Management and monitoring of chest tube drainage systems is a crucial part of the care of many patients with chest diseases and can prove to be challenging. Chest tube drainage systems are routinely used to remove blood, fluid, and air from the pleural space. Air leaks are one of the most prevalent complications related to chest tube use after many common surgical procedures (such as pulmonary resections) and have been associated with increased length of stay and morbidity. Conventional chest tube drainage systems typically have a chest tube that is connected to a collection system which includes a drainage collection chamber, a water seal chamber, and a suction control chamber.
One of the primary functions of the water seal chamber is to visually detect pulmonary air leaks. However, detection of air leaks is completely subjective and is highly variable amongst medical professionals. An experienced surgeon/observer can easily discern air leakage through the chest tube system, and currently, air leaks are typically visually detected by a trained observer, such as a surgeon. However, such highly trained individuals are available to monitor air leakage for only a few minutes each day. Furthermore, there are few other qualified hospital personnel outside of thoracic specialists trained to reliably detect and manage ongoing or changing air leaks. The lack of knowledge as to variations and changes in air leakage and the uncertainty as to resolution of these leaks leads to longer hospitalization than often necessary, since a “wrong” decision or judgment can lead to life-threatening consequences. Recently, systems such as the collection system marketed under the tradename Thopaz (Medela Inc., McHenry, Ill., USA) have been introduced that consist of a drainage system used to remove air and liquids, similar to common chest tubes. They have the additional feature of air flow and pressure detectors to provide clinicians with information regarding the presence and extent of air leakage, and claim the ability to indicate the presence of a pneumothorax inside the chest. Such devices are also designed to alert hospital staff in a rare case of a needed intervention. These devices are dedicated systems, and require the purchase of a completely new electronic drainage and monitoring system, which further requires a significant commitment to personnel training.
In addition, when a patient takes a deep breath followed by exhalation, an oscillation occurs at the water level within the water seal chamber. This oscillation corresponds to back and forth displacement of air without actually having a leak or bubble. Conventional in-line flow meters suffer from the inability to discriminate between detecting these oscillations versus detecting bubbles.
What is needed in the art is a device and method for automatically and objectively detecting air leaks in a chest tube drainage system. Further, what is needed is a device and method that is compatible with a variety of conventional chest tube drainage systems as an “add on” component. Finally, what is needed in a device and method for monitoring the water seal chamber that can discriminate between detecting oscillations versus detecting bubbles.
In one embodiment, a chest tube drainage system includes a chest tube collection system including a drainage collection chamber, a water seal chamber, a suction control chamber, and a water seal tube in fluid communication with the drainage collection chamber and the water seal chamber; and an air leak detection system including a light emitting element and a photodetector disposed near a bottom portion of the water seal tube so that the photodetector can detect reflected light emission generated by the light emitting element. In one embodiment, the reflected light emission is reflected off of a fluid in the water seal chamber. In one embodiment, the reflected light emission is reflected off of one or more bubbles in the water seal chamber. In one embodiment, the light emitting element is an LED. In one embodiment, the light emitting element is disposed closer to the bottom portion of the water seal tube than the photodetector. In one embodiment, the photodetector is disposed closer to a bottom of the water seal chamber than the light emitting element. In one embodiment, multiple photodetectors are deployed and some are used to subtract background noise. In one embodiment, the light emitting element and the photodetector are disposed on a securement device that is configured to attach to the chest tube collection system. In one embodiment, the securement device includes at least one of a clip and an adhesive. In one embodiment, the securement device is transparent. In one embodiment, the air leak detection system is configured to perform a fast fourier transform on the detected signal from the photodetector for determining when there is an air leak. In one embodiment, the air leak detection system includes high and low bandpass filters to pass frequencies of 20-30 HZ and 70-90 Hz.
In one embodiment, an air leak detection system includes a light emitting element and a photodetector disposed on a securement device configured to attach to a chest tube collection system; wherein the photodetector is configured to detect light emission reflected off of bubbles within the chest tube collection system. In one embodiment, the securement device is transparent. In one embodiment, the securement device includes at least one of an adhesive and a clip. In one embodiment, the light emitting element is an LED. In one embodiment, the light emitting element and the photodetector are disposed on the securement device so that when the securement device is attached to a chest tube collection system, the light emitting element is positioned closer to the bottom portion of the water seal tube than the photodetector. In one embodiment, the light emitting element and the photodetector are disposed on the securement device so that when the securement device is attached to a chest tube collection system, the photodetector is positioned closer to a bottom of the water seal chamber than the light emitting element. In one embodiment, the air leak detection system includes high and low bandpass filters to pass frequencies of 20-30 HZ and 70-90 Hz. In one embodiment, the air leak detection system includes an alert module configured to send a signal when a plurality of detected bubble events corresponding to the detected light emission reaches a threshold.
