US2478876A - Automatic intermittent bladder irrigator - Google Patents

Description

Aug. 9, 1949. O.'A. NELSON AUTOMATIC INTERMITTENT BLADDER IRRIGATOR Filed May 10, 1948 INVENTOR. OLE A. NELSON ATTORNEYS Patented Aug. 9, 1949 opener-i AUT MATIC .IQNTERMITTENT BLADDER v mmGA'mR Ole A. Nelson,*Sea-ttle, Wash. Appli a ion May in, 1948,, Seria No- 25486 As a result of disease or injury to the nerves or muscles that control the function of the urinary bladder, the patient is frequently unable to voi hence artificial means must be used to empty the bladder. 7

The c nd tion t at ca s s u ogenic v si al obstruction varies from irreparable damage to the spinal cord to'temporary malfunction from shock or operation upon pelvic or abdominal ore ans. Under such conditions the closer the man: made or artificial Way to urinate comes to simulating the normal physiological process of void: ing, the less will the damage be iromyesical obstruction. Irreversible damag o the kid ys and heart is the sequela if vesical obstruct-io is 7 severe or of lon standi g.

By alte nately fill n nd mp ing he bladd r, at regularintervals, many patients who have para ysi from sp nal c rd inj ry eve op an automatic bladder. This means that the blad-I der. will fill to a certain degree of distension and mpty i lf even th h the p nal c rd is s ereol so that no nerve impulses can go from the brain to the ne ronius la struct es the bladder. Therefore, such a patient can be re habi atod o a on iderable ree. 7 'An automatic intermittent irrigator is of value:

ii) To re i v osi al bstru ion- (2) To exercise the mus le of the bladde y Pe odi d st ti and eleasin atul bladder. 3) To r igate th bladder w t ant biot c s lutions to control infection. 7

While there are devices int ndc to enabl s ch pe i dic vacuati n or rrigation of he bladd r, exp rien e has d m nstr ed that t s devi es 11-2 Claims. (01.- lac-227) shoe o d smant ing, cy the nurses r d r ie on duty, w thout more than rout e t i ing,

. Acc rdin ly, it is a p imar j c of th s i vention t pr vid a evi e Whi hhas a p sitive act n the nature o an autom ti r s or, capab e of interm ttent or p riodica op a ion, which is simpl an c nven e t to p e in operation; and t adins for troub e-tree pera ion over long p riods of time it s a so an bject to provi e an irr gator of the c ara er m ntioned wher n adjust ent way be on eni n y a compli hed, to r gula e the o flow, and the periodic ty f the aut matic i n, n such manne as w l est t the needs o vari us patients :It is a s an e t to pr vid in such n irr sato a ip r control there or det rmi ati e oil th periodic ty of. operation, which is o suc on truction a to in ure su stantially compl t are so de i e in adjust n and so ppar ntly cli ific lt to set and djust cor e t that p rs ns specially ski l d in s doin mu t b onstantl available in the hospital, as disturbances of adjustment are of frequent occurrence because of the necessity of the nurses and orderlies caring for the physical wants of the patient. Since it is inconv n n a s me imes impo s e, e en in hospitals, f r p rs ns so pecia s lled o be always available or to be free to attend to such evacuation locior shuttin of the d ainaeoflo 'It is, o urse, o oiect to ro ide s ch an i riea or is ortable and ead l t an port d from one loca to a oth for he isn c ssiye pati s as reonired- 1 a sti l inrth r ob ec is th prov s on o t of thisna nr whi h is cons-tr ed'in th rnain o i ple p r s, eadil a a le in hospita and e sily tak n part .for steril zat on or im lar pu pose and. as read ly sot up again r ope a on w thout li elihood o maladjustment, 7 W th such obj cts hino, and thers s will appear h r na ter, this nven i n m i es he hote rrisa o and the novel con truction and arr ement of the arts th reof a h wn th accompanying drawings, and as will b more inlly in ribed h reina ter, and h pr nciples whereof will he define n the appended claims.- n the accompanying drawin s, the i vention hown emb d a rep esentativ form, and it w ll h unders od that he form; character and arrangement o the par s may be varied as, conditions may -eouire, within t p inci es hereinthings at the time When attention is needed, and 7 yet regularity of voiding is essential to the .estabs lishmen o he a mati bla de in s ch cases, it is extremely desirable to provide mecha-. nism to acco sh uch rr gatio and e u tion wh h is so s mpl and subs a t l y anti matic i t p ratio 'that n at sk l is re: qni ed to ad ust it and s t whe o e, o ce set, it is n ubject to di turbance, and it can be set u an i adjusted initial y, or a ter is urb= otte ma e c ean i .Eisjore i is a side elevational view of tho irri= ator, shown in o e at ve relationship to a pa.- tient with i s arts n l qni supplyr ins posit ns, nd figur 2 is a si ilar view, parts being emitted, not showing the per ti e p ts, dr ining posi oni Figu e 3 is a e on o the ca et r and th bra ch ducts ad n thereto and the efro and Figure is a detail secti na view o a typ cal valve niechani n r s ch i ig t on produced by the id o a o th: oter l wh h s ins rte into the patie bladder,-

Liquid for irrigation or medication is supplied from a suitable source, such as the elevated tank 2, by means of a duct 2| leading to the catheter by way of a Y-branched fitting 22, to one branch of which the duct 2| connects, to another branch of which the catheter l connects, and from the third branch of which extends a liquid outlet duct 32. The latter should trenddownwardly for good drainage.

