure An introducing catheter for use with a pair of different diameter wire guides, the larger of which is a J-type wire guide, is provided in order to enlarge a tract to facilitate the passage of a drainage catheter through the tract. The introducing catheter includes an inwardly curved portion which lies between the distal and proximal ends of the catheter with the curved portion being located nearer to the distal end. The catheter also has a flexible tapered tip at its distal end and a lumen which decreases in area towards the distal end. The catheter further has a side port which is distally positioned from the curved portion and on the inward side of the curved portion so that when a J-type wire guide is advanced within the catheter from the proximal end, the wire guide will automatically emerge through the side port. The side port has an oval or elliptical shape with its major axis along the length of the tube. The catheter lumen has a diameter at the distal end which is substantially smaller than the minor axis diameter of the side port so that a wire guide having a substantially smaller external diameter than that of the J-type wire guide may be used as a guide for the catheter distal end. The introducing catheter is radiopaque, so that its position within a body can be monitored. The introducing catheter has a base portion at the proximal end for grasping and manipulating the catheter during a catheterization.
Description
5514e APPARATUS AND METHOD FOR
CATHETERIZATION P~MITTING
USE OF A SMALLER &AGE NEEDLE
Background_of ~he Invention Field of the Invention:
The invention relates generally to the field of catheters and, more particularly to the catheteri~a~ion of organs such as the renal pelvis or the like.
Description of _the Prior Art.
Present procedures Eor percutaneous introduction of large bore drainage ca~heters in order to drain blocked cavities or ducts such as the renal pelvis a~d the biliary duct are, at best, somewbat hazardous. For instance, one widely practiced method for obtain:ing long term drainage of an obstructed upper urinary tract is to perform a percutaneous nephrostomy which involves catheterization of the renal pelvis. In order to instaLl the drainage catheter, an initial percutaneous puncture ;nto the renal pelvis may be made with a hollow 18 gauge (1~3 mm) needle. Then, a guide wire is advanced inside the needle until prop~rly positioned whereupon the needle is removed over the guide wire. Appropriately sized fascial dilators are then advanced over the guide wire to enlarge the tract so ag to facilitate the subsequent passage of ~he drainage 9(3~32~
catheter over the guide wire. A similar tecbnique is used to install a drainage cathe~er into the biliary duct Eor transhepatic antigrade biliary drainage.
The initial punc~ure made in attempting to enter the renal pelvis of the kidney or the biliary tract is seldom a direct bit. For this reason, several punctures are commonly required in order to properly position the needle. The resulting damage ~o the kidney or biliary duct can be very traumatic for the patient, especially slnce the kidney or biliary duct ls usually already traumatized by disease. Thus, physicians would obviously prefer using a smaller gauge needle in making this initial puncture, so as to minimize the damage and resulting trauma caused by multiple puncturesO
Suprapubic catheterization methods and devices which involve percutaneous entry by a puncturing device are disclosed in U.S. Pa~en~ 3~752,158 to Kariher; U~S. Patent 3,8~0,006 to Patel; and U.S. Patent 3,924 9 633 to Cook et al. U.S. Patent 3,640,281 to Robertson and U.S. Patent 3,920,023 to Dye et al. dlsclose me~hods for draining the urinary bladder by inserting the catheter transurethrally into the bladder.
Other cat~eterization devices which may have some general relevance are disclosed in U.S. Patent ~,118,631 to Wappler; U.S. Patent 2,856,~34 to Petillo; U.S. Patent 3,804,097 to Rudie; and U.S. Patent 4,212,304 to Finney.
None of the above patents, however, discloses a method or apparatus which minimizes the damage and trauma caused by catheterization of cavities or ducts which because of their small size or difficult to reach location commonly require multiple punctures to properLy position the catheter.
Accordingly, it is an object of the present ;nvention to provide an apparatus and method which minimizes the damage and ~rauma caused by catheterization procedures which are commonly characterized by multiple punctures ;n
CATHETERIZATION P~MITTING
USE OF A SMALLER &AGE NEEDLE
Background_of ~he Invention Field of the Invention:
The invention relates generally to the field of catheters and, more particularly to the catheteri~a~ion of organs such as the renal pelvis or the like.
Description of _the Prior Art.
Present procedures Eor percutaneous introduction of large bore drainage ca~heters in order to drain blocked cavities or ducts such as the renal pelvis a~d the biliary duct are, at best, somewbat hazardous. For instance, one widely practiced method for obtain:ing long term drainage of an obstructed upper urinary tract is to perform a percutaneous nephrostomy which involves catheterization of the renal pelvis. In order to instaLl the drainage catheter, an initial percutaneous puncture ;nto the renal pelvis may be made with a hollow 18 gauge (1~3 mm) needle. Then, a guide wire is advanced inside the needle until prop~rly positioned whereupon the needle is removed over the guide wire. Appropriately sized fascial dilators are then advanced over the guide wire to enlarge the tract so ag to facilitate the subsequent passage of ~he drainage 9(3~32~
catheter over the guide wire. A similar tecbnique is used to install a drainage cathe~er into the biliary duct Eor transhepatic antigrade biliary drainage.
