Medical irrigation device

A medical irrigation device includes means for connecting a bulb-type syringe to a cannula such as a resectoscope so that fluid may be circulated therethrough in either direction and selectively either by a direct path therebetween or by a circuitous path including a specimen collecting receptacle whereby lavage may be accomplished with rapid reversal of fluid flow direction yet with periodic removal of particulate matter from the circulating fluid.

BACKGROUND OF THE INVENTION 
This invention relates to apparatus for use in medical proceedures, and 
more particularly to irrigation apparatus in which the direction of fluid 
flow may be rapidly reversed and particulate matter in the circulating 
fluid may be rapidly removed, thereby facilitating lavage. 
Medical irrigation devices are well-known, and are particularly used in 
urology for lavage in a variety of procedures, such as the treatment of 
chronic infections, the cleansing of the inspection field prior to 
cystoscopy, and the post-operative treatment of the urinary bladder. 
A common prior art device widely utilized for irrigation of the urinary 
bladder is the so-called Ellik evacuator. This device comprises a unitary 
body, typically of glass, forming a pair of hollow chambers the interiors 
of which directly communicate with one another through a short restricted 
passageway. One of the chambers is further provided with a pair of 
conduits communicating with its interior, one of such conduits being 
provided with means for connecting it with a cannula, such as a 
resectoscope or similar device, and the other conduit being adapted to be 
connected to a bulb-type syringe. In use, the syringe and both chambers of 
the Ellik evacuator are filled with a suitable sterile fluid, and the 
resectoscope or like catheter is introducted into the urinary bladder or 
other body cavity to be irrigated. Compression of the syringe then 
introduces the fluid into the body cavity, and expansion of the syringe 
withdraws it. If the evacuator is held such that the chamber having the 
conduits communicating with the syringe and the resectoscope is uppermost, 
then particulate matter carried by the fluid stream into the evacuator 
during the expansion of the syringe, may settle by gravity into the lower 
chamber, provided of course that the density of the particles is greater 
than that of the fluid. Once the particulate matter has settled into the 
lower chamber, the restricted passageway between the two chambers acts to 
minimize this material from being agitated by, and drawn again into, the 
flow stream passing through the upper chamber, between syringe and 
catheter. 
A disadvantage of the Ellik evacuator is the slow rate of precipitation of 
the particulate matter, much of which has a density not unlike that of 
water. As a consequence, if the syringe is rapidly and cyclically 
compressed and expanded in order to produce vigorous agitation during 
lavage, a large percentage of the particulate matter evacuated during the 
expansion of the syringe will remain in suspension in the upper chamber 
and be re-introduced into the body cavity during the next compression 
cycle of the syringe, or alternatively be drawn into the syringe and 
trapped therein. Even if vigorous agitation is not desired, the use of 
gravity to effect separation of the debris from the fluid results in a 
time-consuming lavage procedure. A further disadvantage of the Ellik 
evacuator is that, in order to subject to laboratory examination the 
particulate matter collected in the evacuator, it is necessary to remove 
the material collected in the lower chamber as well as in the upper 
chamber and syringe, a time-consuming procedure which may not be performed 
with confidence that there will be no loss. 
A variety of evacuators have been devised to overcome these disadvantages. 
A common approach is to provide the evacuator with a fluid-transmissive 
manifold having a pair of separate paths, one path for the fluid injected 
into the body cavity and one for the fluid removed. The debris-ladened 
fluid drained from the body cavity may either by separately collected, 
with new sterile fluid being supplied for lavage, as in U.S. Pat. No. 
3,233,609, or it may be filtered and recycled, as in U.S. Pat. Nos. 
1,925,230, and 3,892,226, among others. 
It is clear that the first of these types of apparatus requires large 
reservoirs for the sterile fluid and the effluent, particularly if a 
substantial quantity of fluid is to be circulated through the body cavity 
being cleansed. This in turn requires the reservoirs be connected to the 
manifold by lengths of sterile flexible tubing if the surgeon is to easily 
manipulate the apparatus. Fluid circulation in such evacuators is 
generally gravity powered, and is controlled by the coordinated operation 
of a pair of manually operated valves, one between the manifold and the 
sterile fluid reservoir and the other between the manifold and the 
collection receptacle, although a syringe may be added (as indeed it is in 
U.S. Pat. No. 3,233,309) to provide alternate pressure and suction if 
desired. A disadvantage of this type of evacuator is in its complexity. 
