WO2009068661A1 - Device for thoracostomy - Google Patents

Device for thoracostomy Download PDF

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Publication number
WO2009068661A1
WO2009068661A1 PCT/EP2008/066461 EP2008066461W WO2009068661A1 WO 2009068661 A1 WO2009068661 A1 WO 2009068661A1 EP 2008066461 W EP2008066461 W EP 2008066461W WO 2009068661 A1 WO2009068661 A1 WO 2009068661A1
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WO
WIPO (PCT)
Prior art keywords
cannula
needle
spring
guide
catch
Prior art date
Application number
PCT/EP2008/066461
Other languages
French (fr)
Inventor
Johannes Eugene Aerts
Peter Rinze Gérard BRINK
Imme Zengerink
Jeroen Gerhard Pieter Cox
Paul Barteld Kwant
Original Assignee
Universiteit Maastricht
Academisch Ziekenhuis Maastricht
Priority date (The priority date 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 date listed.)
Filing date
Publication date
Application filed by Universiteit Maastricht, Academisch Ziekenhuis Maastricht filed Critical Universiteit Maastricht
Publication of WO2009068661A1 publication Critical patent/WO2009068661A1/en

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/34—Trocars; Puncturing needles
    • A61B17/3415—Trocars; Puncturing needles for introducing tubes or catheters, e.g. gastrostomy tubes, drain catheters
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/34—Trocars; Puncturing needles
    • A61B17/3494—Trocars; Puncturing needles with safety means for protection against accidental cutting or pricking, e.g. limiting insertion depth, pressure sensors
    • A61B17/3496—Protecting sleeves or inner probes; Retractable tips
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/34—Trocars; Puncturing needles
    • A61B2017/348—Means for supporting the trocar against the body or retaining the trocar inside the body
    • A61B2017/3492—Means for supporting the trocar against the body or retaining the trocar inside the body against the outside of the body
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/03—Automatic limiting or abutting means, e.g. for safety
    • A61B2090/033—Abutting means, stops, e.g. abutting on tissue or skin
    • A61B2090/034—Abutting means, stops, e.g. abutting on tissue or skin abutting on parts of the device itself
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/03—Automatic limiting or abutting means, e.g. for safety
    • A61B2090/033—Abutting means, stops, e.g. abutting on tissue or skin
    • A61B2090/036—Abutting means, stops, e.g. abutting on tissue or skin abutting on tissue or skin
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/08—Accessories or related features not otherwise provided for
    • A61B2090/0801—Prevention of accidental cutting or pricking
    • A61B2090/08021—Prevention of accidental cutting or pricking of the patient or his organs
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/08—Accessories or related features not otherwise provided for
    • A61B2090/0807—Indication means
    • A61B2090/0811—Indication means for the position of a particular part of an instrument with respect to the rest of the instrument, e.g. position of the anvil of a stapling instrument