Sup-ported at a level above the patient but below the liquid supply tank 2 is a liquid receiver 3. Below it, at a level somewhat below the level of the catheter l is a T-fitting 3|,to one branch of which connects the liquid outlet duct 32. riser duct 33 extends from a second branch of the T-fitting 3! to the bottom of the receiver 3. From the third branch of the T-fitting 3! a drain duct 4 extends generally downwardly. The lower end of the drain duct 4 extends to a waste drain or to'a collector, such as the jug 5, which rests upon the floor andwhieh serves to indicate or as a measure of the liquid output or the patent.

, intermediate the ends of the drain duct 4 is a valve, generally indicated by the numeral 40. Since the several ducts already mentioned are preferably lengths of rubber tubing, the valve 40 may be merely a loop in the drain duct 4,. together with means for pinching the loop upon itself to close, or for permitting the loop to expand so that passage of liquid is unrestricted. It is shown in detail in Figure 4, and is of a type commonly used in hospitals. It will be understood, of course, that this is only a fonnfi which is convenient, and that any other suitable type of valve mechanism may be used in lieuthereof. As the means for opening and closing the valve T have shown a sleeve 4! encircling the loop at one point and a link 42 extending upwardly from sleeve iii, and by its movement upwardly accomplishing closing of the valve, and by its downward movement opening the valve.

The entire mechanism is conveniently supported from the stand 6 that rests upon the floor, supporting for vertical adjustment a tubular post 69, the latter in turn supporting for vertical adjustment a rod 6 I, having a gooseneck at its top terminating in a hook 62 whereon is hungthe supply tank 2. Upon the post 6!], and vertically adjustable thereon so that it will always be located below the catheter level, is an arm 63, the adjustment being accomplished by means of the collar and set screw at 64, and this arm supports the T-fitting 3i and a guide 43 for" the link 42, as also a shield 44 for the valve.

Supported tiltably at El! near the upper end of the post 69 is a tiltable lever 1 whereon, through the medium'of a hook 13, is supported the receiver 3, and to which is connected the upper end of the link 42. The receiver 3 is supported at one side of the tilting pivot 10, and on the opposite arm of the lever l is adjustably supported a counterwight H, the adjustment being indicated as by means of a sleeve and set screw at 12. Preferably this counterweight is of particular type, that is to say, it is an elongated tube extended lengthwise of the lever l and filled with a heavy liquid, such as mercury. By such an expedient as this, when the lever is tilted as far in one direction as engagement of the sleeve 4! with the shield 64 will permit, as shown in Figure 1, the mercury ,col-lects near the outer end of the tube H, and it requires a considerable weight of water collected in the receiver 3 to overbalance the mercury and to tilt the lever 1 to open the valve 40. However, once the lever I has been thus tilted from the position of Figure 1 to that of Figure 2', and is stopped by engagementwith the stop 11, the mercury will run to the inner end of the tube H, lessening its mechanical ad vantage, and it will now require thatsubstan tially all the liquid drain from the receiver 3 before the counterweight will again overbalance the arm 1 and tilt it in the opposite sensa to close the valve 40. is assured substantially com plete drainage of the receiver 3, and as will shortly be explained such drainage can occur only coincident with or after substantially complete evaci'nation of the patients bladder, and so full and and complete evacuation is assured automatically.

' substituted therefor, for the aim is to deter or prevent opening of the valve until a substantial quantity of liquid has collected in and distends the bladder and also arises to collect in the re- .ceiver 3. Then, when so much liquid has collected, full and substantially complete evacuation thereof is desired before the valve is again closed.

It will be observed that there is a tube clamp 35 in the riser duct 33 just below the receiver 3, and there is also a tube clamp 25 in the liquid supply duct 2! just below the liquid supply tank 2. These function as metering valves, andactual valves or cocks might be substituted therefor. The clamp regulates the supply of liquid from the tank 2 generally to a low rate, drop by drop, and the rate of supply can be observed in the sight glass 25 which is inserted in the supply duct 2! below the clamp 25. The clamp 35 does not greatly impede the rise of liquid into the receiver 3, but serves to slow down the rate of discharge from the receiver, so that that rate is less than the rate of discharge by way of the outlet-duct 32 and drain-4i.

