The present disclosure relates generally to a medical drainage system, and in particular, a motorized chest drainage system and a method of use thereof.
The human pleura and chest wall are normally in opposition. A variety of iatrogenic or organic states can least to interposition of either gas or fluid between the pleura and chest wall, which if unchecked may compromise the lungs and may cause a variety of sequelae, from shortness of breath to profound hypoxia/hypotension. Thoracic surgical procedures where the pleura are violated may naturally result in pneumothorax; also, occasionally people may spontaneously pop diseased lung tissue, which also results in pneumothorax. In lung resection procedures, this problem can persist, therefore chest drainage systems are routinely placed within a patient's pleural space to treat this pneumothorax and minimize the accumulation of fluid. In certain disease states including trauma, pneumonia, and cancer, fluid may accumulate in the pleural space more quickly than it can be evacuated. As noted, this may lead to unchecked compression of the lungs leading to the aforementioned sequelae. Frequently these fluid collections move. A chest drainage system with a motorized tip may assist in the removal of fluid within a patient's pleural cavity.
A basic chest drainage system includes a chest tube and drainage canister. Advancements have been made to the basic system. A chest drainage system can now include a suction system, de-clogging system, or a sensor system or any combination thereof. The inclusion of these systems permits a chest drainage system to appropriately handle the dynamic atmosphere within the pleural cavity. However, despite these advancements, chest drainage systems may still lack mobility once placed within a patient's pleural cavity.
Accordingly, a motorized chest drainage system capable of being repositioned after being placed within the patient's pleural cavity is desirable.
The present disclosure is directed to a motorized chest drainage system. The motorized chest drainage system includes a flexible tube having proximal and distal ends, a tip positioned at the distal end, an articulation assembly operatively coupled with the flexible tube, and a control assembly which is operated by a motor. The control assembly is operatively coupled with the articulation assembly, and the articulation assembly is adapted to articulate the tip.
In one embodiment, the chest drainage system may include a suction source. This suction source may be coupled with a sensor unit that will collect data on the suction pressure, fluid flow rate, or content type or any combination thereof. The sensor may also be coupled with a data processor, which will evaluate the data collected by the sensor. The data evaluated by the data processor may be communicated to a display located on the case of the device. The case may house the articulation assembly, the motorized control assembly, the suction source, sensor, and data processor. The case may also include controls for the articulation assembly, a motor control, a power outlet or battery, or both, and a fluid reservoir that will collect all fluids being drained from a patient's pleural cavity.
In another embodiment, there may be an optionally detachable sensor unit that will attach in-line with the chest drainage tube, between the distal end of the chest tube and the case of the drainage system. The detachable sensor unit will connect to the chest tube via a set of fittings at each end of the detachable sensor unit. The detachable sensor unit might contain one or more sensors that could monitor various parameters of the fluids and/or solids that travel through the detachable sensor unit. These parameters include, but are not limited to, pressure, flow rate, pH, presence of blood, carbon dioxide levels, glucose levels, as well as other parameters of the contents of the chest tube. The detachable sensor unit may also contain wireless communications capabilities. The detachable sensor unit may also contain a data processor, which would analyze the data collected by the various sensors in the detachable sensor unit, and wirelessly communicate information about the analyzed data to mobile communication devices, such as mobile phones or pagers carried by monitoring personnel. Additionally, the detachable sensor unit may have a display system, which can display data collected by the various sensors. The detachable sensor unit may also contain a replaceable battery to provide power for the sensors, data processor, display system, and wireless communications units.
In another embodiment, the articulation assembly may be remotely operated, programmed to have a set oscillation pattern, programmed to have a user defined pattern or any combination thereof.
These and other features of the current disclosure will be explained in greater detail in the following detailed descriptions of the various embodiments.
Various embodiments of the present disclosure are described herein below with reference to the drawings, wherein:
Other features of the present disclosure will become apparent from the following detailed description taken in conjunction with the accompanying drawings, which illustrate, by way of example, the principles of the present disclosure.