Definitions

  • the invention relates to a device for thoracostomy, in particular for relief of a (tension) pneumothorax, comprising a cannula and a needle slidingly sheathed in the cannula.
  • the invention further relates to a kit of parts for assembling such a device.
  • spontaneous pneumothorax is a relatively common medical emergency.
  • a pneumothorax occurs when the potential space between the lung and the inside of the chest wall (the pleural space) is breached and becomes an actual space and the lung collapses as the closed space fills with air. If the degree of collapse is significant or causing distress, the air in the closed pleural space (between the collapsed lung and chest wall) must be evacuated allowing full lung expansion.
  • Needle aspiration is a relatively painless and simple procedure that is often highly effective and allows full lung expansion to be achieved quickly and easily.
  • the equipment required is a metal hypodermic needle and a plain syringe. The needle is passed through the chest wall and once the tip is positioned in the pleural space air can be aspirated (sucked out) with the syringe allowing the lung to re-inflate.
  • GB 2 344 289 addresses the problem that in existing needles there is no means of signalling when the pleural space has been reached and the cannula is correctly sited.
  • the needle according to GB 2 344 289 has in communication with its interior a signalling device comprising a housing containing a member, in particular a light weight ball, movable in response to breathing, the housing having an opening remote from the needle.
  • WO 2006/090148 relates to an apparatus for the aspiration of a fluid from an individual suffering from e.g. tension pneumothorax.
  • the apparatus comprises a fluid passage switch.
  • US 5,545,141 relates to a gastrostomy device, which has an elongated body for insertion into the patient's stomach, a removable needle for piercing a channel through the stomach and abdomen walls, a shield means for removably covering the needle as it is inserted into the stomach, and an actuating means for moving the needle forward to pierce the channel.
  • a biasing means is included in the device 10 for biasing the rod 30 backwards relative to the tube 32, so that the needle 50 is shielded except when the surgeon purposely pushes the rod 30 forward.
  • the biasing means is a coiled spring 66, which extends to force apart the rod handle 64 and the tube proximal region 40.”
  • US 5,066,288 relates to trocars used to puncture tissue for the performance of laparoscopic or arthroscopic surgery and, in particular, to such trocars which employ a safety device to shield the obturator point immediately after the point has perforated tissue.
  • the embodiment shown in Figure 22 comprises a mechanism (92) that will exhibit a ratchet-like operation, permitting extension of the obturator in small incremental distances.
  • US 6,298,851 relates to an apparatus for performing emergency tracheotomies.
  • the device according to the present invention is characterized by a spring, e.g., a coiled spring, which, at least during insertion of the device, resiliently couples the needle to the cannula.
  • a spring e.g., a coiled spring
  • the resistance experienced by the needle is reduced and the spring that couples the needle and the cannula is further compressed, providing a signal to the operator to stop.
  • the device comprises a stop mechanism which, upon relative movement of the needle and the cannula, prevents both from further insertion.
  • the effective length of the needle is automatically adjusted to the thickness of the tissue, on the one hand establishing a vent between the pleural cavity and the surroundings and on the other hand preventing the needle from penetrating too deep, which might result in damage to tissue or organs beneath. I.e., proper insertion is facilitated, even under emergency (hectic) conditions.
  • the device comprises a guide which can be placed, with its distal end, on the skin of a patient, typically between two ribs.
  • the guide slidingly accommodates the cannula and comprises a catch or a plurality of recesses, whereas the needle comprises, respectively, a plurality of recesses or a catch.
  • the recesses and catch upon relative movement of the needle and the cannula, lock the needle to the guide. As the guide rests on the patient, the needle and cannula can penetrate no further.
  • the cannula comprises a plurality of openings and the needle comprises a plurality of recesses which are staggered with respect to the openings.
  • a guide slidingly accommodates the cannula and in turn comprises a catch in register with the openings.
  • the openings, recesses and catch provide a straightforward yet effective stop mechanism and may produce an audible signal during insertion.
  • the invention further relates to a kit of parts for assembling the device described above comprising a cannula, a needle to be slidingly sheathed in the cannula, and a spring for resiliently coupling the needle to the cannula.
  • the kit further comprises a stop mechanism having an opening for slidingly accommodating the cannula and a catch which, during sliding of the cannula and upon relative movement of the needle and the cannula, locks the needle and the cannula relative to the mechanism.
  • the kit can be assembled beforehand or during an emergency. It facilitates sterilization and hence repeated use .
  • Figure 1 is a perspective view of a device for relief of a (tension) pneumothorax according to the present invention.
  • Figures 2 and 3 are schematic cross-sections of the device shown in Figure 1.
  • Figures 4 and 5 are a schematic side view and cross-section of a second example of a device according to the present invention.