The initial punc~ure made in attempting to enter the renal pelvis of the kidney or the biliary tract is seldom a direct bit. For this reason, several punctures are commonly required in order to properly position the needle. The resulting damage ~o the kidney or biliary duct can be very traumatic for the patient, especially slnce the kidney or biliary duct ls usually already traumatized by disease. Thus, physicians would obviously prefer using a smaller gauge needle in making this initial puncture, so as to minimize the damage and resulting trauma caused by multiple puncturesO
Suprapubic catheterization methods and devices which involve percutaneous entry by a puncturing device are disclosed in U.S. Pa~en~ 3~752,158 to Kariher; U~S. Patent 3,8~0,006 to Patel; and U.S. Patent 3,924 9 633 to Cook et al. U.S. Patent 3,640,281 to Robertson and U.S. Patent 3,920,023 to Dye et al. dlsclose me~hods for draining the urinary bladder by inserting the catheter transurethrally into the bladder.
Other cat~eterization devices which may have some general relevance are disclosed in U.S. Patent ~,118,631 to Wappler; U.S. Patent 2,856,~34 to Petillo; U.S. Patent 3,804,097 to Rudie; and U.S. Patent 4,212,304 to Finney.
None of the above patents, however, discloses a method or apparatus which minimizes the damage and trauma caused by catheterization of cavities or ducts which because of their small size or difficult to reach location commonly require multiple punctures to properLy position the catheter.
Accordingly, it is an object of the present ;nvention to provide an apparatus and method which minimizes the damage and ~rauma caused by catheterization procedures which are commonly characterized by multiple punctures ;n
2~3 attempting to properly position the puncturing device.
It is a fur-~her object of the present invention to provide an apparatus and method for catheterization wbich permits the use of a smaller gauge hollow needle than would otherwise be necessary using present devices or techniques~
It is a yet further object of the present invention to provide a method Eor ca~heterization using a smaller gauge hollow needle whicb method is relatively simple to follow and requires relatively inexpensive additional equipment.
These and other objects and advantages of the present invention wi].l become more appacent in the following figures and detailed description.
Summa-ry of the Invention One embodimen~ of this invention might include an in~roducing ca~heLer fo-r use with a plurality of different diameter wire guides, the larger of which is a J type wire guide, in order to enlarge a tract and facilitate the passage of a drainage catheter through said tract. There is provided a ~ube having proximal and distal open ends and curved inwardly for a portion of its length between the distal and proximal ends. The tube also has a tapered tip at its distal end and a lumen wbich decreases in size towards the distal end. The tube also has a side port which is distally positioned from tbe curved portion and is located along the inward side of the curved portion so tbat wben a J-type w;re guide is advanced within the tube from the proximal end, t~e wire guide will automatically emerge through the side port. It sbould be understood that t~e "J~type" wire guide bas a tip w~ich is spring biased into a 3-shape but is capable of being straightened by overcoming the bias. The lumen of the tube has a diameter at the distal end of the tube which is substantially smaller than the diameter of the side port so that a wire guide having a substantially smaller external diameter than that of the J-type wire guide may be used as a guide means for the distal end of the catheter.
BrieE De~ n of the Draw;ngs . .
FIG. 1 is an elevation view pa-rtially in section of the introducing cathete-r of the subject invention.
FIG. lA is an enlarged fragmentary detail view oE the introducing catheter showing ~he configuration of a side port forming a part thereof.
FIGS. 2-7 are elevational views, partially in section, showing successiYe steps in practicing the met~od oE the subject invention.
FI~. 4A is an elevational view similar to FIG. 4 but partially in section and showing the relationship of the introducing catheter and a stiffening cannula fully inserted therein.
Descrip~ion of ~he Preferred_Embod-iment For ~he purposes of promoting an unde-rstanding of the principles of the invention, reference will now be made to the embodiment illustrated in the drawings and specific language will be used to describe the same. It will nevertheless be understood that no limita~ion of the scope of the invention is thereby intended, such alterations and further modifications in the illustrated device, an~ such further applications of the principles of the invention a~
illustrated th~rein being contemplated as would normally occur to one skilled in the art to which the invention relates.
Referring to FIG. 1, introducing catheter 10 includes a 6.3 French sized tubular shaped member 11 and base portion 12 which is press fitted for fixed attachment to tubular member 11. Base portion 12 facilitates the grasping and manipulating of introducing catheter 10 in practicing the method of the subject invention.