Embodiments of the presently disclosed motorized chest drainage system are described in detail with reference to the drawings, in which like reference numerals designate identical or corresponding elements in each of the several views. As used herein, the term “clinician” refers to a doctor, a nurse, or any other care provider. Throughout this description, the term “distal” refers to that portion of the tool or component thereof which is farther from the user while the term “proximal” refers to the portion of the tool or component thereof which is closer to the user. The presently disclosed chest drainage system is usable in openings through a patient's tissue.
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As forces are transmitted to the connecting members 160 (shown in phantom view), displacement of the first and second segments 112, 113 is effected in a first plane, i.e., plane X (across the page) and a second plane, i.e., plane Y (into and out of the page). Connecting members 160 associated with a first actuation assembly 130 may be attached to opposing surfaces in each of the first and second segments 112, 113 to effect articulation in plane X, and connecting members 160 associated with a second articulation assembly 130 may be attached to opposing surfaces in each of the first and second segments 112, 113 and radially spaced from the connecting members 160 of the first articulation assembly 130 to effect articulation in plane Y. Forward and reverse engagement of the pair of actuation assemblies 130 allows for bi-directional articulation of the first and second segments 112, 113 in both plane X and plane Y. Accordingly, articulable tip 111 can be articulated in opposing directions in multiple planes. The first and second segments 112, 113 of the articulable tip 111 may be continuous flexible members, or may include independently movable members 115 that, when assembled, engage in a manner such that each movable member 115 is free to pivot relative to an adjacent movable member 115.
Chest tube 108 includes a lumen 114 (shown in phantom). Lumen 114 may be a separate tube having flexibility or flexible portions to correspond to the first and second segments 112, 113 of the articulable tip 111. The lumen 114 provides an access pathway between a distal end of the chest tube 108 and a proximal portion thereof (e.g., the distal tip and the reservoir). The lumen 114 may be used for irrigation, vacuum, suction, de-clogging, or providing instrument access into the patient's pleural cavity. Suction may be delivered by a number of different methods. In one embodiment, suction may be provided by a combined vacuum/pressure system, which will be connected to lumen 114 and chest tube 108. The combined vacuum/pressure system will provide negative pressure to lumen 114, which will allow the fluids contained within the patient's pleural cavity to be drawn out quicker. The user may reverse the pressure within the lumen 114 to de-clog chest tube 108 using positive pressure to dislodge an obstruction. In another embodiment, de-clogging can be achieved by temporarily removing chest tube 108 from the pleural cavity and manually removing the obstruction. In another embodiment, de-clogging might be achieved by a morcellator disposed inside lumen 114 that grinds up any blocking material into small enough pieces that will adequately pass through the drain and out of the patient's pleural cavity. De-clogging may also be achieved by means of an obturator to expel the blockage. In another embodiment, de-clogging might be made unnecessary by placing a filter at the distal end of the tube to prevent anything other than liquid or smaller material to pass through. Also, in another embodiment the chest tube 108 may include two or more lumens (not shown).
A detailed description of articulation assembly and methods of effecting articulation of the articulable portion are found, for example, in U.S. Patent Application Publication No. 2012-0310220, the entire contents of which is incorporated herein by reference.
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The display system 200 described herein may also utilize one or more controllers to receive various information and transform the received information to generate an output. The controller may include any type of computing device, computational circuitry, or any type of processor or processing circuitry capable of executing a series of instructions that are stored in a memory. The controller may include multiple processor and/or multicore central processing units (CPUs) and may include any type of processor, such as a microprocessor, digital signal processor, microcontroller, or the like. The controller may also include a memory to store data and/or algorithms to perform a series of instructions.
A network interface card (NIC) or other suitable network interface utilizes any known communication methods for transmitting and/or receiving data to or from sensors 260, 262, 264, and 266.
