US2959171A - Apparatus for bloodless phlebotomy - Google Patents

Description

Nov. 8, 1960 H. SELIGMAN 2, 5

APPARATUS FOR BLOODLESS PHLEBOTOMY Filed Feb. 28, 1956 a Sheets-Sheet 1 INVENTOR.

HANS S E li M AN A TTORNE Y.

Nov. 8, 1960 H. SELIGMAN APPARATUS FOR BLOODLESS PHLEBO'IOMY 3 Sheets-Sheet 2 Filed Feb. 28, 1956 EHI Nov. 8, 1960 H. SELIGMAN 2,959,171

APPARATUS FOR BLOODLESS PHLEBOTOMY Filed Feb. 28, 1956 3 Sheets-Sheet 3 IN V EN TOR.

HAN/S g E ILLIMAIJ you; Q W

United States Patent APPARATUS FOR BLOODLESS PHLEBOTOMY Hans Seligman, 164 Main St., Groton, N.Y.

Filed Feb. 28, 1956, Ser. No. 568,320

Claims. (Cl. 128325) This invention relates to a novel apparatus for the treatment of pulmonary edema.

Pulmonary edema, the accumulation of serum in the cellular tissue of the lungs, may be treated in various ways. Sedation, bloodless phlebotomy with tourniquets or with blood pressure cuffs, oxygen and mercurial diuretics, and/ or digitalization are the measures most commonly employed, thus fairly standardizing the treatment of pulmonary edema. Although the beneficial results of bloodless phlebotomy have been recognized by the medical profession for a great number of years, there have been no practical, and at the same time, exact methods of performing it, so that as a result, it is generally used as a last, rather than, a first resort. Undoubtedly, a great many lives may have been saved in the past, had this form of treatment for pulmonary edema been used promptly and efficiently.

Actual bloodletting, or phlebotomy, is rarely indicated, except for the occasional patient with polycythemia vera, an excess of corpuscles in the bloor. In the majority of patients, this type of treatment is contra-indicated and may prove to be dangerous partly due to the fact that such a form of treatment is not immediately reversible. All other treatments with respect to pulmonary edema vary according to the specific needs of each patient.

As known to those familiar with the art, bloodless phlebotomy is the temporary trapping of up to 800 ml. of blood in three extremities of the body. This may be performed in two ways. In the first method, tourniquets are applied to three of the four extremities, and once every fifteen minutes, one tourniquet is released and applied to the limb that has been formerly free. The great disadvantages of this method are obvious. Every fifteen minutes the patient had to be disturbed for changing the tourniquet. This is particularly a handicap when the patient is located in an oxygen tent. It was necessary to apply the pressure of each tourniquet at the diastolic or just below the diastolic pressure so that the arterial flow into the extremities was not impeded and that only the venous return was blocked off. The pressure exerted on each of these tourniquets could not be gauged accurately. If it were too high, it would increase the circulatory disturbance; if it were too low, value of the treatment would be useless.

Furthermore, there was always the possibility of inducing local vascular damage if a tourniquet were left in place too long under too much pressure, particularly if these vessels have been damaged by atherosclerosis or other such vascular disease. It has been established that the use of these tourniquets have led to major vascular occlusions resulting in subsequent amputations.

The second method used in treating pulmonary edema is with blood pressure cuffs. Although applying blood pressurecuffs with manometers is a definitely superior method, in spite of this fact, tourniquets used in rotation is the method most commonly used today. In the use of blood pressure culfs, the pressure applied to each limb can be measured and maintained accurately at its most effective level through the use of the manometers attached thereto. Furthermore, the pressure is applied over a wide area so that the danger of thrombosis is minimized. However, the application of three separate sphygmomanometers (inflating them to the proper level) and having to carefully watch the three dials, all at the same time, is so impractical and cumbersome, that this method, in spite of its obvious advantages over the tourniquet method, has largely been abandoned.

It is the main object of this present invention to make the treatment of pulmonary edema, using the bloodless phlebotomy method, a more practical and accurate method of treatment.