Introducing catheter lO is open at proximal end 14 and distal end 15. Further, introducing catbeter 10 has a lumen or hollow in~erior 16 wbich is relatively large in the area 17, but which tapers to a very small internal diameter at the area 18 which at t~e distal end 15 is only slig~tly larger than the external diameter of wire guide 19 shown in FIG. 3. The cat~eter lO is also externally tapered Erom the 6.3 French size down to the distal end 15. The axial length o.E this taper in the preferred embodiment i5 approximately l.5 cm and the thickness oE
the material is such at the distal end 15 that a relatively sharp or thi.n edge is presented at distal end 15. Introducing ca~heter 10 is inwardly curved along portion 20 of its length and bas a total length in the preferred embodiment oE approximately 22 cm. Side port 21 is loca~ed slightly distal to curved portion 20 and along the inner side of the curved portionO Side port 21 is sized to permit passage therethrough oE J-type wire guide 31 which is sbown in FIG. 5.
Curved portion 20 and side port 21 are located sufficiently near distal end 15 so that side port 21 and distal end 15 can both be wi-thin the renal pelvis 30 when introducing catheter 10 is introduced into the renal pelvis, as will be more fully discussed hereafter.
Preferably, side port 21 has an oval or elliptical shape (FIG. lA) with its major axis parallel to tbe longitudinal axis of introducing catheter lO. With the side port 21 thus formed and positioned, J-type wire guide 31 will automatically emerge through side por~ 21 when advanced from proximal end 14 as will also be more fully described hereaEter. Introducing catheter lO is formed of flexible material such as plastic which is capable of being straigbtened by the introduction into the catheter of a stiffening cannula. Preferably, introducing catheter 10 is Eormed of a polyet~ylene material and is radiopaque, so that positioning of the introducing catheter can be monitored on a fluoroscope.
ReEerring now to FlGo 2, in order to perform a percutaneous nephrostomy a conven~lonal hollow thin wall needle 24 i5 inserted percutaneously into the body 40 in order to make an initial puncture into the renal pelvis 30 oE the kidney 35. It i5 to be understood that the instruments other than introducing catheter 10 are well known in the art and are manufactured in many standard sizes accordlng to the specific requirements of different proceduresO It is also to be understood that wh:ile the previous known technique Eor a percutaneous nephrostomy would require an 18 gage (1.3 ~m) needle, practicing the m thod of t~e subject invention requires only a ~1 gage (0.46 mm) needle in the present preEe-rred embodiment.
Preferably, needle 24 is 15 cm in length and is made of stainless s~eel. As is common in similarly performed nephrostomy procedures it is to be understood that several ~ 2 ~
attempts may be required to obtain a successful nephrostomy puncture. Thus, since needle 24 has a much smaller diameter than the needle previously required for this step~ the damage to kidney 35 is minimized.
Referring now to FIG. 3, once needle 24 is successfully positioned with the ~ip in the renal pelvis, wire guide 19 is inserted in the needle at proximal end 25 and passed completely there-~hrough until it projects slightly from distal end 26 of the needle. Wire guide 19, which is of a type well known in the art, has a stiff wire shaf~ portion 27 and a flexible gently curved spring tip portion 28. Portions 27 and 28 are Eormed and connected in a well known manner. In the preferred embodiment, wire guide 19 is approximately 60 cm long and has an external diameter of approxima~ely 0.46 mm. The needle 24 then is withdrawn from the body over wire guide 19 while the wire guide is still in place within the renal pelvis 30.
Referring now to FIGS. 4 and 4A, stiffener cannula 29 is fully inserted into introducing catheter 10 as in FIG.
4A in order to rein~orce and straighten the otherwise relatively flexible introducing catheter 10 so that it may be more easily introduced into the body as hereinaEter described. Cannulas such as stiffening cannula 29 shown in FIG. 3 are well known in the art. Stiffening cannul3 29 is preferably of 20 gauge (0.35" O.D.) formed of stainless steel and approximately 20 cm in length. The cannula 29 is thin wa]led having .025 I.D. so as to slidably fit the O.D. of the wire guide 19. The catheter 10 and cannula 29 are then advanced over wire guide 19 under fluoroscopic monitoring with a rotary motion through the tissues to a depth of 5 to 7 cm. While the patient holds his breath, introducing catheter 10 is tben advanced over the cannula 29 until 3 to 5 cm of the thicker nonrtapered portion of cakheter 10 lies within the renal pelvis 30. Wire guide 19 should not kink as long as the operator constan~ly rotates introducing catheter 10 as it 3J~
g is advanced~ Wire guide 19 and cannula 29 are then removed while firmly holding introducing catheter 10 in its pl~ce relative to renal pelvis 30, and aspiration and irrigation are accomplished. Next, as shown in Fig. 5, J-type wire guide 31, which has a well known construction, is ~hreaded through the proximal end 14 of the introducing catheter. J-~ype wire guide 31, is composed of a helically wound strip of spring metal, such as stainless steel. J-type wire guide 31 preferably has an external diameter of approximately 0.97 mm and has a ~otal length of approximately ]00 cm. J-type wire guide 31 also has a flexible J-curved tip 32 at l~s distal end and maintains the J-shape by a sprin~ bias. J~type wire guide 31 is availsble from Cook, Inc. oE Bloomington, Indiana, or from Vance Products, Inc., of Spencer, Indiana, under part no.