Display screen 202 (
Sensor 260 may be a pressure sensor for monitoring pleural pressure. Pressure sensors generate a signal related to the pressure being measured. Pressure sensors can be classified in terms of pressure ranges they measure, temperature ranges of operation, and most importantly the type of pressure they measure. In terms of pressure type, pressure sensors can be divided into five categories. Absolute pressure sensors which measure the pressure relative to perfect vacuum pressure (0 PSI or no pressure). Gauge pressure sensors may be used in different applications because it can be calibrated to measure the pressure relative to a given atmospheric pressure at a given location. Vacuum pressure sensors are used to measure pressure less than the atmospheric pressure at a given location. Sealed pressure sensors are similar to the gauge pressure sensors except that it is previously calibrated by its manufacturer to measure pressure relative to a sea level pressure. Sensor 260 may be configured to monitor pleural pressure within a predetermined range, and will trigger an alert to a clinician if the pleural pressure is outside that predetermined range. The predetermined range of sensor 260 may range between −4 and −20 cmH2O with a sensitivity of 1 cmH2O; however, the predetermined range of sensor 260 is not limited to this specified range, and may be greater or less. Also, a visual signal, audio signal or both may alert a clinician when the pleural pressure reaches a predetermined level, for example a clinician may be alerted when the pleural pressure equals 0 cmH2O and/or is outside of the predetermined range by ±5 cmH2O. In another embodiment sensor 260 may monitor fluid pressure. Additionally, a single pressure sensor can be used to measure fluid level in a container.
Sensor 260 may also be a sensor for monitoring fluid (e.g., liquid or gas) flow rate. Flow rate sensors generate a signal related to the velocity of the measured fluid. Differential pressure sensors measure the difference between two or more pressures introduced as inputs to the sensing unit. Differential pressure sensors may also be used to measure flow or level in pressurized vessels. Sensor 260 may be configured to monitor fluid flow rate within a predetermined range, and will trigger an alert to a clinician if the fluid flow rate is outside that predetermined range. The predetermined range for sensor 260 may range between 0 mL/h and 100 mL/h with a sensitivity of 10 mL; however, the predetermined range of fluid flow rate is not limited to this specified range, and may be greater or less. Also, a visual signal, audio signal or both may alert a clinician when the fluid low rate reaches a predetermined rate, for example a clinician may be alerted when the fluid flow rate equals 0 mL/h and/or when the fluid flow rate is outside of the predetermined range by ±100 mL/H.
In another embodiment, the fluid flow rate may be monitored by altering the shape the fluid reservoir 109 to a tipping bucket configuration. The tipping bucket configuration may include a central pivoting cone shaped fluid reservoir with a drainage valve that is mounted on a support device, a set of calibration screws, a magnet and a magnetic sensor. The set of calibration screws are mounted on the base of the support device and beneath the fluid reservoir, with each calibration screw positioned at one end of the fluid reservoir opposite of one another. The magnetic sensor may be located at the top of the support device and magnet may be placed at the top of the fluid reservoir adjacent to the magnetic sensor. The magnetic sensor may be a number of different types of sensors, for example the magnetic sensor may be a reed switch sensor. The cone shaped fluid reservoir is configured to the support device by a centrally located pivot at the base of the fluid reservoir. The fluid reservoir is dimension to contain a predetermined volume of fluid. After the fluid reservoir is filled with the predetermined volume, the fluid reservoir pivots about the central pivot, which allows the fluid reservoir to tip to one side draining all the fluid from the drainage valve of the fluid reservoir. When the fluid reservoir tips to one side it rests on one of the set of calibration screws. The set of calibration screws are placed under the fluid reservoir to provide stability for the fluid reservoir when in the tipped position. Also, when the fluid reservoir tips to one side the magnet moves from its original central location and passes by the magnetic sensor. The volume of fluid is tracked by the number of times the magnet passes by the magnetic sensor.
The clinician may consider the information gathered by the sensors 260 in evaluating when chest tube 108 should be removed from the patient. Also, the information gathered by the sensor 260 may indicate to a clinician that the chest tube 108 is dislodged or clogged. Further, the information gathered by the sensor 260 may also indicate to a clinician that there is excess drainage or a number of other clinical indications. In another embodiment, there will be a feedback loop between the suction source and the sensor 260. The motorized chest drainage system 100 will adjust the suction pressure based on the flow rate so as to minimize trauma to the healing tissue.