In one embodiment, a method of detecting an air leak in a chest tube collection system includes positioning a light emitting element and a photodetector near a bottom portion of a water seal tube, the water seal tube positioned within a water seal chamber of the chest tube collection system; emitting light from the light emitting element towards bubbles generated by air leaving the water seal tube; and detecting a reflection of the light using the photodetector. In one embodiment, the method includes the step of positioning the light emitting element closer to the bottom portion of the water seal tube than the photodetector. In one embodiment, the method includes the step of positioning the photodetector closer to a bottom of the water seal chamber than the light emitting element. In one embodiment, the method includes the step of detecting a bubble event corresponding to a threshold frequency rise in the 20-30 HZ and 70-90 Hz ranges. In one embodiment, the method includes the step of detecting a plurality of bubble events. In one embodiment, the method includes the step of signaling an alert when the plurality of bubble events reaches a threshold.
The foregoing purposes and features, as well as other purposes and features, will become apparent with reference to the description and accompanying figures below, which are included to provide an understanding of the invention and constitute a part of the specification, in which like numerals represent like elements, and in which:
It is to be understood that the figures and descriptions of the present invention have been simplified to illustrate elements that are relevant for a more clear comprehension of the present invention, while eliminating, for the purpose of clarity, many other elements found in systems and methods of optically detecting air leaks in a chest tube drainage system. Those of ordinary skill in the art may recognize that other elements and/or steps are desirable and/or required in implementing the present invention. However, because such elements and steps are well known in the art, and because they do not facilitate a better understanding of the present invention, a discussion of such elements and steps is not provided herein. The disclosure herein is directed to all such variations and modifications to such elements and methods known to those skilled in the art.
Unless defined otherwise, all technical and scientific terms used herein have the same meaning as commonly understood by one of ordinary skill in the art to which this invention belongs. Although any methods and materials similar or equivalent to those described herein can be used in the practice or testing of the present invention, the preferred methods and materials are described.
As used herein, each of the following terms has the meaning associated with it in this section.
The articles “a” and “an” are used herein to refer to one or to more than one (i.e., to at least one) of the grammatical object of the article. By way of example, “an element” means one element or more than one element.
“About” as used herein when referring to a measurable value such as an amount, a temporal duration, and the like, is meant to encompass variations of ±20%, ±10%, ±5%, ±1%, and ±0.1% from the specified value, as such variations are appropriate.
“LED” as used herein refers to light emitting diode.
“ROC” as used herein refers to receiver operating characteristic.
Ranges: throughout this disclosure, various aspects of the invention can be presented in a range format. It should be understood that the description in range format is merely for convenience and brevity and should not be construed as an inflexible limitation on the scope of the invention. Where appropriate, the description of a range should be considered to have specifically disclosed all the possible subranges as well as individual numerical values within that range. For example, description of a range such as from 1 to 6 should be considered to have specifically disclosed subranges such as from 1 to 3, from 1 to 4, from 1 to 5, from 2 to 4, from 2 to 6, from 3 to 6 etc., as well as individual numbers within that range, for example, 1, 2, 2.7, 3, 4, 5, 5.3, and 6. This applies regardless of the breadth of the range.
Referring now in detail to the drawings, in which like reference numerals indicate like parts or elements throughout the several views, in various embodiments, presented herein are devices, systems and methods for optically detecting air leaks in a chest tube drainage system.
In one embodiment, a chest tube drainage system includes a chest tube collection system including a drainage collection chamber, a water seal chamber, a suction control chamber, and a water seal tube in fluid communication with the drainage collection chamber and the water seal chamber. An air leak detection system includes a light emitting element and a photodetector disposed near a bottom portion of the water seal tube so that the photodetector can detect reflected light emission generated by the light emitting element. With reference now to
In certain embodiments, the light emitting element emits electromagnetic radiation in the visible light spectrum and in certain embodiments, the light emitting element emits electromagnetic radiation at wavelength that is not visible. In certain embodiments, the light emitting element emits electromagnetic radiation in an ultraviolet or an infrared wavelength. In one embodiment, the air leak detection system 10 includes an LED 60 and a photodetector 50 secured to a transparent housing of the water seal chamber 16. In one embodiment, the LED 60 and photodetector 50 are positioned near the bottom 32 of the water seal chamber tube 15. In one embodiment, the LED 60 is adjacent to the bottom 32 of the water seal chamber tube 15, and the photodetector 50 is positioned lower and spaced further away from the water seal chamber tube 15 than the LED 60. In certain embodiments, the LED and photodetector are spaced about 2 cm apart. In certain embodiments, the LED and photodetector are spaced between 0.5 cm and 3 cm apart. In certain embodiments, the water seal chamber 16 housing is transparent and the air leak detection system 10 is secured to the outside of the water seal chamber 16, so that light emitted by the LED 60 is reflected from the fluid in the water seal chamber 16, and detected by the photodetector. In certain embodiments, the LED and photodetector are positioned on the same surface of the water seal chamber housing. In certain embodiments, the LED and photodetector are positioned on adjacent sides or opposite transparent sides of the water seal chamber housing. When the LED and photodetector are positioned on opposing sides of the water seal chamber housing, according to one embodiment, the LED and photodetector are aligned so that interruption or refraction of detected light is indicative of bubbles in the water seal. In one embodiment, the light emitting element is disposed closer to the bottom portion of the water seal tube than the photodetector. In one embodiment, the photodetector is disposed closer to a bottom of the water seal chamber than the light emitting element. When air goes through the water seal chamber 16, the bubbles that rise diffract the emitted light from the LED 60, generating a signal in the photodetector 50. The placement of the air leak detection system 10 can be on the transparent area on the water seal chamber 16 that is normally used clinically to visibly detect air leaks. In certain embodiments, one or both of the LED and photodetector are water resistant, and are placed inside the water seal chamber 16 in contact with fluid. The LED can be substituted for another suitable light emitting element in the air leak detection system.
