CA1152408A - Method and apparatus for the treatment of ascites - Google Patents
Method and apparatus for the treatment of ascitesInfo
- Publication number
- CA1152408A CA1152408A CA000353261A CA353261A CA1152408A CA 1152408 A CA1152408 A CA 1152408A CA 000353261 A CA000353261 A CA 000353261A CA 353261 A CA353261 A CA 353261A CA 1152408 A CA1152408 A CA 1152408A
- Authority
- CA
- Canada
- Prior art keywords
- patient
- catheter
- ascites
- flexible
- valve
- 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
- A61M27/00—Drainage appliance for wounds or the like, i.e. wound drains, implanted drains
- A61M27/002—Implant devices for drainage of body fluids from one part of the body to another
Abstract
ABSTRACT OF THE DISCLOSURE
In the method of treating ascites disclosed herein, an intraperitonal inlet tube is connected to an implanted jug-ular catheter through a valving unit including a pair of one-way valve units which are connected in series through a flexible intermediate chamber to another pair of one-way valve units. The flexible chamber is surgically secured near the surface of the patient's abdomen or chest, preferably over the sternum, so that, by manual pressure, the patient can periodically deform the con-duit thereby to effect pumping of the ascites fluid.
In the method of treating ascites disclosed herein, an intraperitonal inlet tube is connected to an implanted jug-ular catheter through a valving unit including a pair of one-way valve units which are connected in series through a flexible intermediate chamber to another pair of one-way valve units. The flexible chamber is surgically secured near the surface of the patient's abdomen or chest, preferably over the sternum, so that, by manual pressure, the patient can periodically deform the con-duit thereby to effect pumping of the ascites fluid.
Description
~.~52408 The present invention relates to the treatment of asci-tes and more particularly such treatment ~y means of an implanted peritoneo - venous shunt, In the treatment of ascites, i.e, the accumulation of large amounts of fluid in theperitoneal cavity of the patient, it has previously been proposed to shunt or reroute ascitic fluid from the peritoneal cavity into the superior vena cava, the thoracic duct or the bladder. The providing of a shunt from the peritoneal cavity to the central venous system has offered many advantages over other types of treatment but certain difficulties have existed with prior devices and methods for effecting such treatment, The shunt devices proposed heretofore for such treat-ment have typically been either quite bulky, i.e. so as to require a mor~ ela~orate surgical procedure, or have ~een unduly subject to clogging by the presence of complex protein compounds in the ascitic fluid, Among the several objects of the present invention may be noted the provision of an improved peritoneovenous shunt which is highly resiatant to clogging; which is highly effective in the treatment of ascites; which is relatively easily implanted in a comparativel~ simple surgical procedure; which is of relatively si~ple and in~xpensive construction and which is highly reliable wh~^ch can ~e sterilized ~y autoclave without altering its inter~
nal mechanism. Other objects and features will be in part apparent and in part poin.ted out hereinafter, BRIEF DESCRIPTIO~ OF THE DRAWING
Fig. 1 is a schematic representation of a patient assumed to be suffering from ascites and illustrates the placement of the apparatus disclosed herein;
S ~S2408 1 Fig. 2 is a view, partially in section, of the overall arrangement of the shunt system disclosed herein;
Fig. 3 is a view, partially in section, of the construction of the shunt valve unit; and Fig. 4 is a side sectional view of the shunt valve disclosed herein, and appears on the same page as Figure 1.
BRIEF DESCRIPTION OF THE PREFERRED EMBODIMENT
Referring n~w to Fig. 1 a patient,assumed to be suf-fering from ascites, is indicated generally by reference charac-ter 11. In accordance with the practice of the present invention - la -r p~ .