Another object of this apparatus is to reduce the equipment now in use, from three separate sphygmomanometers to one compact unit.

Another advantage of this device is that once the cuffs are in place on the patient, he need not be moved or disturbed any more for inflating or deflating the cuffs. This results in less work on the part of the doctor, as well as more comfort assured to the patient.

Still another advantage of this novel device is the fact that pressure in all three cuffs is uniform and equal at all times and can be read on a single manometer attached to the new apparatus.

Another purpose of this invention is to provide a main valve whereby, after maintaining the desired pressure for approximately fifteen minutes, the handle is turned onefourth of the way to automatically deflate one of the cuffs and connect the pressure line to the culf that had been formerly empty.

It is another object of this apparatus to provide a main valve which, when rotated every fifteen minutes and adequate pressure is maintained in the cuffs, continues the treatment indefinitely and accurately, with no disturbance to the patient and with a minimum of nursing care.

The construction of the cuffs used with respect to this apparatus are of a simple snap-on type so that they may be quickly attached to the limbs of the patient. Two extra length cuffs are provided for the thighs whereby a greater area of the body may be covered.

Because of the construction of this unit, through the window of a handle, it may be seen which of the four cuffs is not inflated and in use, thereby allowing the physician to recognize which limb may be used in the case of intravenous medication. It also enables the physician to set the apparatus on, for example, left arm empty" if he wants to inject into the left antecubital vein.

Another advantage of this novel apparatus is the provision of a small valve, through which use, the pressure in the cuffs may be reduced in case it has been accidentally raised to a higher degree than that called for. This valve may also be used for gradual decrease in culf pressure at the termination of the treatment.

This compact unit may be used continuously for more than twelve days and nights of treatment. The cost of the operation, that is the refilling of the tank with carbon dioxide, is approximately one dollar. The compact structure enables the easy transporting of the apparatus; this portable apparatus may be used under varying circumstances in regard to location.

In accordance with the present invention, the bloodless phlebotomy apparatus consists chiefly of a cylinder containing a gas, such as carbon dioxide, which is the source of power. A lever connected to the tank or cylinder regulates the outflow of the gas into the main distributing valve. The gas pressure flowing through to the main valve is recorded on a manometer attached thereto. This gas is passed through the main valve into outlet tubes connected to inflatable cuffs attached to limbs of the patient. A flat handle located on the top of the main valve is employed to inflate three of the four cuffs simultaneously in rotation. A Window, showing clearly which of the four cuffs is not inflated at the time, is located on this .handle. -A second valve,;-s imilar. to that,. used on a blood pressure pump,,is attached t -the cylinder .containing' the gas. This valve may be, openedif the pressure in the cuffs accidentally has been raised ,too high, or for a gradual decrease in: the cuff pressure atft-he termination of the treatment.

Other objects and advantages of this present invention will be fully set forth in the following description and the novel features thereof will be specifically defined by the appended claims,

Further references are made to the accompanying drawings in which:

Figure l is atop elevation in perspective of the bloodless phlebotomy apparatus.

Figure 2 is. a front elevation. illustrating the cooperation of the lever with the stop screw, the manometer and the main distributing valve at the top of line 44.

Figure 3 is a side elevation in cross section showing the main distributing valve.

Figure 4 is a top elevation of the distributing valve with the handle removed.

Figure 5 is a bottom view of the notch plate of a section of the valve taken at line 5-5 of Figure 3.

Figure 6 is a side elevation and cross section showing the cone in the valve and the springs which fit into the notches of the notch plate when it is turned.

With reference being made to the drawings, as illus trated in Figure 1, an assembly board 96 is shown having a cylinder 1 filled with a suitable gas, such as carbon dioxide, attached thereto. The gas from the cylinder 1 is fed into the inlet 21 through pressure reduction valve 100, and pressure release valve 2. Located on one end of the cylinder 1 is a spring attachment 7 which is connected to the lever 5 by suitable means 8. In the same manner, and referring to Figure 2, the opposite end of the spring 7 is attached to the assembly board 96, The circular arm extension 10 of the lever 5 is held in position around a disc 11 by means of a screw 9. A stop screw 6 for lever 5 is affixedto the assembly board 96 by suitable means 12. This stop screw 6prevents the full escape of the gas located in the cylinder 1 into the inlet 21 leading to the main distributing valve 50. A Tent 14 in the inlet 21, as illustrated specifically in Figures 1 and 2, joins a tube 15 which connects to the manometer 31, so that themanometer 31 may record the pressure on the line of the gas flowing from the outlet of the, cylinder 1, through the inlet 21, into the main distributing valve 50.