Sensor 262 may detect the pH levels of the fluid. Sensor 262 may be configured to monitor the pH levels of the fluid within a predetermined range, and will alert a clinician if the pH level is outside that predetermined range. The predetermined range for the pH level may range from 7.25 to 7.75 with a sensitivity of 0.1 pH; however, the predetermine range of the pH level is not limited to this specified range, and may be greater or less than this specified range. Also, a visual signal, audio signal or both may trigger an alert to a clinician when the pH level reaches a predetermined level within the range, for example a clinician may be alerted when the pH level is ≦7.5. A clinician may use the information gathered from sensor 262 about the pH level to determine the onset of an infection.
Sensor 264 may detect level of carbon dioxide (CO2). Sensor 264 may be configured to monitor the level of CO2 within a predetermined range, and will trigger an alert to a clinician if the level of CO2 is outside that predetermined range. The predetermined range for the CO2 level may range from 0.3 mmHg to 40 mmHg with a sensitivity of 0.1 mmHg; however, the predetermine range of the CO2 level is not limited to this specified range, and may be greater or less than this specified range. Also, a visual signal, audio signal or both may trigger an alert to a clinician when the CO2 level reaches a predetermined level, for example when the CO2 level is >0 mmHg and/or >8 mmHg. A clinician may use the information gathered from sensor 264 about the CO2 level to determine if there is any air leaking from the lung.
Sensor 266 may detect the presence of blood in the fluid within chest tube 108. Sensor 266 may be configured to monitor for the presence of blood within a predetermined range, and will trigger an alert to a clinician if the amount of blood is outside that predetermined range. The predetermined range for the amount of blood may range from 0 red blood cells (“RBC”) per mm3 to 100,000 RBC per mm3; however, the predetermine range of the amount of blood is not limited to this specified range, and may be greater or less than this specified range. Also, a visual signal, audio signal or both may alert a clinician when the amount of blood reaches a predetermined amount, for example when the amount of blood is >100,000 RBC per mm3. In some embodiments, the sensor 266 will be a RGB sensor. An RGB sensor may measure the red, green, and blue components of light with the sensitivity similar to human vision. Detection of those colors will allow the sensor 266 to gather information on whether or not blood is present within the fluids within the chest tube 108. Sensor 266 may also monitor the fluid turbidity. The color and turbidity sensed by sensor 266 may indicate a number of different clinical indications, such as:
Also, a clinician may use the information gathered by sensor 266 to determine if there is a hemorrhage or the onset of an infection.
The data collected from the sensors 260, 262, 264, and 266 may be considered by a clinician during treatment and may be used in determining when a patient is ready to be discharged. An algorithm can be developed to analyze data to determine if a patient may safely be discharged, thereby customizing the solution to the patient and potentially reducing the cost of a patient's healthcare.
In another embodiment, display system 200 may include addition sensors to gather information about a number of different clinical metrics. In one embodiment, the display system 200 may include a sensor that can detect glucose within the fluids draining from the patient. That sensor may be configured to monitor the presence of glucose within a predetermined range, and will trigger an alert to a clinician if the amount of glucose is outside that predetermined range. The predetermined range for the amount of glucose may range from 40 mg/dL to 125 mg/dL with a sensitivity of 10 mg/dL; however, the predetermine range of the amount of glucose is not limited to this specified range, and may be greater or less than this specified range. Also, a visual signal, audio signal or both may alert a clinician when the amount of glucose reaches a predetermined amount, for example a clinician may be alerted when the amount of glucose is ≦70 mg/dL. A clinician may use the information gathered about the presence of glucose to determine the onset of an infection. In another embodiment, the display system 200 may include a sensor that can detect the presence of blood hematocrit. That sensor may be configured to monitor the presence of blood hematocrit within a predetermined range, and will trigger an alert to a clinician if the amount of blood hematocrit is outside that predetermined range. The predetermined range for the amount of blood hematocrit may range from 0% to 50% of blood hematocrit with a sensitivity of 5%; however, the predetermine range of the amount of blood hematocrit is not limited to this specified range, and may be greater or less than this specified range. Also, a visual signal, audio signal or both may alert a clinician when the amount of blood hematocrit reaches a predetermined amount, for example a clinician may be alerted when the amount of blood hematocrit is <5% and/or <25%. A clinician may use the information gathered about the amount of blood hematocrit to determine if there is hemorrhaging. In another embodiment, display system 200 may include a sensor that can detect the presence of neutrophils. The information gathered by this sensor may allow a clinician to determine the onset of an infection.