1 ~ r;;~408 1 a perforate inlet catheter 13 ~eritoneal catheter~ is surgically introduced into the peritoneal cavity of the pa~ient, through an a~dominal incision 14, so as to provide a means for drawing off accumulated ascitic fluid~ Peritoneal catheter 13 is con-nected ~y means of a strai~ht connector 12, and a proximal tu~e 15 to an antecham~er 17 and valve unit 1~ described in greater detail hereinafter, which is implanted in a su~cutaneous pocket surgically formed over the patient's sternum 16, Proximal tu~e 15, antecham~er 17, and the valve unit lQ are implanted through a subcutaneous tunnel in accordance with conventional surgical procedures. After passing through valve unit 19, the ascitic fluid is directed into the central venous system through the distal tube 20 and atrial catheter 22. In contrast with more conventional systems, the distal tu~e 20 and atrial catheter 22 are of relatively small diameter, This small diameter facilitates a simpler mode of implantation wherein the distal tu~e is led, through a subcutaneous tunnel up to the patient's neck where a small cervical incision is made 21, Working through this incis-ion 21, the atrial catheter 22 i9 inserted into the exterior jugular vein as indicated at 24. The length of the atrial cath-eter 22 is such to allow its tip to extend, from the point of introduction at the external jugular vein, down the superior vena cava into the patient's right atrium. After this placement, the atrial catheter 22 and the distal tu~e 20 are trimmed at the cervical incision and connected ~y the U-shaped connector 23, The introduction of the atrial catheter into the external jug-ular vein is again made possi~le owing to the relatively small diameter of the catheter, Leaving the tip of the catheter with in the right atrium inhibits ingrowth and eventual blockage of the catheter such as would occur if it were terminated near the 1 point at which it enters the venous system. The overall arrange-ment of the shunt system is illustrated in Fig. 2 in greater detail and the actual construction of the valve unit 19 is illustrated in Fig. 3.
In accordance with the concepts of the present inven-tion, the valving unit 19 comprises two pairs of one-way valves ~hich are connected in series through a flexible conduit. In the preferred embodiment illustrated, four identical one-way valve elements 31-34 are employed in a series-parallel arrange-ment in a flexible silicone rubber housing 35 i.e. valve element31 is in parallel with valve element 32 and this parallel pair is in series with a second parallel pair of elements 33 and 34.
The series connection is established by an elongate section 37 of the silastic rubber valve housing 35. This section 37 func-tions as a deformable conduit for purposes explained hereinafter.
Each of the valve elements 31-34 is generally of the type disclosed in U.S. Patent 3,288,142. This construction, illustrated in Fig. 4, employs a rigid base S1 in which is formed a conical valve seat 53 connected to an inlet port 55.
A rigid spherical valving element 57 is biased into the conical seat by a convoluted cantilever spring S9 which is secured to the base 51, e.g. by spot welding. A cylindrical shell 58 encloses the base 51, valving element 57 and spring 59 so as to facilitate its being held within the,overall valve assembly body 35. Another suitable form of valve element is that shown in U.S. patent number 4,332,255. In each case, the one way valv-ing is accomplished by a rigid or hard valving element (biased against a rigid seat). This is preferred over so~t valving elements e.g. such as those formed of silastic rubber, in that the hard surfacesare better suited for making a seal, even in , .~ .
., ~5;~4Q8 1 the presence of protein materials which might come to rest at the valving surface~ If complete closing is not o~tained some highly undesirable back flushing from the venous system may occur.
In addition to providing a larger total flow path the paralleling of valving elements is a greater protection against clogging since, even if one valving element s~ould clog, its parallel counterpart will typically ~e adeqùate to pass a ~enefi cial quantity of the ascitic fluid~
As noted previously, t~e valve assem~ is pre-fera~ly secured e,g, in a suitable subcutaneous pocket, at a point over the patient's sternum, With the valving element assembly 19 so located, it i8 possible for the patient himself or his physician to effect the actual pumping of fluid from the peritoneal cavity to the central venous system ~y manually press-ng against the valve assembly and there~y periodically collaps-ing or compressin~ the flexi~le conduit portion 37 ~etween the two pairs of paralleled valving elements. As will ~e understood, compressing this section will expell fluid through a downstream valvlng element, i,e., into the venous system, while releasing the manual pressure and allowing the conduit to assume its normal shape will draw fluid into the valving unit through the upstream valves i~e. the valving elements nearest the inlet tu~e in the peritoneal cavity~ The availability of this pumping procedure not only frees the patient from the tiresome exercises otherwise involYed in generating a negative pressure within the chest and a positive pressure in the peritoneal cavity. The valving elements and the small bore jugular catheter also can be effect-ively flushed by the pumping actions so that protein deposits w~ich might other~ise tend to clog the system can be effectively ~2408 1 cleared. In prior art systems where no such pumping action is available, it has ~een necessary to employ relatively large kore tu~ing for the venous catheter, This large size cannot--~e routed up to the external jugular as can the present system nor can it be then allowed to extend along the jugular internally to a lo-cation of such that the atrium ~here the danger of tissuing growth essentiaily absent. As indicated previously, it is highly advan-tageous to have the catheter enter the external jugular since it is much easier to accomplish insertion of the catheter at this point on the patient's neck.where this large vein is close to the surface, This easier access often means that the procedure can be performed under a local anesthesia rather than requiring the application of general anesthesia to a patient who may al-ready he considerably ~eakened ~y his illness~
The antecham~er 17, being similarly accessi~le near the surface of the patient, provide a means for momentarily back flushing the peritoneal catheter 13~ This is accomplished by just fully compressing the conduit portion 25 thereby éffectively ~locking flow through the valving elements and then compressing the antecham~er itself so as to generate a momentary back~low.