In use, after the catheter i has been inserted into the patients bladder, its free end is connected to the Y-fitting 22. The arm 63 is adjusted upwardly or downwardly on the post 6|], as may be necessary to locate the T-fitting SI and the valve 40 at a level below the catheter. The post fill is adjusted vertically in the stand 6 to locate the receiver 3 at the desired elevation above the catheter. The elevation of supply tank 2 is not particularly critical, since the liquid is supplied therefrom rather slowly, as determined by the pinch clamp 25. Adjustment of the clamp 35 is made as may be necessary, primarily for the purpose of slowing down discharge from the receiver 3. It is important, of course, that the riser duct 33 be not closed completely, in order that a suincient quantity of liquid may collect therein in the predetermined time to overbalance the counterweight ll None of these adjustments are particularly critical, hence require no special skill to accomplish, for the rate of liquid supply as determined by the clamp 25 can be determined by sight in the sight glass 2G, and otherwise it is only necessary to observe that the T-fitting 3| is below the level of the catheter and the receiver 3 is at a level somewhat above the catheter. It may readily be determined whether the clamp 35 is closed down too much, and it is unlikely that it will be closed too little.

Now liquid is supplied to the supply tank 2, and

the closed valve 40 and then it will back up into the riser 33, this is only when initially setting the system into operation. Thereafter it will begin to collect within the bladder, entering by way of the catheter I, and eventually the bladder will be distended and the liquid, having no other place to go, will begin to rise into the receiver 3. When sufiicient liquid has collected in the receiver that its weight overbalances the counterweight H the lever l tilts, and, as shown in Figure 2, the valve to opens. Liquid begins to drain from the liquid outlet 32 and drain 4 into the waste receiver 5, and of course, liquid may drain by way of the riser 33 into the drain duct 4, but because of the restriction at 35 in the riser 33 the liquid drains more slowly from the receiver 3' than from the liquid outlet duct 32, and in consequence the bladder will be completely evacuated before sumcient liquid has drained from the receiver 3 to permit the counterweight H to tilt the lever 1 back into the Figure 1 position. As soon as sufficient liquid has drained from the receiver 3, the lever 1 will tilt back, closing the valve 40 and the cycle recommences. The periodicity may be anything desired, but ordinarily the parts will be so adjusted as to effect evacuation approximately once each hour.

While liquid will continue to drop from the supply tank 12 during drainage, the rate of supply, as determined by the clamp at 25, is so low that there is no appreciable waste of liquid on this account. It will be understood that the liquid at 2 may be clear water or may be a medicated solution.

I claim as my invention:

1. A bladder irrigator of the character described comprising, in combination with a catheter, a liquid receiver supported at a level above the catheter, a first duct interconnecting the catheter and receiver for discharge of liquid from the catheter into the receiver, following distention of the patients bladder, a downwardly trending drain duct connected to said first duct intermediate the latters ends, and affording means to drain the receiver and the bladder, a normally closed valve in said drain duct, means to supply liquid at a predetermined rate to the catheter, and means operatively interconnecting the receiver and the valve, and sensitive to the weight of liquid in the receiver, to retain the valve normally closed, but to open the valve when a suflicient weight of liquid has backed up in the 7 receiver from the catheter and the patients bladder.

2. A bladder irrigator as in claim 1, including means to regulate the rate of flow in the receiver- 'connected duct.

5. A bladder irrigator as in claim 4, wherein the counterweight is formed as a. liquid-filled tube extending lengthwise of the balance lever, to effect tilting and retention of the latter in each tilted position until a material change occurs in the weight of the receiver-contained liquid.

6. A bladder irrigator as in claim 4, including means to adjust the counterweight lengthwise of the balance lever, to vary the timing of valve opening.

7. A bladder irrigator as in claim 1, including means adjustable to vary the time interval between successive openings of the valve.

8. A bladder irrigator as in claim 1, including means to retain the valve in either open or closed position until a, substantial change has occurred in the weight of the receiver-contained liquid.

9. A bladder irrigator as in claim 1, including a liquid supply tank supported at a level above the catheter and the liquid receiver, and connected to the catheter, constituting the means to supply liquid to the catheter.

10. A bladder irrigator as in claim 9, and means to adjust the elevation of the supply tank relative to the catheter and the receiver.

11. A bladder irrigator of the character described comprising, in combination, a first tribranched fitting, a catheter connected to one arm of said fitting, a liquid supply duct connected to another arm, and a liquid outlet duct connected to the. third arm; a second tri-branched fitting connected by one branch to the other end of the liquid outlet duct, a drain duct connected to a second branch and extending thence downwardly to a drain, and a riser duct connected to the third branch of the second fitting and extending thence upwardly; a liquid receiver connected to the upper, opposite end of the riser duct, and located at a level above the catheter; a valve in the drain duct; and means operatively interconnecting the liquid receiver and the valve, and sensitive to the weight of liquid in the liquid receiver, to hold said valve normally closed, but to open the same upon collection in the liquid receiver of a predetermined weight of liquid.

12. A bladder irrigator as in claim 11, including a balance lever on one arm whereof the receiver is hung, a liquid-filled counterweight tube mounted on the opposite arm for adjustment lengthwise such arm, and a link interconnecting the balance lever and the valve, the whole constituting the operative interconnection between the receiver and the valve.

OLE A. NELSON.

REFERENCES CITED The following references are of record in the file of this patent:

UNITED STATES PATENTS Number Name Date 844,478 Spalding Feb. 19, 1907 1,794,404 I-Ierradora Mar. 3, 1931 FOREIGN PATENTS- Number Country Date 203,551 Switzerland June 16, 1939

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