RU234317U1 - PNEUMATIC ANALYZER OF BRONCHIAL FISTULAS - Google Patents

Abstract

The utility model relates to medicine, in particular to thoracic surgery, and can be used to detect the presence of air in the pleural cavity in order to identify a bronchial fistula in the early postoperative period in patients who have undergone surgical interventions on the lungs, namely pulmonectomy. The technical result is a reduction in the risk of postoperative complications due to the timely detection of a bronchial fistula in the early postoperative period. The technical result is achieved in that, according to the solution, a vane-tachometric flow meter is built into the drainage tube of a bronchial fistula pneumatic analyzer containing a Bulau siphon, having a housing inside which a rod with an impeller in the form of a blade wheel is located, made with the possibility of rotation, while a volumetric air flow sensor is installed inside the housing, connected to the rod and a digital panel on the housing for displaying the readings from the sensor. 2 fig.

Description

Field of technology

The utility model relates to medicine, in particular to thoracic surgery, and can be used to detect the presence of air in the pleural cavity in order to identify a bronchial fistula in the early postoperative period in patients who have undergone surgical interventions on the lungs, namely pulmonectomy.

State of the art

Pleural cavity drainage - insertion of a perforated drainage tube into the pleural cavity to evacuate pathological contents (exudate, blood, pus, air) is indicated for massive exudative pleurisy, pneumothorax, hemothorax, pleural empyema, chylothorax. Pleural cavity drainage is performed under local anesthesia through a trocar puncture of the chest wall and parietal pleura. The installed drainage is connected to an active aspiration apparatus or a Bulau siphon for passive outflow of contents. If necessary, periodic lavage of the pleural cavity with antiseptics and administration of drugs are performed (see https://www.krasotaimedicina.ru/treatment/pulmonology-procedures/thoracostomy).

Various devices are known from the state of the art that allow drainage of the pleural cavity (see https://mz-don.com/stati/pokazaniya-i-tehnika-punkcii-plevralnoj-polosti.html):

Redon's vacuum method uses a medical bottle, hermetically sealed with a nylon cap. The bottle contains boiling water. The bottle is connected to a drainage tube, and during the cooling process of the water, self-outflow occurs inside the pleural accumulations. This method allows you to remove about one hundred and eighty milliliters of fluid.

Subbotin's method uses two sealed vessels, which are fixed one under the other. There is a tight connecting tube between the vessels. The upper vessel contains water, the lower one is empty. Under the influence of gravity, water gradually flows from the upper vessel to the lower one, creating a vacuum that allows all excess pleural fluid to be pumped out.

In the closed vacuum method - a hermetically sealed container and a Janet syringe are used. Air is pumped out using a syringe. The tube is connected to a hermetically sealed container and the liquid is vacuum pumped out. It is important to create a perfectly hermetically sealed space in the vessel.

Active aspiration is the most effective method, which involves the use of a water jet or electronic pump. The peculiarity of this method is not only the effective pumping of liquid, but also the rapid contraction of the technological wound.

A device for drainage of the pleural cavity according to Bulau is known (see https://gkmk.ru/files/-/gUYYjl9LVeIGDLFKMMR8jQ/sv/document/39/2b/e6/333334/240/i_remizov_osnovy_reanimatologii%20%282%29.pdf?1468844196), containing a container with a sealed rubber stopper, into which two hollow tubes are inserted: a long one lowered into the liquid, and a short one located above the liquid. Drainage tubes extend from the outside of the tubes.

However, the above devices are not equipped with a function to detect (signal) the presence of air in the pleural cavity, but are only capable of evacuating excess pleural fluid from the cavity.

A device is known for determining the localization of a bronchus (see patent RU 104435, IPC A61B 1/267, published 20.05.2011) ventilating a section of the lung parenchyma bearing a bronchopleural fistula, comprising a fiber bronchoscope with a Levin valve attached to it, and a sealed jar. In order to increase the accuracy of determining the localization of one or more bronchi ventilating a part of the lung parenchyma bearing a bronchopleural fistula, the device is equipped with a silicone tube, one end of which is attached to the outer end of the instrument channel of the fiber bronchoscope, and the other is placed in a sealed jar, to which a second tube is also hermetically connected, an expandable rubber or plastic container is hermetically attached to the end of which, located in the cavity of the jar, and a device for pumping air and monitoring its pressure (a rubber bulb and a pressure gauge) is attached to the outer end of the same tube.

However, in case of multiple fistulas, it is impossible to determine their localization using this device. This is explained by the fact that when one of the fistulas is obstructed (blocked), air comes from other fistulas into the pleural cavity. In this case, the obstructed bronchus is considered as one through which air does not escape into the pleural cavity. Thus, it can be concluded that the device has a limitation on the number of fistulas, since it does not allow for their precise localization.

Revealing the essence

The technical problem is to develop a device designed for the timely detection of air formation in the pleural cavity in order to identify bronchial fistula in the early postoperative period in patients who have undergone lung surgery.

The technical result is a reduction in the risk of postoperative complications due to the timely detection of bronchial fistula in the early postoperative period.

The technical result is achieved in that, according to the solution, the pneumatic analyzer for bronchial fistulas contains a Bulau siphon, including a container with a lid, long and short hollow tubes fixed in the lid, a rubber valve to prevent backflow, located on the long hollow tube inside the container, drainage tubes extending from the hollow tubes, a vane-tachometric flow meter, a rod with an impeller in the form of a paddle wheel made with the possibility of rotation, a volumetric air flow sensor made with the possibility of detecting the formation of air in the pleural cavity, and a digital panel made with the possibility of displaying indicators from the volumetric air flow sensor, wherein the rod with the impeller and the volumetric air flow sensor are located in the housing of the vane-tachometric flow meter, and the digital panel is mounted on the housing of the vane-tachometric flow meter, wherein the volumetric air flow sensor is connected to the rod with impeller and digital panel, and the impeller-tachometric flow meter is built into the drain pipe.