The antechAm~er also provides a convenient means for drawing off samples of ascitic fluid for analysis, For this purpose the antec~am~er is constructed of a flexi~le silicone ru~ber which tends to ~e self sealing with regard to needle punctures, The bottom of the antecham~er has a metal needle stopper, The fac~ that this system can ~e separated into its different components i.e~: peritoneal cathet~er 13, distal tube 20~ valve unit 19, atrial catheter 22, and connectors 12 and 23;
makes an~ surgical revision simple since there is no need to remove t~e ~hole system., hut only the failing part, B~ proper ~5- .
~2408 1 use of the antechamber and the valve pumping chamber, a failure along the system can be easily located.
In vie~ of the foregoing, it may ~e seen that several o~jects of the present invention are achieved and other advan-tageous results have ~een attained.
As various changes could ~e made in the above construc-tions uithout departing from the scope of the invention, it should ~e understood that allmatter contained in the a~ove description or shown in the accompan~ing drawings shall ~e interpreted as illustrative and not in a limiting means~
nal mechanism. Other objects and features will be in part apparent and in part poin.ted out hereinafter, BRIEF DESCRIPTIO~ OF THE DRAWING
Fig. 1 is a schematic representation of a patient assumed to be suffering from ascites and illustrates the placement of the apparatus disclosed herein;
S ~S2408 1 Fig. 2 is a view, partially in section, of the overall arrangement of the shunt system disclosed herein;
Fig. 3 is a view, partially in section, of the construction of the shunt valve unit; and Fig. 4 is a side sectional view of the shunt valve disclosed herein, and appears on the same page as Figure 1.
BRIEF DESCRIPTION OF THE PREFERRED EMBODIMENT
Referring n~w to Fig. 1 a patient,assumed to be suf-fering from ascites, is indicated generally by reference charac-ter 11. In accordance with the practice of the present invention - la -r p~ .
1 ~ r;;~408 1 a perforate inlet catheter 13 ~eritoneal catheter~ is surgically introduced into the peritoneal cavity of the pa~ient, through an a~dominal incision 14, so as to provide a means for drawing off accumulated ascitic fluid~ Peritoneal catheter 13 is con-nected ~y means of a strai~ht connector 12, and a proximal tu~e 15 to an antecham~er 17 and valve unit 1~ described in greater detail hereinafter, which is implanted in a su~cutaneous pocket surgically formed over the patient's sternum 16, Proximal tu~e 15, antecham~er 17, and the valve unit lQ are implanted through a subcutaneous tunnel in accordance with conventional surgical procedures. After passing through valve unit 19, the ascitic fluid is directed into the central venous system through the distal tube 20 and atrial catheter 22. In contrast with more conventional systems, the distal tu~e 20 and atrial catheter 22 are of relatively small diameter, This small diameter facilitates a simpler mode of implantation wherein the distal tu~e is led, through a subcutaneous tunnel up to the patient's neck where a small cervical incision is made 21, Working through this incis-ion 21, the atrial catheter 22 i9 inserted into the exterior jugular vein as indicated at 24. The length of the atrial cath-eter 22 is such to allow its tip to extend, from the point of introduction at the external jugular vein, down the superior vena cava into the patient's right atrium. After this placement, the atrial catheter 22 and the distal tu~e 20 are trimmed at the cervical incision and connected ~y the U-shaped connector 23, The introduction of the atrial catheter into the external jug-ular vein is again made possi~le owing to the relatively small diameter of the catheter, Leaving the tip of the catheter with in the right atrium inhibits ingrowth and eventual blockage of the catheter such as would occur if it were terminated near the 1 point at which it enters the venous system. The overall arrange-ment of the shunt system is illustrated in Fig. 2 in greater detail and the actual construction of the valve unit 19 is illustrated in Fig. 3.