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A network interface car (NIC) or other suitable network interface utilizes any known communication methods for transmitting and/or receiving data to or from sensor 306.
Any of the herein described methods, programs, algorithms or codes may be converted to, or expressed in, a programming language or computer program. A “Programming Language” and “Computer Program” is any language used to specify instruction to a computer, and includes (but is not limited to) these languages and their derivatives: Assembler, Basic, Batch files, BCPL, C, C+, C++, Delphi, Fortran, Java, JavaScript, Machine code, operating system command language, Pascal, Perl, PL1, scripting languages, Visual Basic, meta-languages which themselves specify programs, and all first, second, third, fourth, and fifth generation computer languages. Also included are database and other data schemas, and any other meta-languages. For the purpose of this definition, no distinction is made between languages which are interpreted, compiled, or use both compiled and interpreted approaches. For the purpose of this definition, no distinction is made between compiled and source versions of a program. Thus, reference to a program, where the programming language could exist in more than one state (such as source, compiled, object, or linked) is a reference to any and all such states. The definition also encompasses the actual instructions and the intent of those instructions.
Any of the herein described methods, programs, algorithms or codes may be contained on one or more machine-readable media or memory. The term “memory” may include a mechanism that provides (e.g., stores and/or transmits) information in a form readable by a machine such a processor, computer, or a digital processing devices. For example, a memory may include a read only memory (ROM), random access memory (RAM), magnetic disk storage media, optical storage media, flash memory devices, or any other volatile or non-volatile memory storage device. Code or instructions contained thereon can be represented by carrier wave signals, infrared signals, digital signals, and by other like signals.
Sensor 306 may gather data about the fluids (e.g., liquid or gas) passing through the chest tube 108. Sensor 306 may be a pressure senor for monitoring the fluid pressure within the chest tube 108. Pressure sensor 306 will function the same or similar to the pressure sensor 260 as described above. Additionally, sensor 306 may be capable to monitor the fluid flow rate. Flow rate sensor 306 will function the same or similar to the flow rate sensor 260 as described above. Sensor 306 may be capable of monitor other characteristics of the fluids passing through the chest tube 108. Sensor 306 may be able to differentiate the types of fluids exiting from the patient's chest cavity. Also, sensor 306 may be able to identify the presence and volume or concentration of blood, if any, in the contents of the chest tube 108. When sensor 306 is gathering information regarding the presence of blood, sensor 306 will function the same or similar to the sensor 266. Sensor 306 may have the capabilities of measuring the pH level of the fluids, as well as the ability to detect the presence of CO2 . When sensor 306 is gathering information regarding the pH level and/or CO2 level, sensor 306 will function the same or similar to sensor 262 and/or sensor 264. Also, if blood is present in the fluid within the chest tube 108, sensor 306 may have the ability to detect the glucose levels. Additionally, sensor 306 may have the capability of identifying the color and turbidity of the fluids within the chest tube 108. In gathering information regarding the color and turbidity of the fluids, sensor 306 will function the same or similar to sensor 266. Measuring the pH and glucose levels and detecting the color and turbidity of the fluids within the chest tube 108 may enable the clinician to detect the presence of an infection. The detection of carbon dioxide may indicate an air leak in the patient's lung. Sensor unit 300 communicates with sensor 306 and display unit 400 to analyze the data collected by sensor 306 and uses algorithms to determine if any of the collected data were outside of the normal range and if so, sends a communication to the appropriate clinician.