  • Figure 1 shows a disposable device 1 for thoracostomy, in particular for relief of a tension pneumothorax, comprising a cannula 2, a needle 3 slidingly (in axial direction) and rotatably (about its axis) sheathed in the cannula 2, and a guide 4 comprising a catch mechanism 5.
  • the cannula 2 has a diameter of e.g. 2 mm and comprises a protrusion, e.g. a flange 6, at its proximal end and a flat portion 7 running the length of the cannula 2 itself.
  • the flat portion 7 is provided with a plurality of openings 8, located at equal mutual distance ("D") and on a straight line parallel to the central axis of the cannula 2.
  • the cannula 2 and its features were made or stainless steel or obtained by injection-molding a suitable synthetic material, such as polymethyl methacrylate (PMMA) .
  • PMMA polymethyl methacrylate
  • the needle 3 comprises a pushbutton 9 at its proximal end.
  • the needle 3 has a sharpened distal end 10 and plurality of notches 11, also located at equal mutual distance ("D") .
  • the needle 3 further comprises an axial groove 12 interconnecting the notches 11.
  • the needle was made of stainless steel and the pushbutton was made of a suitable synthetic material, such as PMMA.
  • a metal coiled spring 13 is located between the flange 6 and the pushbutton 9 so as to resiliently couple the needle 3 to the cannula 2.
  • the length and stiffness (spring constant, C) of the spring are selected such that the notches in the needle are axially staggered and tangentially aligned with the openings in the cannula, at least during insertion.
  • the stiffness of the spring is such that the force resulting form the friction between the cannula and tissue in which the device is inserted is greater than the initial spring force.
  • the spring force in turn is greater than the force required to insert the device.
  • the spring force substantially equals 1/2 x D x C.
  • the guide 4 comprises a main body, e.g. a disc 14, with a central through-opening 15 having the same rotationally non-symmetrical cross-section as the cannula 2, i.e. circular with a flat portion, thus preventing the cannula 2 from rotating relative to the catch mechanism 4.
  • the guide 4 comprises an insert 16.
  • the disc and flat portion can be formed as an integral whole.
  • the catch mechanism 5 comprises a pin 17 abutting the outer wall of the cannula 2 or the needle 3 (if one of the openings in the cannula is in register with the pin and the pin extends through this opening) .
  • the mechanism 5 further comprises a spring 18 and a screw 19 for mounting the catch mechanism 5 inside the main body 14, e.g. in a stepped bore extending along a radius of the main body 14, and for adjusting the force with which the pin 17 abuts the cannula .
  • Treating e.g. pneumothorax with the assembled device can be preformed by the following steps:
  • the needle 3 is rotated about its axis until the catch pin 17 reaches the axial groove 12 interconnecting the notches 11 thus unlocking the needle 3 yet maintaining the lock between the cannula 2 and the guide 4.
  • Figures 4 and 5 show a second example of a device 1 for thoracostomy, in particular for relief of a tension pneumothorax, comprising a cannula 2, a needle 3 slidingly (in axial direction) and rotatably (about its axis) sheathed in the cannula 2, and a guide 4.
  • the cannula 2 has an outer diameter of e.g. 2,5 mm and an inner diameter of e.g. 2 mm and comprises, at its proximal end, a cylindrical (female) guide tube 2B having significantly larger outer and inner diameters, e.g. 12 and 10 mm, respectively.
  • the needle 3 comprises a pushbutton 9 at its proximal end, a cylindrical (male) guide element 3B, and a sharpened distal end 10.
  • the guide element 3B has an outer diameter only slightly smaller than the inner diameter of the guide tube 2B of the cannula 2, such that the guide element 3B is slidingly and rotatably received in the same (2B) .
  • the needle 3 has a central bore 20 and, near the pushbutton 9, a vent 21.
  • the guide element 3B further comprises a catch mechanism 5 in turn comprising a pin 17 protruding from the outer wall of the guide element 3B and a spring and screw for mounting the catch mechanism 5 inside said guide element 3B.
  • the catch mechanism 5 is mounted in a stepped bore extending along a radius of the guide element 3B.
  • a metal coiled spring 13 is located between the lower surface of the guide element 3B of the needle 3 and the bottom of the guide tube 2B of the cannula 2.
  • the guide 4 comprises a main body 4A and a base 4B removably attached to the main body 4A, e.g. by friction or a bayonet coupling.
  • the main body 4A and the base 4B each have a central cylindrical bore 15 for accommodating respective sections of the cannula 2. I.e., these bores have inner diameters only slightly larger than the outer diameters of, respectively, the guide tube 2B of the cannula 2 and the cannula 2 itself, such that the cannula 2, 2B is slidingly received inside the guide 4.
  • the inner wall of the main body 4A of the guide 4 comprises a plurality of annular notches 11, at equal mutual distance, and an axial groove 12 interconnecting the notches 11. Treating e.g. pneumothorax with the assembled device can be preformed by the following steps:
  • the needle 3 and the main body can be removed simply by pulling these elements over the cannula 2. In that case, unlocking of the needle 3 and the guide 4 is not required and the axial groove 12 can be omitted.
  • the effective length of the needle is automatically adjusted to the thickness of the tissue and proper insertion of the cannula is facilitated.
  • the risk of inadequate decompression resulting from insufficient insertion depth on the one hand and damage to organs in the thoracic cavity on the other is reduced.
  • the invention is not restricted to the above- described embodiments, which can be varied in a number of ways within the scope of the claims.