In accordance with the concepts of the present inven-tion, the valving unit 19 comprises two pairs of one-way valves ~hich are connected in series through a flexible conduit. In the preferred embodiment illustrated, four identical one-way valve elements 31-34 are employed in a series-parallel arrange-ment in a flexible silicone rubber housing 35 i.e. valve element31 is in parallel with valve element 32 and this parallel pair is in series with a second parallel pair of elements 33 and 34.
The series connection is established by an elongate section 37 of the silastic rubber valve housing 35. This section 37 func-tions as a deformable conduit for purposes explained hereinafter.
Each of the valve elements 31-34 is generally of the type disclosed in U.S. Patent 3,288,142. This construction, illustrated in Fig. 4, employs a rigid base S1 in which is formed a conical valve seat 53 connected to an inlet port 55.
A rigid spherical valving element 57 is biased into the conical seat by a convoluted cantilever spring S9 which is secured to the base 51, e.g. by spot welding. A cylindrical shell 58 encloses the base 51, valving element 57 and spring 59 so as to facilitate its being held within the,overall valve assembly body 35. Another suitable form of valve element is that shown in U.S. patent number 4,332,255. In each case, the one way valv-ing is accomplished by a rigid or hard valving element (biased against a rigid seat). This is preferred over so~t valving elements e.g. such as those formed of silastic rubber, in that the hard surfacesare better suited for making a seal, even in , .~ .
., ~5;~4Q8 1 the presence of protein materials which might come to rest at the valving surface~ If complete closing is not o~tained some highly undesirable back flushing from the venous system may occur.
In addition to providing a larger total flow path the paralleling of valving elements is a greater protection against clogging since, even if one valving element s~ould clog, its parallel counterpart will typically ~e adeqùate to pass a ~enefi cial quantity of the ascitic fluid~
As noted previously, t~e valve assem~ is pre-fera~ly secured e,g, in a suitable subcutaneous pocket, at a point over the patient's sternum, With the valving element assembly 19 so located, it i8 possible for the patient himself or his physician to effect the actual pumping of fluid from the peritoneal cavity to the central venous system ~y manually press-ng against the valve assembly and there~y periodically collaps-ing or compressin~ the flexi~le conduit portion 37 ~etween the two pairs of paralleled valving elements. As will ~e understood, compressing this section will expell fluid through a downstream valvlng element, i,e., into the venous system, while releasing the manual pressure and allowing the conduit to assume its normal shape will draw fluid into the valving unit through the upstream valves i~e. the valving elements nearest the inlet tu~e in the peritoneal cavity~ The availability of this pumping procedure not only frees the patient from the tiresome exercises otherwise involYed in generating a negative pressure within the chest and a positive pressure in the peritoneal cavity. The valving elements and the small bore jugular catheter also can be effect-ively flushed by the pumping actions so that protein deposits w~ich might other~ise tend to clog the system can be effectively ~2408 1 cleared. In prior art systems where no such pumping action is available, it has ~een necessary to employ relatively large kore tu~ing for the venous catheter, This large size cannot--~e routed up to the external jugular as can the present system nor can it be then allowed to extend along the jugular internally to a lo-cation of such that the atrium ~here the danger of tissuing growth essentiaily absent. As indicated previously, it is highly advan-tageous to have the catheter enter the external jugular since it is much easier to accomplish insertion of the catheter at this point on the patient's neck.where this large vein is close to the surface, This easier access often means that the procedure can be performed under a local anesthesia rather than requiring the application of general anesthesia to a patient who may al-ready he considerably ~eakened ~y his illness~
The antecham~er 17, being similarly accessi~le near the surface of the patient, provide a means for momentarily back flushing the peritoneal catheter 13~ This is accomplished by just fully compressing the conduit portion 25 thereby éffectively ~locking flow through the valving elements and then compressing the antecham~er itself so as to generate a momentary back~low.
The antechAm~er also provides a convenient means for drawing off samples of ascitic fluid for analysis, For this purpose the antec~am~er is constructed of a flexi~le silicone ru~ber which tends to ~e self sealing with regard to needle punctures, The bottom of the antecham~er has a metal needle stopper, The fac~ that this system can ~e separated into its different components i.e~: peritoneal cathet~er 13, distal tube 20~ valve unit 19, atrial catheter 22, and connectors 12 and 23;
makes an~ surgical revision simple since there is no need to remove t~e ~hole system., hut only the failing part, B~ proper ~5- .
~2408 1 use of the antechamber and the valve pumping chamber, a failure along the system can be easily located.