070~6.
In order to put the J-type wire guide 31 into the introducing catheter, the curved tip 27 is s~raightened.
Tbis can be done by pulling the turns of the J-type wire guide apart towards ~he proximal end thereoE, or it can he done by merely taking ~he Eingers and straightening the J-shape. However, it should be understood that the flexible curved tip 32 assumes the J configura~ion in a spring biascd fashion, but against the urging of the spring can be straightened out into a straight line configuration~ The flexible curved tip 32 however, does tend to attempt to return to t~e J conEiguration illustrated in FIG. 5. Thus, as the J~type wire guide 31 is moved down the inside of the introducing catheter 10, tbe flexible curved tip 32 is attempting to assume -~he illustrated J shape. It of course cannot do so~ because the inside oE the introducing catheter guides it until it reaches the curved portion 20 at which point the J
configuration orients îtself so that the J curved tip 32 is in t~e same direction as the curved portion 20. Thus, as the J tip moves down toward and ~o the side port 21 it will be so oriented, that as soon as it gets to side port 21 the J tip automatically passes through the side port.
It should be understood that the tip 23 of ~he introducing catheter is sufficiently projected into the renal pelvis 30 so that the location of side port 21 is within the area of the renal pelv:is that is to be drained. The next step is ~o withdraw the catheter 10 from the body by removing it over the J-type wire guide 31. Of course as it is withdrawn it will move alongside the wire guide 31. J-type wire guide 31 is then used for inserting a loop nephros~omy drainage catheter 330 Loop drainage catheter 33 is of a ~ype similar to that disclosed in U.S. Patent 3,924,633 to Cook et al. and is avilable through Cook, Inc. of B].oomington, Indiana, under catalog No~ NCL-l. Catheter 33 has a drawstring (not shown~ attached at distal end 34 which when drawn from proximal end 35 causes distal end 34 to form into a tight self retaining loop such as shown in FIG. 7, thus anc~oring drainage catheter 33 firmly inside renal pelvis 30. One method o anchoring is described in U.S. Patent
It is a fur-~her object of the present invention to provide an apparatus and method for catheterization wbich permits the use of a smaller gauge hollow needle than would otherwise be necessary using present devices or techniques~
It is a yet further object of the present invention to provide a method Eor ca~heterization using a smaller gauge hollow needle whicb method is relatively simple to follow and requires relatively inexpensive additional equipment.
These and other objects and advantages of the present invention wi].l become more appacent in the following figures and detailed description.
Summa-ry of the Invention One embodimen~ of this invention might include an in~roducing ca~heLer fo-r use with a plurality of different diameter wire guides, the larger of which is a J type wire guide, in order to enlarge a tract and facilitate the passage of a drainage catheter through said tract. There is provided a ~ube having proximal and distal open ends and curved inwardly for a portion of its length between the distal and proximal ends. The tube also has a tapered tip at its distal end and a lumen wbich decreases in size towards the distal end. The tube also has a side port which is distally positioned from tbe curved portion and is located along the inward side of the curved portion so tbat wben a J-type w;re guide is advanced within the tube from the proximal end, t~e wire guide will automatically emerge through the side port. It sbould be understood that t~e "J~type" wire guide bas a tip w~ich is spring biased into a 3-shape but is capable of being straightened by overcoming the bias. The lumen of the tube has a diameter at the distal end of the tube which is substantially smaller than the diameter of the side port so that a wire guide having a substantially smaller external diameter than that of the J-type wire guide may be used as a guide means for the distal end of the catheter.
BrieE De~ n of the Draw;ngs . .
FIG. 1 is an elevation view pa-rtially in section of the introducing cathete-r of the subject invention.
FIG. lA is an enlarged fragmentary detail view oE the introducing catheter showing ~he configuration of a side port forming a part thereof.
FIGS. 2-7 are elevational views, partially in section, showing successiYe steps in practicing the met~od oE the subject invention.
FI~. 4A is an elevational view similar to FIG. 4 but partially in section and showing the relationship of the introducing catheter and a stiffening cannula fully inserted therein.