Not only does it consist of a number of parts which must be assembled in 
sterile condition for use, but its very use is somewhat cumbersome, 
requiring as it does the sumultaneous manipulation of not only a catheter 
and a syringe, but also of several valves, the whole connected together 
and to various reservoirs by lengths of flexible tubing. 
The second type of apparatus, by filtering and recirculating the initially 
sterile fluid, avoids a number of these problems. Since the fluid is 
recirculated, only small reservoirs are needed, and the entire unit may be 
hand held, as is the Ellik evacuator. As the fluid is circulated by the 
alternate compression and expansion of a syringe, flow control may be 
accomplished by a pair of automatically operated check valves arranged to 
provide unidirectional flow of fluid through the filter. Aside from the 
loss in performance that slow acting and/or jammed valves can produce, 
such apparatus is relatively complex, requiring the assembly of a number 
of parts, and is consequently difficult to clean during use and to 
sterilize if used more than once. Further, such evacuators are not as 
inexpensive as the Ellik evacuator if used only once. 
OBJECTS OF THE INVENTION 
Accordingly, it is an object of the present invention to provide an 
irrigation device for cyclically injecting and withdrawing initially 
sterile fluid from a body cavity, which device has provision for filtering 
cellular debris and other particulate matter from the effluent in order 
that the fluid may be reused, and yet which may be easily and positively 
manipulated. 
Another object of the present invention is to provide such an irrigation 
device which has relatively few parts and consequently may be easily 
assembled and dissassembled for cleaning if desired. 
Yet another object of the present invention is to provide such an 
irrigation device which is relatively inexpensive to manufacture. 
A further object of the present invention is to provide an irrigation 
device in which the filtering or settling portion of the irrigation cycle 
may, if desired, be omitted so that rapid reversal of flow of fluid may be 
achieved in order to thoroughly agitate and better suspend particulate 
matter in a body cavity. 
BRIEF SUMMARY OF THE INVENTION 
These and other objects are met in the present invention of an irrigation 
device in which a single manually operable valve controls the path of 
fluid flow within a fluid transmissive manifold connecting together 
syringe, a sample collection receptacle, and a resectoscope or like 
device. The parts are so disposed that the device can easily be operated 
by both hands of the therapist, one hand holding the manifold and attached 
sample receptacle, the other, the syringe. The manifold is configured to 
incorporate a valve seat and a pair of directional ports, and includes the 
filter to remove particulate matter from the effluent withdrawn from the 
body cavity. The valve stem is hollow and fluid transmissive and 
communicates between the interior of the syringe and the selected 
directional valve port; it may be incorporated into the structure of the 
syringe. This configuration of valve seat and valve stem allows the 
directional valve to be operated by the relative motion between the 
syringe and the manifold. The sample collection receptacle may be a simple 
wide mouth jar configured to be threaded onto a mating section of the 
manifold. Thus the irrigation device may be fabricated as three simple 
parts: manifold, syringe and valve stem, and receptacle. 
Other objects of the invention will in part be obvious and will in part 
appear hereinafter. The invention accordingly comprises the apparatus 
possessing characterisic features exemplified in the following detailed 
disclosure, the novel features of which are set forth in the appended 
claims.

DETAILED DESCRIPTION 
Referring to FIG. 1, there may be seen a medical, e.g. urological, 
irrigation device made in accordance with the principles of the present 
invention which in a preferred embodiment comprises a bulb-type syringe 
20, a fluid transmissive manifold 22, and a collection receptacle 24. 
Syringe 20 may be of natural or synthetic rubber or similarly resiliently 
deformable material and manifold 22 and receptacle 24 may be of a 
relatively rigid impervious polymeric material, such as nylon or 
polysulfone, or alternately of glass or metal. All materials are futher 
chosen on the basis of chemical and biological inertness and compatability 
with the chosen method of sterilization (i.e., gas, autoclave, etc.). The 
device is dimensioned such that syringe 20 may be held and manipulated 
with one hand while manifold 22 and receptacle 24 are held in the other. 
Syringe 20 comprises a hollow bulb 26 communicating with a hollow stem 28. 
In a preferred embodiment bulb 26 and stem 28 are of unitary construction, 
being molded as a single piece, with the walls of the stem being so 
dimensioned as to be thicker, and therefore more rigid, than those of the 
bulb, which is intended to be resiliently compressible. It will be 
understood, however, that bulb 26 and stem 28 could be individually 
fabricated and then joined together, as by a tight elastic friction fit, 
by an appropriate adhesive, or otherwise. Preferrably bulb 26 is ovate 
with minor axes dimensioned to fit within the palm of a partly closed 
hand. 