Abstract

The invention relates to a device (1) for thoracostomy, in particular for relief of a (tension) pneumothorax, comprising a cannula (2) and a needle (3) slidingly sheathed m the cannula (2). A spring (13) resiliently couples the needle (3) to the cannula (2), at least during insertion of the device (1).

Description

Device for thoracostomy
The invention relates to a device for thoracostomy, in particular for relief of a (tension) pneumothorax, comprising a cannula and a needle slidingly sheathed in the cannula. The invention further relates to a kit of parts for assembling such a device.
As explained in GB 2 344 289, spontaneous pneumothorax (collapsed lung) is a relatively common medical emergency. A pneumothorax occurs when the potential space between the lung and the inside of the chest wall (the pleural space) is breached and becomes an actual space and the lung collapses as the closed space fills with air. If the degree of collapse is significant or causing distress, the air in the closed pleural space (between the collapsed lung and chest wall) must be evacuated allowing full lung expansion.
This can be done by cutting a hole through the chest wall under local anaesthetic and placing a large bore (1 cm) flexible rubber tube through the hole and into the pleural space. In emergency situations a quicker procedure, using a large bore needle is appropriate.
Needle aspiration is a relatively painless and simple procedure that is often highly effective and allows full lung expansion to be achieved quickly and easily. In its simplest form the equipment required is a metal hypodermic needle and a plain syringe. The needle is passed through the chest wall and once the tip is positioned in the pleural space air can be aspirated (sucked out) with the syringe allowing the lung to re-inflate.
GB 2 344 289 addresses the problem that in existing needles there is no means of signalling when the pleural space has been reached and the cannula is correctly sited. To solve this problem, the needle according to GB 2 344 289 has in communication with its interior a signalling device comprising a housing containing a member, in particular a light weight ball, movable in response to breathing, the housing having an opening remote from the needle.
WO 2006/090148 relates to an apparatus for the aspiration of a fluid from an individual suffering from e.g. tension pneumothorax. According to this document, in the emergency arena the correct diagnosis of the relevant condition is not always guaranteed and it would be advantageous to be able to selectively close the open end of the cannula or catheter to prevent the unwanted passage of fluid therethrough, either into or out of the body. To this end, the apparatus comprises a fluid passage switch.
It is stated in WO 2006/090148 that by using a hollow needle it is possible to determine when the desired body cavity has been reached since the excess fluid is likely to immediately flow through the needle. Alternatively, conventional electrical, mechanical or chemical sensors such as, for example, visual indicators or micro electrical-mechanical (MEM) sensors can be used to determine the correct placement of the catheter.
US 5,545,141 relates to a gastrostomy device, which has an elongated body for insertion into the patient's stomach, a removable needle for piercing a channel through the stomach and abdomen walls, a shield means for removably covering the needle as it is inserted into the stomach, and an actuating means for moving the needle forward to pierce the channel. "Preferably, a biasing means is included in the device 10 for biasing the rod 30 backwards relative to the tube 32, so that the needle 50 is shielded except when the surgeon purposely pushes the rod 30 forward. In the preferred embodiment, the biasing means is a coiled spring 66, which extends to force apart the rod handle 64 and the tube proximal region 40."
US 5,066,288 relates to trocars used to puncture tissue for the performance of laparoscopic or arthroscopic surgery and, in particular, to such trocars which employ a safety device to shield the obturator point immediately after the point has perforated tissue. The embodiment shown in Figure 22 comprises a mechanism (92) that will exhibit a ratchet-like operation, permitting extension of the obturator in small incremental distances.
US 6,298,851 relates to an apparatus for performing emergency tracheotomies.
It is an object of the present invention to provide an improved device for thoracostomy, in particular for relief of a (tension) pneumothorax.
To this end, the device according to the present invention is characterized by a spring, e.g., a coiled spring, which, at least during insertion of the device, resiliently couples the needle to the cannula.
When the tip of the needle reaches the pleural cavity, the resistance experienced by the needle is reduced and the spring that couples the needle and the cannula is further compressed, providing a signal to the operator to stop.
In one embodiment, the device comprises a stop mechanism which, upon relative movement of the needle and the cannula, prevents both from further insertion. Thus, the effective length of the needle is automatically adjusted to the thickness of the tissue, on the one hand establishing a vent between the pleural cavity and the surroundings and on the other hand preventing the needle from penetrating too deep, which might result in damage to tissue or organs beneath. I.e., proper insertion is facilitated, even under emergency (hectic) conditions.