Descrip~ion of ~he Preferred_Embod-iment For ~he purposes of promoting an unde-rstanding of the principles of the invention, reference will now be made to the embodiment illustrated in the drawings and specific language will be used to describe the same. It will nevertheless be understood that no limita~ion of the scope of the invention is thereby intended, such alterations and further modifications in the illustrated device, an~ such further applications of the principles of the invention a~
illustrated th~rein being contemplated as would normally occur to one skilled in the art to which the invention relates.
Referring to FIG. 1, introducing catheter 10 includes a 6.3 French sized tubular shaped member 11 and base portion 12 which is press fitted for fixed attachment to tubular member 11. Base portion 12 facilitates the grasping and manipulating of introducing catheter 10 in practicing the method of the subject invention.
Introducing catheter lO is open at proximal end 14 and distal end 15. Further, introducing catbeter 10 has a lumen or hollow in~erior 16 wbich is relatively large in the area 17, but which tapers to a very small internal diameter at the area 18 which at t~e distal end 15 is only slig~tly larger than the external diameter of wire guide 19 shown in FIG. 3. The cat~eter lO is also externally tapered Erom the 6.3 French size down to the distal end 15. The axial length o.E this taper in the preferred embodiment i5 approximately l.5 cm and the thickness oE
the material is such at the distal end 15 that a relatively sharp or thi.n edge is presented at distal end 15. Introducing ca~heter 10 is inwardly curved along portion 20 of its length and bas a total length in the preferred embodiment oE approximately 22 cm. Side port 21 is loca~ed slightly distal to curved portion 20 and along the inner side of the curved portionO Side port 21 is sized to permit passage therethrough oE J-type wire guide 31 which is sbown in FIG. 5.
Curved portion 20 and side port 21 are located sufficiently near distal end 15 so that side port 21 and distal end 15 can both be wi-thin the renal pelvis 30 when introducing catheter 10 is introduced into the renal pelvis, as will be more fully discussed hereafter.
Preferably, side port 21 has an oval or elliptical shape (FIG. lA) with its major axis parallel to tbe longitudinal axis of introducing catheter lO. With the side port 21 thus formed and positioned, J-type wire guide 31 will automatically emerge through side por~ 21 when advanced from proximal end 14 as will also be more fully described hereaEter. Introducing catheter lO is formed of flexible material such as plastic which is capable of being straigbtened by the introduction into the catheter of a stiffening cannula. Preferably, introducing catheter 10 is Eormed of a polyet~ylene material and is radiopaque, so that positioning of the introducing catheter can be monitored on a fluoroscope.
ReEerring now to FlGo 2, in order to perform a percutaneous nephrostomy a conven~lonal hollow thin wall needle 24 i5 inserted percutaneously into the body 40 in order to make an initial puncture into the renal pelvis 30 oE the kidney 35. It i5 to be understood that the instruments other than introducing catheter 10 are well known in the art and are manufactured in many standard sizes accordlng to the specific requirements of different proceduresO It is also to be understood that wh:ile the previous known technique Eor a percutaneous nephrostomy would require an 18 gage (1.3 ~m) needle, practicing the m thod of t~e subject invention requires only a ~1 gage (0.46 mm) needle in the present preEe-rred embodiment.
Preferably, needle 24 is 15 cm in length and is made of stainless s~eel. As is common in similarly performed nephrostomy procedures it is to be understood that several ~ 2 ~
attempts may be required to obtain a successful nephrostomy puncture. Thus, since needle 24 has a much smaller diameter than the needle previously required for this step~ the damage to kidney 35 is minimized.
Referring now to FIG. 3, once needle 24 is successfully positioned with the ~ip in the renal pelvis, wire guide 19 is inserted in the needle at proximal end 25 and passed completely there-~hrough until it projects slightly from distal end 26 of the needle. Wire guide 19, which is of a type well known in the art, has a stiff wire shaf~ portion 27 and a flexible gently curved spring tip portion 28. Portions 27 and 28 are Eormed and connected in a well known manner. In the preferred embodiment, wire guide 19 is approximately 60 cm long and has an external diameter of approxima~ely 0.46 mm. The needle 24 then is withdrawn from the body over wire guide 19 while the wire guide is still in place within the renal pelvis 30.
Referring now to FIGS. 4 and 4A, stiffener cannula 29 is fully inserted into introducing catheter 10 as in FIG.