In vie~ of the foregoing, it may ~e seen that several o~jects of the present invention are achieved and other advan-tageous results have ~een attained.
As various changes could ~e made in the above construc-tions uithout departing from the scope of the invention, it should ~e understood that allmatter contained in the a~ove description or shown in the accompan~ing drawings shall ~e interpreted as illustrative and not in a limiting means~
Claims (2)
1. Apparatus for treating a patient suffering from ascites, said apparatus comprising:
a perforate inlet catheter adapted to be implanted in the peritoneal cavity of the patient;
a drainage catheter adapted to be inserted into the patient's central venous system; and connecting said inlet catheter to said drainage catheter, a valve assembly comprising two pairs of one-way valves, the valves in each pair being in parallel with the pairs being connected in series through a flexible conduit, the conduit being deformable by manual pressure to effect pumping of ascitic fluid from the peritoneal cavity to the venous system.
a perforate inlet catheter adapted to be implanted in the peritoneal cavity of the patient;
a drainage catheter adapted to be inserted into the patient's central venous system; and connecting said inlet catheter to said drainage catheter, a valve assembly comprising two pairs of one-way valves, the valves in each pair being in parallel with the pairs being connected in series through a flexible conduit, the conduit being deformable by manual pressure to effect pumping of ascitic fluid from the peritoneal cavity to the venous system.
2. Apparatus as set forth in claim 1 further comprising a flexible antechamber interposed between said inlet tube and said valve assembly, said antechamber being essentially self-sealing for hypodermic needle punctures.
Applications Claiming Priority (2)
| Application Number | Priority Date | Filing Date | Title |
|---|---|---|---|
| US046,947 | 1979-06-08 | ||
| US06/046,947 US4261341A (en) | 1979-06-08 | 1979-06-08 | Method and apparatus for the treatment of ascites |
Publications (1)
| Publication Number | Publication Date |
|---|---|
| CA1152408A true CA1152408A (en) | 1983-08-23 |
Family
ID=21946238
Family Applications (1)
| Application Number | Title | Priority Date | Filing Date |
|---|---|---|---|
| CA000353261A Expired CA1152408A (en) | 1979-06-08 | 1980-06-03 | Method and apparatus for the treatment of ascites |
Country Status (7)
| Country | Link |
|---|---|
| US (1) | US4261341A (en) |
| CA (1) | CA1152408A (en) |
| DE (1) | DE3020991A1 (en) |
| FR (1) | FR2458287B1 (en) |
| GB (1) | GB2055294A (en) |
| NL (1) | NL8003261A (en) |
| SE (1) | SE8004211L (en) |
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| US3496878A (en) * | 1967-04-07 | 1970-02-24 | Bio Medical Systems Inc | System and apparatus for transfer of human fluids |
| US3566868A (en) * | 1968-08-26 | 1971-03-02 | American Hospital Supply Corp | Parenteral liquid administration set with injection site and method of making same |
| US3669094A (en) * | 1970-07-06 | 1972-06-13 | Heyer Schulte Corp | Device and method for measuring intracranial pressure |
| US3910283A (en) * | 1973-10-09 | 1975-10-07 | Harry H Leveen | Process for treatment of ascites and device to accomplish same |
-
1979
- 1979-06-08 US US06/046,947 patent/US4261341A/en not_active Expired - Lifetime
-
1980
- 1980-06-03 DE DE19803020991 patent/DE3020991A1/en active Granted
- 1980-06-03 CA CA000353261A patent/CA1152408A/en not_active Expired
- 1980-06-04 GB GB8018313A patent/GB2055294A/en not_active Withdrawn
- 1980-06-04 NL NL8003261A patent/NL8003261A/en unknown
- 1980-06-05 SE SE8004211A patent/SE8004211L/en unknown
- 1980-06-06 FR FR8012654A patent/FR2458287B1/en not_active Expired
Also Published As
| Publication number | Publication date |
|---|---|
| SE8004211L (en) | 1980-12-09 |
| NL8003261A (en) | 1980-12-10 |
| DE3020991C2 (en) | 1989-01-05 |
| US4261341A (en) | 1981-04-14 |
| FR2458287A1 (en) | 1981-01-02 |
| FR2458287B1 (en) | 1986-08-22 |
| DE3020991A1 (en) | 1980-12-18 |
| GB2055294A (en) | 1981-03-04 |
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Legal Events
| Date | Code | Title | Description |
|---|---|---|---|
| MKEX | Expiry |