As illustrated in Figures 2 and 3, the inlet 21 is connected to the cylinder 1 and leads to the main distributing valve 50. The gas passing through the inlet 21 enters the main distributing valve 50 by means of a passage 22, in through the canal 23 and up into the chamber 24 located in the main distributing valve 50.

Before further'details will be given With respect to the work of the main distributing valve 50, its construction will be explained. The handle 41 of the-main distributing valve 50 has a View opening 40. A window plate 83 is connected to a notch plate 84 by means of screw 82, as shown in Figure 3. A cone 91 is held in position through its stem 92 which passes up through the notch plate 84 and the window plate Y83, and is aflixed onto the handle 41 by means of a screw 93.

With reference now to Figures 3, 5, and 6, a spring 61 exerts tension on the notch plate 84 so that, as the handle 41 of the main distributing valve 51!, is turned, the clovershaped recesses 74 hold the cone 91 of the valve 50 in position, with respect to the entrance of the gas therein into the cuffs.

As the gasv entersthe chamber .24 in the main dis- Iibuting valve,.50,- itpasses through the threeopenpas-v sageways 25 into the valve outlets 26 which lead by means of suitable tubing 10 into the inflatable cuffs (not shown), located on the limbs of a patient. In this setting of the main distributing valve 50, one passageway, here designated by the numeral 29 is connected to the atmosphere (the opening not being shown). As the handle 41 of the main distributing valve 50 is rotated, one of the four valve outlets 26leading to the inflatable cuffs, is closed by means of the clover-shaped recesses 74 holding the cone, 91 on position, and connects this valve to the atmosphere as is valve 32, shown in Figure 3.

In the operation of this bloodless phlebotomy apparatus, the cuffs, identical with those used with a blood pressure recording machine, are placed one on each thigh and upper arm of the patient. The main distributing valve 59 on this apparatus is set so that the gas enters only three of the four cuffs located on the patient; that is, the handle 41 with the view opening 40 is placed with respect to the window plate 83 sothat the cuff not being inflated is seen, as illustrated in-Fig-ure 1, the left leg cuff being the one that is blocked off. With the setting of the handle 41, the clover-shaped recesses hold the valve 50 in position. The lever 5 is pressedallowing the flow of the gas from the cylinder 1 to enter the inlet 21. As the gas passes throughthe inlet 21, the pressure is recorded on the manometer 31 attached thereto, allowing the operator to see the amount of pressure entering through the main distributing valve 50, into the three open valves leading to the inflatable cuffs. The pressure is applied to the three extremities of the patients limbs that are contacted by the inflated cuffs. As it is desired to change the pressure on the limbs of the patient at each 15 minute interval, by'turning the handle 41 in rotation, each of they fourcuifs will receive the pressure, one of which at all times will be empty.

In treating various cases, for example, in the case of mitral stenosis, extreme activity causes a damming upof blood behind the mitral valve. In this disease, the pressure in the left atrium rises and the blood content of the lungs increases, causing some congestive failure with dyspenea and an abnormally long period of tachycardia. Over a period of time, increased pressure in the left auricle results in enlargement of this chamber. which is demonstrable by roentgenography. This present invention cuts down the amount of blood pumped from'the lungs out into the right heart, so. that. the left heart can catch up with it and the fluid in the lungs will decrease. In this manner, the inflow and outflow are kept equal, so that the blood located in the lungs accounts for about 6 percent of their total volume, as is found in a normal heart function. I l V I I Caution is to be practiced in operating the-handle-of the valve, making sure that the handle is set leaving one cuff open to the atmosphere.v Otherwise, the pressure from the cylinder will be brought to bear on the manometer.