4A in order to rein~orce and straighten the otherwise relatively flexible introducing catheter 10 so that it may be more easily introduced into the body as hereinaEter described. Cannulas such as stiffening cannula 29 shown in FIG. 3 are well known in the art. Stiffening cannul3 29 is preferably of 20 gauge (0.35" O.D.) formed of stainless steel and approximately 20 cm in length. The cannula 29 is thin wa]led having .025 I.D. so as to slidably fit the O.D. of the wire guide 19. The catheter 10 and cannula 29 are then advanced over wire guide 19 under fluoroscopic monitoring with a rotary motion through the tissues to a depth of 5 to 7 cm. While the patient holds his breath, introducing catheter 10 is tben advanced over the cannula 29 until 3 to 5 cm of the thicker nonrtapered portion of cakheter 10 lies within the renal pelvis 30. Wire guide 19 should not kink as long as the operator constan~ly rotates introducing catheter 10 as it 3J~
g is advanced~ Wire guide 19 and cannula 29 are then removed while firmly holding introducing catheter 10 in its pl~ce relative to renal pelvis 30, and aspiration and irrigation are accomplished. Next, as shown in Fig. 5, J-type wire guide 31, which has a well known construction, is ~hreaded through the proximal end 14 of the introducing catheter. J-~ype wire guide 31, is composed of a helically wound strip of spring metal, such as stainless steel. J-type wire guide 31 preferably has an external diameter of approximately 0.97 mm and has a ~otal length of approximately ]00 cm. J-type wire guide 31 also has a flexible J-curved tip 32 at l~s distal end and maintains the J-shape by a sprin~ bias. J~type wire guide 31 is availsble from Cook, Inc. oE Bloomington, Indiana, or from Vance Products, Inc., of Spencer, Indiana, under part no.
070~6.
In order to put the J-type wire guide 31 into the introducing catheter, the curved tip 27 is s~raightened.
Tbis can be done by pulling the turns of the J-type wire guide apart towards ~he proximal end thereoE, or it can he done by merely taking ~he Eingers and straightening the J-shape. However, it should be understood that the flexible curved tip 32 assumes the J configura~ion in a spring biascd fashion, but against the urging of the spring can be straightened out into a straight line configuration~ The flexible curved tip 32 however, does tend to attempt to return to t~e J conEiguration illustrated in FIG. 5. Thus, as the J~type wire guide 31 is moved down the inside of the introducing catheter 10, tbe flexible curved tip 32 is attempting to assume -~he illustrated J shape. It of course cannot do so~ because the inside oE the introducing catheter guides it until it reaches the curved portion 20 at which point the J
configuration orients îtself so that the J curved tip 32 is in t~e same direction as the curved portion 20. Thus, as the J tip moves down toward and ~o the side port 21 it will be so oriented, that as soon as it gets to side port 21 the J tip automatically passes through the side port.
It should be understood that the tip 23 of ~he introducing catheter is sufficiently projected into the renal pelvis 30 so that the location of side port 21 is within the area of the renal pelv:is that is to be drained. The next step is ~o withdraw the catheter 10 from the body by removing it over the J-type wire guide 31. Of course as it is withdrawn it will move alongside the wire guide 31. J-type wire guide 31 is then used for inserting a loop nephros~omy drainage catheter 330 Loop drainage catheter 33 is of a ~ype similar to that disclosed in U.S. Patent 3,924,633 to Cook et al. and is avilable through Cook, Inc. of B].oomington, Indiana, under catalog No~ NCL-l. Catheter 33 has a drawstring (not shown~ attached at distal end 34 which when drawn from proximal end 35 causes distal end 34 to form into a tight self retaining loop such as shown in FIG. 7, thus anc~oring drainage catheter 33 firmly inside renal pelvis 30. One method o anchoring is described in U.S. Patent
3,924,663 to Cook et al. Drainage catheter 33 has a 10 French size a~ its largest diameter and is 25 cm in length.
Wbile the foregoing description applies to a percutaneous nephrostomy, it is to be under.stood that the introducing catheter and catheterization method of the subject invention can be used for catheterization of other cavitles or ducts. One such similar appl;.cation would :involve the installation of a drainage catheter into the biliary duct for transhepatic antigrade biliary dralnage.
Of course, it is to be understood that the size and lengths of the catheters, wi-re guides, and cannula as disclosed herein are sui~ed for a percutaneous nepbros~omy, and may ~herefore vary when used in conjunction with other medical procedures.
While the invention has been illustrated and described in detail in the drawing~ and foregoing description, the same is to be considered as lllustrative and not restrictive in character, it being understood -~hat only the preferred embodimen~ has been shown and de~cribed and that all changes and modifica~ions that come within the spirit of the invention are desired to be protec~ed.
Wbile the foregoing description applies to a percutaneous nephrostomy, it is to be under.stood that the introducing catheter and catheterization method of the subject invention can be used for catheterization of other cavitles or ducts. One such similar appl;.cation would :involve the installation of a drainage catheter into the biliary duct for transhepatic antigrade biliary dralnage.