Brief description of the drawings

The utility model is illustrated by drawings, where Fig. 1 shows the claimed device, and Fig. 2 shows the design of a vane-tachometric flow meter.

The following positions are indicated on the drawings:

1. capacity;

2. lid;

3. hollow tube;

4. drainage tube;

5. vane tachometric flow meter;

6. flow meter body;

7. rod with impeller;

8. air flow sensor;

9. digital panel.

Implementation of a utility model

The claimed device comprises a Bulau bellows, which has a glass container 1 with a lid 2 (Fig. 1). In the lid 2, two openings are made in which two hollow tubes 3 are tightly fixed - a long one and a short one. Inside the container, on the long tube, there is a rubber valve to prevent backflow of the contents. Drainage tubes 4 extend from the outside of the tubes 3. A vane-tachometric flow meter 5 is built into one of the drainage tubes, having a housing 6, inside which a rod with an impeller 7 in the form of a blade wheel is located, made with the possibility of rotation for capturing and displaying the volume of air flow from the pleural cavity (Fig. 2). Inside the housing 6, an air flow volume flow sensor 8 is installed, connected to the rod and a digital panel 9, made in the housing 6. The air flow volume flow sensor 8 measures the air flow speed and transmits data to the digital panel 9.

Hollow tubes 3 and drainage tubes 4 are made of silicone or polyvinyl chloride.

The vane-tachometric flow meter 7 records the air flow in ml/min.

During operation, the long hollow tube 3 should be lowered into the liquid (sterile water), and the short one should be above the liquid.

The claimed device operates as follows.

For the puncture, the patient is placed in a lying or sitting position. The doctor determines the place for the drainage. Then, with a marker, the puncture site is marked and the site is treated with a local anesthetic. The needle is inserted along the upper edge of the rib so as not to damage the vessels and nerves located at its lower edge. When the needle reaches the pleural cavity, the feeling of elasticity and resistance when inserting the needle into the soft tissues is replaced by a dip into the void. Air bubbles or pleural contents in the syringe indicate that the needle has reached the puncture site. The doctor sucks out a small amount of effusion (blood, pus, or lymph) with a syringe for visual analysis. The drainage tube of the claimed device is carefully and quickly inserted into the intercostal space, fixing it with a U-shaped suture. The drainage tube is fixed stably along the body to ensure self-outflow of fluid into the container. The puncture is performed under local anesthesia. In the presence of a fistula, air from the pleural cavity under pressure enters the vane-tachometric flow meter. The impeller makes slight rotational movements under the pressure of the moving flow. When a bronchial fistula appears, the claimed device records the movement of air from the pleural cavity - the air flow volume flow sensor sends a signal, which allows for timely detection of air formation in the pleural cavity, while the digital panel allows for convenient monitoring of the air pressure value in the pleural cavity. The impeller rotation speed is proportional to the air flow speed from the pleural cavity. The presence of a fistula is diagnosed by the start of impeller rotation with air from the pleural cavity and the transmission of a signal to the air flow volume flow sensor, which then transmits information to the digital panel, which displays the digital value of the air flow volume. The air flow volume should not exceed 500 ml/min.

Examples of application of the claimed device from surgical practice.

Example 1.

Patient: a 58-year-old man, condition after left-sided pneumonectomy for lung cancer. In order to promptly detect possible air formation in the pleural cavity, the patient had the claimed device installed intraoperatively along the midclavicular line between the 3rd and 4th ribs (2nd intercostal space) along the upper edge of the lower rib, according to the method described above. Then sterile water was poured into the container. The patient was left to rest. A nurse conducted dynamic monitoring of the patient's health indicators. Two hours after the pneumoanalyzer was installed, the air flow rate sensor signaled that the air pressure value in the pleural cavity had changed. The nurse saw on the digital panel the gas volume value exceeding 500 ml at a rate of 27 ml/min. The patient urgently underwent fibrobronchoscopy. A bronchial fistula was detected.

Example 2.

Example 2 is similar to example 1, with the difference that the patient is a 45-year-old woman, with a condition following right-sided pneumonectomy for a lung abscess. 2 hours and 35 minutes after installing the pneumoanalyzer, the air flow sensor signaled that the air pressure in the pleural cavity had changed to 600 ml at a rate of 36 ml/min. The patient underwent emergency fibrobronchoscopy, which revealed the formation of a bronchial fistula.

Thus, the claimed device allows monitoring of air pressure values in the pleural cavity and timely detection of the formation of a bronchial fistula in the early postoperative period in patients who have undergone surgical interventions on the lungs.

Claims (1)

A pneumatic analyzer for bronchial fistulas, comprising a Bulau siphon, including a container with a lid, long and short hollow tubes fixed in the lid, a rubber backflow prevention valve located on the long hollow tube inside the container, drainage tubes extending from the hollow tubes, a vane-tachometric flow meter, a rod with an impeller in the form of a paddle wheel designed to rotate, a volumetric air flow sensor designed to detect the formation of air in the pleural cavity, and a digital panel designed to display readings from the volumetric air flow sensor, wherein the rod with the impeller and the volumetric air flow sensor are located in the housing of the vane-tachometric flow meter, and the digital panel is mounted on the housing of the vane-tachometric flow meter, wherein the volumetric air flow sensor is connected to the rod with the impeller and the digital panel, and the vane-tachometric flow meter is built into the drainage tube.