Sensor unit 300 may communicate with the motorized chest drainage system 100 via any conventional wireless technology. Also, the sensor unit 300 may communicate with the motorized chest drainage system 100 through a wired port on the sensor unit 300, such as a USB port or any similar technology. The sensor unit 300 may also communicate with a mobile device, such as a mobile phone or pager. This communication may be accomplished by using any conventional wireless technology. The clinician may preselect the information the sensor unit 300 will communicate with the motorized chest drainage system 100 and/or the mobile device.
The sensor unit 300 can work in tandem with motorized chest drainage system 100 or can be placed on a non-smart chest drainage system. Also, the motorized chest drainage system 100 can fully function without the inclusion of sensor unit 300. When sensor 300 is included in the motorized chest drainage system 100, sensor 300 may augment the function of the motorized chest drainage system 100.
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In any of the embodiments disclosed herein, the motorized chest drainage system 100 can be programmed to have an autonomous, randomly oscillating tip with intelligence. The movement of the articulable tip 111 can randomly oscillate, or follow a simple algorithm that defines a pattern, such as circular, criss-crossing movement, up and down or side to side reciprocation, or a combination of these. Thus, the motorized chest drainage system 100 can have a flexible or articulated tube that is motorized and has pre-programmed movements. Furthermore, in the presently disclosed embodiments, the sensor positioned on the suctioning tip may be a pressure sensor, a flow rate sensor, a pH sensor, a gas sensor, or a fluid content sensor. The pressure sensor may be used to determine the pressure of the fluids in the pleural space and can detect leaks in the lung.
A gas sensor can be used to determine if there is a leak by detecting the presence or quantity of CO2, O2, or other gases. A fluid content sensor can detect the presence of blood or another fluid, and the pH sensor can be used to identify a possible infection.
Pressure changes at the articulable tip 111 can also indicate the presence of a blockage, or that the articulable tip 111 has suctioned tissue or other particulate matter in the pleural space. In the event that the pressure sensor indicates a blockage or that the articulable tip 111 is stuck on tissue, the motorized chest drainage system 100 can be programmed to “puff” and blow air, CO2 or another biocompatible gas or liquid through the chest tube 108 and then to move the articulable tip 111 in an opposite direction. In any of the embodiments disclosed herein, the motorized chest drainage system 100 can be programmed so that after detecting an undesirable reading from the sensors 260, 262, 264, and 266, the movement of the articulable tip 111 is changed, reversed in direction, or modified. In addition, a user of the motorized chest drainage system 100 can manually, or by interaction with an interface on the housing 140, change the movement of the articulable tip 111. In another example, the motorized chest drainage system 100 can be programmed so that the movement of the articulable tip 111 is automatically changed in response to an indication that movement is resisted. Such indication can come from movement and positioning sensors on the articulable tip 111.
Smart programming, or artificial intelligence, can be included in the motorized chest drainage system 100, in any of the embodiments. For example, the motorized chest drainage system 100 can track how often the articulable tip 111 becomes blocked or stuck, and establish a different pattern of movement on that basis. The motorized chest drainage system 100 can provide a report to the user, so that the user can understand that certain patterns of movement are undesirable and interact with the motorized chest drainage system 100 to make changes.
The entire contents of U.S. Patent Application Serial No. 62/275,829 filed Jan. 7, 2016, is hereby incorporated by reference herein.
It is contemplated that the motorized chest drainage system 100 may use wireless communications to send configurable reports or notifications on the patient's condition to mobile communications devices, such as mobile phones or pagers, as carried by a clinician who may be monitoring the patient's condition. Such wireless notifications may alert a clinician that the chest tube 108 has become blocked, or disconnected from the patient, the presence of a possible infection, or a leak coming from the patient's lungs.
It will be understood that various modifications may be made to the embodiments disclosed herein. Therefore, the above description should not be construed as limiting, but merely as exemplifications of embodiments. Those skilled in the art will envision other modifications within the scope and spirit of the present disclosure.
This application claims the benefit of and priority to U.S. Provisional Patent Application No. 62/275,829 filed Jan. 7, 2016, the entire disclosure of which is incorporated by reference herein.
Number | Date | Country | |
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62275829 | Jan 2016 | US |