While certain novel featuresof the invention have been disclosed and are pointed out in the annexedvclairns, it will be understood that various omissions, substitutions and changes may be made by those familiar in the art without departing from the spirit of the invention.

I claim:

1. A bloodless phlebotomy apparatus comprising a reservoir containing gas under pressure, an outlet from said reservoir, a main distributing valve and an inlet thereto connected to said outlet, a pressure release valve in said outlet forming means for regulating the. flowiof said gas from said reservoir to said inlet, a manometer attached to said inlet, valve outlets from said-main distributing valve and four inflatable cuffs connected thereto, said main distributing valve forming means for the alternate application of pressure simultaneously into three of said four inflatablecuffs.

2. A bloodless phlebotomy apparatus comprising in combination a cylinder containing a gas under pr e ss 1pe and an outlet therefor, a main distributing valve and an inlet thereto connected to said outlet forming means for passage of said gas from said cylinder to said distributing valve, a manometer connected to said inlet for registering the pressure of said gas passing through said inlet, a pressure release valve for regulating the flow of gas into said inlet, valve outlets connected to said main distributing valve and four inflatable cuffs connected thereto, said distributing valve comprising means for distributing said gas through three open outlets thereof and inflating three of said four cufi's uniformly and simultaneously for the purpose of regulating the flow of the blood pumped to the lungs of a patient, said pressure release valve forming means for reducing pressure in said cuffs when the pressure is accidentally raised to a higher degree than that called for, said release valve also means for a gradual decrease in the cufl. pressure at the termination of the treatment.

3. A bloodless phlebotomy apparatus comprising a cylinder containing a suitable gas under pressure, an outlet located at one end of said cylinder, a lever arrangement and a pressure reduction valve operated thereby, a pressure release valve located in said outlet forming means for reducing the pressure in the inflatable cuffs and for reducing the pressure at the termination of the treatment, a main distributing valve and inlet therefor connected to said outlet forming means for the passage of gas into said main distributing valve, a manometer attached to said inlet, said manometer forming means for registering the pressure through said inlet into said main distributing valve, valve outlets on said main distributing valve and four inflatable cuffs connected thereto by suitable means, said main distributing valve comprising means for distributing the gas from said cylinder through three open outlets of said four outlets and inflating three of 30 the said four inflatable cufls uniformly and simultaneously for the purpose of regulating the flow of the blood pumped to the lungs of a patient.

4. Bloodless phlebotomy apparatus including a main distributing valve, and four inflatable cuffs attached to the limbs of a patient for the purpose of applying pressure thereto and regulating the blood pumped to the lungs of the patient, said main distributing valve having an inlet to a chamber and four valve outlets connected to said chamber, said cufls being connected to said outlets, and means for distributing gas pressure from said inlet into any three of said four outlets, whereby any three of the said four inflatable cuffs are inflated and a fourth cuff is vented to the atmosphere.

5. A main distributing valve for regulating the gas pressure from an inlet to three of four valve outlets, and four inflatable cufls attached to the limbs of a patient for the purpose of applying pressure thereto and regulating the blood pumped to the lungs of the patient, said main distributing valve having an inlet to a chamber and four valve outlets connected to said chamber, said main distributing valve forming means for distributing gas pressure from said inlet into any three of said four outlets, said cuffs being connected to said outlets, said main distributing valve having a handle with a view opening therethrough and a window plate, said window plate having means for designating which of the four inflatable cufis is empty and which three of the four inflatable cufis are inflated, last said means being formed with respect to said view opening in said handle, said main distributing valve thereby forming means whereby any three of the four inflatable cults are inflated and the fourth cuff is blocked off and vented to the atmosphere.

References Cited in the file of this patent UNITED STATES PATENTS 2,335,085 Roberts Nov. 23, 1943 2,345,073 Rosett Mar. 28, 1944 2,533,504 Poor Dec. 12, 1950 FOREIGN PATENTS 159,922 Great Britain Mar. 7, 1921

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