In a further embodiment, the device comprises a guide which can be placed, with its distal end, on the skin of a patient, typically between two ribs. The guide slidingly accommodates the cannula and comprises a catch or a plurality of recesses, whereas the needle comprises, respectively, a plurality of recesses or a catch. The recesses and catch, upon relative movement of the needle and the cannula, lock the needle to the guide. As the guide rests on the patient, the needle and cannula can penetrate no further.
In a more specific embodiment, the cannula comprises a plurality of openings and the needle comprises a plurality of recesses which are staggered with respect to the openings. A guide slidingly accommodates the cannula and in turn comprises a catch in register with the openings. The openings, recesses and catch provide a straightforward yet effective stop mechanism and may produce an audible signal during insertion.
The invention further relates to a kit of parts for assembling the device described above comprising a cannula, a needle to be slidingly sheathed in the cannula, and a spring for resiliently coupling the needle to the cannula.
In a another embodiment, the kit further comprises a stop mechanism having an opening for slidingly accommodating the cannula and a catch which, during sliding of the cannula and upon relative movement of the needle and the cannula, locks the needle and the cannula relative to the mechanism.
The kit can be assembled beforehand or during an emergency. It facilitates sterilization and hence repeated use .
The invention will now be explained in more detail with reference to the figures, which show several embodiments and details of the present device. Figure 1 is a perspective view of a device for relief of a (tension) pneumothorax according to the present invention.
Figures 2 and 3 are schematic cross-sections of the device shown in Figure 1. Figures 4 and 5 are a schematic side view and cross-section of a second example of a device according to the present invention.
Similar elements and elements performing an at least substantially identical function are denoted by the same numeral.
Figure 1 shows a disposable device 1 for thoracostomy, in particular for relief of a tension pneumothorax, comprising a cannula 2, a needle 3 slidingly (in axial direction) and rotatably (about its axis) sheathed in the cannula 2, and a guide 4 comprising a catch mechanism 5.
The cannula 2 has a diameter of e.g. 2 mm and comprises a protrusion, e.g. a flange 6, at its proximal end and a flat portion 7 running the length of the cannula 2 itself. The flat portion 7 is provided with a plurality of openings 8, located at equal mutual distance ("D") and on a straight line parallel to the central axis of the cannula 2. In this example, the cannula 2 and its features were made or stainless steel or obtained by injection-molding a suitable synthetic material, such as polymethyl methacrylate (PMMA) .
The needle 3 comprises a pushbutton 9 at its proximal end. The needle 3 has a sharpened distal end 10 and plurality of notches 11, also located at equal mutual distance ("D") . The needle 3 further comprises an axial groove 12 interconnecting the notches 11. In this example, the needle was made of stainless steel and the pushbutton was made of a suitable synthetic material, such as PMMA. A metal coiled spring 13 is located between the flange 6 and the pushbutton 9 so as to resiliently couple the needle 3 to the cannula 2. The length and stiffness (spring constant, C) of the spring are selected such that the notches in the needle are axially staggered and tangentially aligned with the openings in the cannula, at least during insertion. Also, the stiffness of the spring is such that the force resulting form the friction between the cannula and tissue in which the device is inserted is greater than the initial spring force. The spring force in turn is greater than the force required to insert the device. In this example, the spring force substantially equals 1/2 x D x C.
The guide 4 comprises a main body, e.g. a disc 14, with a central through-opening 15 having the same rotationally non-symmetrical cross-section as the cannula 2, i.e. circular with a flat portion, thus preventing the cannula 2 from rotating relative to the catch mechanism 4. To obtain the flat portion in this example, the guide 4 comprises an insert 16. As a matter of course, the disc and flat portion can be formed as an integral whole. The catch mechanism 5 comprises a pin 17 abutting the outer wall of the cannula 2 or the needle 3 (if one of the openings in the cannula is in register with the pin and the pin extends through this opening) . The mechanism 5 further comprises a spring 18 and a screw 19 for mounting the catch mechanism 5 inside the main body 14, e.g. in a stepped bore extending along a radius of the main body 14, and for adjusting the force with which the pin 17 abuts the cannula .
Treating e.g. pneumothorax with the assembled device can be preformed by the following steps:
- Placing the device 1 with the tip 10 of the needle 3 between two ribs of the patient, e.g. between in the second intercostal space (ICS) in the midclavicular line (MCL) . - Applying pressure to the pushbutton 9 thus inserting the tip 10 of the needle 3 and the tip of the cannula 2 into the tissue of the patient and slightly compressing the spring 13 once the tips of the needle 3 and the cannula 2 have entered the tissue. After a few millimeters, the guide 4 will contact the skin of the patient and the needle 3 and cannula 2 will translate within the guide 4, generating a rattling or clicking sound as the pin 17 passes the openings 8 in the cannula 2.
- When the tip 10 of the needle 3 reaches the pleural cavity, the resistance experienced by the needle 3 is reduced and the spring 13 that couples the needle 3 and the cannula 2 is further compressed. As a result, the needle 3 translates within the cannula 2 until the catch pin 17 enters the next opening 8 in the cannula 2 and the next notch 11 in the needle 3 and consequently locks both the cannula 2 and the needle 3 with respect to the guide 4. Thus, further insertion is prevented and the operator knows that the cannula 2 is in place.
- With the cannula 2 now in place, the needle 3 is rotated about its axis until the catch pin 17 reaches the axial groove 12 interconnecting the notches 11 thus unlocking the needle 3 yet maintaining the lock between the cannula 2 and the guide 4.
- Finally, the needle 3 is withdrawn from the cannula 2 and decompression commences.
Figures 4 and 5 show a second example of a device 1 for thoracostomy, in particular for relief of a tension pneumothorax, comprising a cannula 2, a needle 3 slidingly (in axial direction) and rotatably (about its axis) sheathed in the cannula 2, and a guide 4.
In this example, the cannula 2 has an outer diameter of e.g. 2,5 mm and an inner diameter of e.g. 2 mm and comprises, at its proximal end, a cylindrical (female) guide tube 2B having significantly larger outer and inner diameters, e.g. 12 and 10 mm, respectively.
The needle 3 comprises a pushbutton 9 at its proximal end, a cylindrical (male) guide element 3B, and a sharpened distal end 10. The guide element 3B has an outer diameter only slightly smaller than the inner diameter of the guide tube 2B of the cannula 2, such that the guide element 3B is slidingly and rotatably received in the same (2B) . In this example, the needle 3 has a central bore 20 and, near the pushbutton 9, a vent 21. The guide element 3B further comprises a catch mechanism 5 in turn comprising a pin 17 protruding from the outer wall of the guide element 3B and a spring and screw for mounting the catch mechanism 5 inside said guide element 3B. In this example, the catch mechanism 5 is mounted in a stepped bore extending along a radius of the guide element 3B. A metal coiled spring 13 is located between the lower surface of the guide element 3B of the needle 3 and the bottom of the guide tube 2B of the cannula 2.
The guide 4 comprises a main body 4A and a base 4B removably attached to the main body 4A, e.g. by friction or a bayonet coupling. The main body 4A and the base 4B each have a central cylindrical bore 15 for accommodating respective sections of the cannula 2. I.e., these bores have inner diameters only slightly larger than the outer diameters of, respectively, the guide tube 2B of the cannula 2 and the cannula 2 itself, such that the cannula 2, 2B is slidingly received inside the guide 4. The inner wall of the main body 4A of the guide 4 comprises a plurality of annular notches 11, at equal mutual distance, and an axial groove 12 interconnecting the notches 11. Treating e.g. pneumothorax with the assembled device can be preformed by the following steps:
- Pushing the pin 17 inwards and pushing the guide element 3B further into the relatively wide guide tube 2B of the cannula 2 until the pin 17 abuts the inner wall and is kept in place (in radial direction) by that tube 2B. At this juncture, the pin 17 should be out of alignment with the axial groove 12 (the Figures show alignment merely to allow concise explanation of the invention) .
- Placing the device 1 with the tip 10 of the needle 3 between two ribs of the patient. - Applying pressure to the pushbutton 9 thus inserting the tip 10 of the needle 3 and the tip of the cannula 2 into the tissue of the patient and further compressing the spring 13. - When the tip 10 of the cannula 2 reaches the pleural cavity, the spring 13 urges the cannula 2 forwards, releasing the pin 17. As a result, the pin 17 is urged outwards and into the nearest notch 11, seen in the direction of insertion, locking the needle 3 to the guide 4. - With the cannula 2 now in place, the needle 3 is rotated about its axis until the pin 17 reaches the axial groove 12 interconnecting the notches 11, thus unlocking the needle 3 and enabling it to be removed.
If the main body of the guide 4 it open at its distal end, the needle 3 and the main body can be removed simply by pulling these elements over the cannula 2. In that case, unlocking of the needle 3 and the guide 4 is not required and the axial groove 12 can be omitted.
With these devices, the effective length of the needle is automatically adjusted to the thickness of the tissue and proper insertion of the cannula is facilitated. The risk of inadequate decompression resulting from insufficient insertion depth on the one hand and damage to organs in the thoracic cavity on the other is reduced. The invention is not restricted to the above- described embodiments, which can be varied in a number of ways within the scope of the claims.