Of course, it is to be understood that the size and lengths of the catheters, wi-re guides, and cannula as disclosed herein are sui~ed for a percutaneous nepbros~omy, and may ~herefore vary when used in conjunction with other medical procedures.
While the invention has been illustrated and described in detail in the drawing~ and foregoing description, the same is to be considered as lllustrative and not restrictive in character, it being understood -~hat only the preferred embodimen~ has been shown and de~cribed and that all changes and modifica~ions that come within the spirit of the invention are desired to be protec~ed.
Claims (8)
1. An introducing catheter for use with a plurality of different diameter wire guides, the larger of which is a J-type wire guide, in order to enlarge a tract and facilitate the passage of a larger diameter catheter through said tract, said introducing catheter comprising:
a tube having proximal and distal open ends, said tube having an inwardly curved portion between said ends, said tube having a tapered tip at said distal end, said tube also having a lumen, the size of said lumen decreasing towards said distal end, said tube further having a side port which is distally positioned from said curved portion and along the inward side of said curved portion so that when a J-type wire guide is advanced within said tube from said proximal end the guide will automatically emerge through said side port, said lumen having a diameter at said distal end which is substantially smaller than the diameter of said side port.
a tube having proximal and distal open ends, said tube having an inwardly curved portion between said ends, said tube having a tapered tip at said distal end, said tube also having a lumen, the size of said lumen decreasing towards said distal end, said tube further having a side port which is distally positioned from said curved portion and along the inward side of said curved portion so that when a J-type wire guide is advanced within said tube from said proximal end the guide will automatically emerge through said side port, said lumen having a diameter at said distal end which is substantially smaller than the diameter of said side port.
2. The apparatus of claim 1 wherein said inwardly curved portion is located closer to said distal end than to said proximal end.
3. The apparatus of claim 2 wherein said side tube is radiopaque and said port is elliptically shaped and has its major axis along the length of said tube, said lumen having a diameter at said distal end which is substantially smaller than the minor axis diameter of said port.
4. The apparatus of claim 3 and further comprising:
a base portion fixed to said tube at said proximal end for grasping and manipulating said introducing catheter during a catheterization.
a base portion fixed to said tube at said proximal end for grasping and manipulating said introducing catheter during a catheterization.
5. A kit used for performing a percutaneous nephrostomy, comprising:
a hollow thin wall needle, said needle having a lumen therethrough;
a first wire guide, said first wire guide having a diameter sized to permit the first wire guide to be received within the lumen of said needle;
an introducing catheter, said introducing catheter including a tube having proximal and distal open ends, said tube having an inwardly curved portion between said ends, said tube having a tapered tip at said distal end, said tube also having a lumen, the size of said lumen decreasing towards said distal end, said tube further having a side port which is distally positioned from said curved portion and along the inward side of said curved portion, said lumen having a diameter at said distal end which is sufficiently large to receive therethrough said first wire guide;
a stiffening cannula, said stiffening cannula having proximal and distal open ends and a lumen therethrough, said cannula sized to be received within said introducing catheter, said cannula having an outer diameter which is larger than the lumen of said introducing catheter at the distal end, said cannula sized to receive the first wire guide through said lumen;
a second wire guide, said second wire guide having a flexible J-tip, said second wire guide having a diameter which is substantially larger than the diameter of said first wire guide and the lumen of said introducing catheter at the distal end, said second wire guide sized to be received through the proximal end and the side port of said introducing catheter;
a drainage catheter, said drainage catheter having a lumen therethrough sized so that said second wire guide may be received through said drainage catheter.
a hollow thin wall needle, said needle having a lumen therethrough;
a first wire guide, said first wire guide having a diameter sized to permit the first wire guide to be received within the lumen of said needle;
an introducing catheter, said introducing catheter including a tube having proximal and distal open ends, said tube having an inwardly curved portion between said ends, said tube having a tapered tip at said distal end, said tube also having a lumen, the size of said lumen decreasing towards said distal end, said tube further having a side port which is distally positioned from said curved portion and along the inward side of said curved portion, said lumen having a diameter at said distal end which is sufficiently large to receive therethrough said first wire guide;
a stiffening cannula, said stiffening cannula having proximal and distal open ends and a lumen therethrough, said cannula sized to be received within said introducing catheter, said cannula having an outer diameter which is larger than the lumen of said introducing catheter at the distal end, said cannula sized to receive the first wire guide through said lumen;
a second wire guide, said second wire guide having a flexible J-tip, said second wire guide having a diameter which is substantially larger than the diameter of said first wire guide and the lumen of said introducing catheter at the distal end, said second wire guide sized to be received through the proximal end and the side port of said introducing catheter;
a drainage catheter, said drainage catheter having a lumen therethrough sized so that said second wire guide may be received through said drainage catheter.