Stem 28 is of right circular cylindrical form and is disposed substantially 
coaxially about the extension of a minor axis of bulb 26. The hollow 
interior of stem 28 communicates with the interior of bulb 26, and the end 
of the stem distal from the bulb is sealed off with a circular end cap 30, 
shown in FIG. 3. A portion of the cylindrical wall of stem 28 is pierced 
near end cap 30, thereby forming a radial aperture 32 through which the 
interior of bulb 26 and stem 28 can communicate with the exterior. In a 
preferred embodiment the line joining aperture 32 to the axis of stem 28 
is made substantially parallel to the long axis of bulb 26. Diametrically 
opposite aperture 32, is a small pin 33. Pin 33 extends axially and 
radially a slight amount and is axially terminated with rounded ends. A 
circumferential ring 34 of slight axial and radial extent is provided 
encircling stem 28 between aperture 32 and bulb 26. Preferrably, ring 34 
is of triangular cross-section, one side of the triangle coinciding with 
the exterior of stem 28 and the other two sides delimiting beveled face 36 
and 38 facing respectively toward and away from bulb 26. 
Considering again FIG. 1, it may be seen that manifold 22 is in the general 
form of a thin walled elbow-shaped hollow conduit having straight arm 
segments 40 and 42 terminating in open ends adapted to secure and 
communicate with the interiors of a cannula, such as a resectoscope, (not 
shown) and collection receptacle 24, respectively. Toward this end, arm 
segment 40 is in the form of a relatively long narrow cylinder while arm 
segment 42 is a relatively short wide cylinder. Further, the open end of 
arm segment 42 is provided with internal threads 44. 
Situated at the exterior bend of the elbow of manifold 22, and in part 
integral with the wall of the manifold, is cross conduit 46. Cross conduit 
46 is of right circular cylindrical form and is disposed with its axis 
substantially orthogonal to the axes of arm segments 40 and 42. Cross 
conduit 46 is of hollow thin walled construction and has an inside 
diameter substantially the same as the outside diameter of stem 28. As may 
be seen with reference to FIG. 3, cross conduit 46 is provided with an 
open end 47, the other end being closed off by wall segment 48 which in a 
preferred embodiment is an extension of the thin wall of manifold. As will 
be explained hereinafter, receptacle 24 and manifold 22 of the preferred 
embodiment are intended to be held by the left hand, while syringe 20 is 
grasped by the right. Consequently, as seen from the open end of arm 
segment 40, with arm segment 42 lowermost, open end 47 is to the left and 
wall segment 48 is to the right. 
Refering again to FIG. 1, it may be seen that cross conduit 46 is further 
provided with a pair of radial apertures 49 and 50 communicating between 
the interior of the cross conduit and the interior of manifold 22. As seen 
from the axis of cross conduit 46, aperture 49 is in the direction of the 
open end of arm segment 40 of manifold 22 and aperture 50 is in the 
direction of the open end of arm segment 42. Apertures 49 and 50 are each 
of similar dimension as aperture 32 in stem 28, and they are spaced apart 
by at least the circumferential extent of a single aperture. Apertures 49 
and 50 are spaced from wall segment 48 an amount similar to the distance 
between aperture 32 and end cap 30 of stem 28. Wall 46 is internally 
relieved with recess 51 dimensioned to receive pin 33 over a 
circumferential arc extending from diametrically opposite aperture 49 to 
diametrically opposite aperture 50. Cross conduit 22 is further provided 
with an internal circumferential notch 52, shown in FIG. 3, dimensioned to 
accept ring 34 of stem 28 and spaced from the interior of wall segment 40 
a similar distance as ring 34 is from the exterior of end cap 30. 
Refering again to FIG. 1, it may be seen that manifold 22 is provided with 
a partition 54 connected to the exterior of cross conduit 22 between 
apertures 49 and 50 and extending into arm segment 42 to a position just 
short of internal threads 44, so as to divided the arm segment into a pair 
of open ended chambers 56 and 58, respectively communicating directly with 
arm segment 40 (and including aperture 49) and with aperture 50. The open 
end of chamber 58 distal from aperture 50 is provided with a pair of 
closely spaced internal lips 60 and 62 defining between them a grove which 
retains filter screen 64. Filter screen 64 may be of plastic or wire mesh 
or other suitable material, and may either be molded in place in the 
fabrication of manifold 22 or inserted later. It will be understood the 
mesh of filter screen 64 is chosen on the basis of the size of the 
particulate matter to be removed by the screen, and if it is sufficiently 
large, the filter can be unitary with the structure of manifold 22. 