In one embodiment, the air leak detection system 10 is integrated into a clip 70 that attaches to a conventional off the shelf chest tube collection system as shown in
The refractive properties of bubbles within the water seal chamber are utilized to the advantage of the system, and a phototransistor captures changes in reflected light. In one embodiment, a method of detecting an air leak in a chest tube collection system includes positioning a light emitting element and a photodetector near a bottom portion of a water seal tube, the water seal tube positioned within a water seal chamber of the chest tube collection system; emitting light from the light emitting element towards bubbles generated by air leaving the water seal tube; and detecting a reflection of the light using the photodetector. In one embodiment, the method includes the step of positioning the light emitting element closer to the bottom portion of the water seal tube than the photodetector. In one embodiment, the method includes the step of positioning the photodetector closer to a bottom of the water seal chamber than the light emitting element. In one embodiment, the method includes the step of detecting a bubble event corresponding to a threshold frequency rise in the 20-30 HZ and 70-90 Hz ranges. In one embodiment, the method includes the step of detecting a plurality of bubble events. In one embodiment, the method includes the step of signaling an alert when the plurality of bubble events reaches a threshold. In one embodiment, multiple photodetectors are deployed and some are used to subtract background noise.
The signal detected by the photodetector can be processed through a software program. The software can be embedded on a portable device, or the photodetector and components of the system can communicate with software run on a remote computer through a wired or a wireless connection. In one embodiment, the software is embedded to make the system completely portable, such as an embodiment on a clip. In one embodiment, as shown in
Advantageously, embodiments of the device described herein are not sensitive to oscillation within the water seal chamber and the detection system only detects actual bubbles passing through the window. Since embodiments of the detector are based on change of refraction index and therefore change in reflection of light when a bubble goes through, the system is much more specific for detecting an actual air leak rather than mere fluctuations in water levels. Conventional in-line flow meters suffer from the inability to discriminate against these oscillations.
The invention is now described with reference to the following Examples. These Examples are provided for the purpose of illustration only and the invention should in no way be construed as being limited to these Examples, but rather should be construed to encompass any and all variations which become evident as a result of the teaching provided herein.
Without further description, it is believed that one of ordinary skill in the art can, using the preceding description and the following illustrative examples, make and utilize the present invention and practice the claimed methods. The following working examples therefore, specifically point out the preferred embodiments of the present invention, and are not to be construed as limiting in any way the remainder of the disclosure.
Through experimentation, it was demonstrated that the system is successful and accurate at being able to detect bubbles and air leaks within a chest tube drainage system. It has high predictive power under both the high and low bandpass filters. In certain instances, the high bandpass filter performed marginally better. Because the system exhibits excellent discriminant power and can automatically and objectively detect air leaks in clinic, its use could potentially result in decreased length of stay, lowered costs of care, and superior health outcomes for the patient.
In one embodiment, a bubble event registration system records the number of events per time period. For example, in certain embodiments, the computer system generates a time log of bubbles over the desired period of time that may be incorporated into clinical electronic health information systems to provide the surgeons/physicians with 24 hr monitoring of air bubbles. An alarm system to alert hospital staff in the case of irregular behavior also can be included. In certain embodiments, any deviation or change >50% from behavior observed in the previous 30 minute epoch is indicative of irregular behavior.
Software can be developed in software suites such as Labview to processes the signal received by the photodetector and display bubble detection information in a guided-user interface, such as the graphical use interface shown in
An experimental setup of a slide-on clip 370 and a chest drainage system 300 is shown in
The disclosures of each and every patent, patent application, and publication cited herein are hereby incorporated herein by reference in their entirety. While this invention has been disclosed with reference to specific embodiments, it is apparent that other embodiments and variations of this invention may be devised by others skilled in the art without departing from the true spirit and scope of the invention.
This application is a national stage filing of International Application No. PCT/US17/43470, filed Jul. 24, 2017, which claims priority to U.S. Provisional Application No. 62/366,369 filed on Jul. 25, 2016, the contents of which are incorporated herein by reference in their entireties.
This work was supported by the U.S. Department of Veterans Affairs, and the Federal Government has certain rights in the invention.
Filing Document | Filing Date | Country | Kind |
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PCT/US17/43470 | 7/24/2017 | WO | 00 |
Number | Date | Country | |
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62366369 | Jul 2016 | US |