Claims

1. Device (1) for thoracostomy, in particular for relief of a (tension) pneumothorax, comprising a cannula (2) and a needle (3) slidingly sheathed in the cannula (2), characterized by a spring (13), which, at least during insertion of the device (1), resiliently couples the needle (3) to the cannula (2) .
2. Device (1) according to claim 1, wherein the spring is a coiled spring (13) .
3. Device (1) according to claim 1 or 2, wherein the proximal end of the needle (3) comprises a pushbutton
(9) and the proximal end of the cannula comprises a protrusion (6) and wherein the spring (13) is positioned between the pushbutton (9) and the protrusion (6) .
4. Device (1) according to any one of the preceding claims, further comprising a stop mechanism (4, 5) which, upon relative movement of the needle (3) and the cannula (2), prevents both (2, 3) from further insertion.
5. Device (1) according to claim 4, further comprising a guide (4), which slidingly accommodates the cannula (2) and which comprises a catch (5) or a plurality of recesses (11), and wherein the needle (3) comprises, respectively, a plurality of recesses (11) or a catch (5), which recesses (11) and catch (5), upon relative movement of the needle (3) and the cannula (2), lock the needle (3) to the guide (4) .
6. Device (1) according to claim 5, wherein the cannula (2) comprises a plurality of openings (8) and the needle (3) comprises a plurality of recesses (11) which are staggered with respect to the openings (8) .
7. Device (1) according to claim 5, wherein the needle (3) comprises a guide element (3B) having a resilient catch (17) and the cannula (2) comprises guide tube (2B) for slidingly receiving the guide element (3) of the needle (3) .
8. Device (1) according to any one of claims 5-7, wherein the needle (3) comprises an axial groove (12) interconnecting the recesses (11) .
9. Kit of parts for assembling the device (1) according to any one of the preceding claims, comprising a cannula (2), a needle (3) to be slidingly sheathed in the cannula (2), and a spring (13) for resiliently coupling the needle (3) to the cannula (2) .
10. Kit according to claim 9, further comprising a stop mechanism (4, 5) having an opening (15) for slidingly accommodating the cannula (2) and a catch which, upon relatively movement of the needle (3) and the cannula, locks the needle (3) and the cannula (2) relative to the mechanism (4, 5) .
11. Kit according to claim 9 or 10, wherein the cannula (2) comprises a plurality of openings (8) and the needle (3) comprises a plurality of recesses (11) which, upon sheathing the needle (3) in the cannula (2) and coupling the two (2, 3) with the spring (13), are staggered with respect to the openings (8) .
PCT/EP2008/066461 2007-11-29 2008-11-28 Device for thoracostomy WO2009068661A1 (en)

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EP07121910 2007-11-29

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