6. The kit of claim 5, wherein said needle is a 21 gauge needle, said first wire guide has a diameter of 0.46 mm, said second wire guide has a dia-meter of 0.97 mm, and said stiffening cannula is 21 gauge having an inner dia-meter of 0.46 mm.
7. An introducing catheter combination comprising: a) a tube formed of resilient material and having an inwardly curved portion between proximal and distal open ends, said tube having a tapered tip at said distal end, said tube also having a lumen the size of which decreases towards said distal end, said tube further having a side port which is distally located relative to said curved portion and along the inward side of said curved portion, said lumen having a diameter at said distal end which is substantially smaller than said side port; b) a stiffening cannula received within said tube and extend-ing into said inwardly curved portion to straighten said curved portion and stiffen said tube, said cannula being removable from said tube to permit said tube to resume its inwardly curved shape.
8. The introducing catheter combination of claim 7 and further comprising:
c) a wire guide received within said tube and cannula and having an external size approximately the same size as said distal end.
c) a wire guide received within said tube and cannula and having an external size approximately the same size as said distal end.
Applications Claiming Priority (2)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| US06/369,598 US4405314A (en) | 1982-04-19 | 1982-04-19 | Apparatus and method for catheterization permitting use of a smaller gage needle |
| US369,598 | 1995-01-06 |
Publications (1)
| Publication Number | Publication Date |
|---|---|
| CA1190828A true CA1190828A (en) | 1985-07-23 |
Family
ID=23456107
Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| CA000426067A Expired CA1190828A (en) | 1982-04-19 | 1983-04-18 | Apparatus and method for catheterization permitting use of a smaller gage needle |
Country Status (5)
| Country | Link |
|---|---|
| US (1) | US4405314A (en) |
| EP (1) | EP0092389B1 (en) |
| AT (1) | ATE24405T1 (en) |
| CA (1) | CA1190828A (en) |
| DE (1) | DE3368523D1 (en) |
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|---|---|---|---|---|
| US1968997A (en) * | 1932-05-21 | 1934-08-07 | Kenneth G Drucker | Device for the treatment of certain ailments |
| US2118631A (en) * | 1935-04-03 | 1938-05-24 | Wappler Frederick Charles | Catheter stylet |
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| US3094124A (en) * | 1960-06-30 | 1963-06-18 | Davol Rubber Co | Arterial catheter |
| US3539034A (en) * | 1966-10-11 | 1970-11-10 | Carl H Tafeen | Paracervical block anesthesia assembly |
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| US3752158A (en) * | 1970-11-23 | 1973-08-14 | Snyder Manuf Co Inc | Apparatus and method for suprapubic drainage of the urinary bladder |
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| US3680562A (en) * | 1971-04-26 | 1972-08-01 | Becton Dickinson Co | Surgical drainage apparatus for bladder |
| US3749134A (en) * | 1972-02-02 | 1973-07-31 | Sunlite Plastics Inc | Radiographically opaque plastic tubing |
| US3804097A (en) * | 1972-12-14 | 1974-04-16 | P Rudie | Method of irrigating and treating an abcess |
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| US3924633A (en) * | 1974-01-31 | 1975-12-09 | Cook Inc | Apparatus and method for suprapubic catheterization |
| US3920023A (en) * | 1974-03-21 | 1975-11-18 | Kendall & Co | Method and apparatus for placement of a suprapubic catheter |
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| US4230123A (en) * | 1978-10-31 | 1980-10-28 | Hawkins Jr Irvin F | Needle sheath complex and process for decompression and biopsy |
| US4306562A (en) * | 1978-12-01 | 1981-12-22 | Cook, Inc. | Tear apart cannula |
| FR2471195A1 (en) * | 1979-12-17 | 1981-06-19 | Technological Supply | DEVICE FOR INTRODUCING A CATHETER OR PROBE IN A BLOOD VESSEL |
-
1982
- 1982-04-19 US US06/369,598 patent/US4405314A/en not_active Expired - Lifetime
-
1983
- 1983-04-14 AT AT83302117T patent/ATE24405T1/en not_active IP Right Cessation
- 1983-04-14 EP EP83302117A patent/EP0092389B1/en not_active Expired
- 1983-04-14 DE DE8383302117T patent/DE3368523D1/en not_active Expired
- 1983-04-18 CA CA000426067A patent/CA1190828A/en not_active Expired
Also Published As
| Publication number | Publication date |
|---|---|
| EP0092389A1 (en) | 1983-10-26 |
| ATE24405T1 (en) | 1987-01-15 |
| EP0092389B1 (en) | 1986-12-30 |
| DE3368523D1 (en) | 1987-02-05 |
| US4405314A (en) | 1983-09-20 |
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| Date | Code | Title | Description |
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