Collection receptacle 24 is a wide-mouth jar dimensioned to be conveniently 
and firmly grasped by one hand and provided with external threads 66 
dimensioned and configured to engage threads 44 of manifold 22. As an aid 
to handling, receptacle 24 is provided with a slight taper top to bottom, 
and as an aid to stability when placed on a surface, the receptacle is 
provided with an enlarged base 68. In a preferred embodiment, base 68 is 
detachable from collection receptacle 24, and comprises a short 
cylindrical body provided with a recess 70 and a threaded recess 74 
disposed coaxially and separated by a thin wall 72. Recess 70 is 
dimensioned to tightly and resiliently fit the bottom of collection 
receptacle 24 and threaded recess 74 is configured to engage threads 66 of 
the receptacle. 
The assembly of the major components of the irrigation device is simple. 
Stem 28 of syringe 20 is inserted into the open end 47 of cross conduit 
46, and end cap 30 is forced toward wall segment 48. When pin 33 comes in 
contact with cross conduit 46, its rounded end cooperates with the cross 
conduit to resiliently distort stem 28 inward, allowing the pin to enter 
the cross conduit. As the end cap further approaches the wall segment, 
beveled face 38 of ring 34 contacts the interior of cross conduit 46, and 
stem 28 adjacent the ring resiliently distorts inwardly, allowing ring 34 
to enter the cross conduit as well. When pin 33 and ring 34 come opposite 
recess 51 and notch 52, respectively, just as end cap 30 comes into 
contact with wall segment 48, the inward force exerted on the pin and the 
ring by cross conduit 46 is relieved, and elastic restoring forces urge 
the ring into the notch and the pin into the recess, thereby captivating 
stem 28 in the cross conduit in such a way that the stem and cross conduit 
may be rotated about their common axis by the angular extent of recess 51, 
but may only be axially moved apart by the exertion of sufficient force to 
distort the stem. Receptacle 24 is attached to manifold 22 by the 
cooperative engagement of threads 44 and 66. 
It will be appreciated that the device is adapted to being individually 
packaged, either assembled or as separate components, in a sterile ready 
to use condition, and that during or after use the device may be 
disassembled to recover a sample of the particulate matter collected or to 
clean filter screen 64, by unscrewing receptacle 24 from manifold 22, or 
for thorough cleaning by further removing syringe 20 from the assembly. 
This may be accomplished by pulling bulb 26 away from manifold 22, 
exerting sufficient force to resiliently distort stem 28 through the 
interaction of beveled face 36 with notch 52. While the apparatus may be 
easily cleaned and sterilized for reuse, it will be noticed that it is of 
such simple construction as to be relatively inexpensive, and therefore 
may be treated as a disposable item after use. 
The operation of the device will now be briefly described. The assembled 
unit is connected, through the attachment at the open end of arm segment 
40, with a resectoscope or other cannula and the entire device is filled 
with an appropriate sterile fluid. The embodiment illustrated is for use 
with the right hand operating syringe 20 and the left hand holding 
receptacle 24 and manifold 22. Bulb 26 is grasped between the fingers and 
thumb of the right hand with its long axis directed along the width of the 
palm. The bulb is compressed and released by the combined action of 
fingers and thumb, and the bulb and its attached stem 28 may be rotated by 
a simple wrist motion. Stem 28 and cross conduit 46 form, in effect, the 
stem and seat respectively of a directional valve which may direct the 
flow to and from syringe 20 either directly through chamber 56 or via 
chamber 58. Aperture 32 is aligned with aperture 49 by rotating bulb 26 
until the major axis of the ovate bulb is substantially parallel with arm 
segment 40. With this arrangement of apertures, it will be noted that 
syringe 20 communicates directly with chamber 56 of manifold 22, and 
compression bulb 26 will force fluid from the bulb, through arm segment 
40, and into the attached (but not illustrated) resectoscope along the 
path indicated by the dashed arrows A of FIG. 1. A quarter turn of bulb 26 
counterclockwise as seen in the Figures results in the alignment of 
apertures 32 and 50, as shown in FIG. 2. Bulb 26 now communicates with 
chamber 58. This same action, of course, closes off aperture 49, which is 
now opposite a portion of the wall of stem 28. Relaxing the compressional 
forces on bulb 26 will now permit the bulb to expand, drawing fluid into 
the syringe through chamber 56, filter screen 64, and chamber 58, along 
the path indicated by the double dashed arrows B of FIG. 1. The extent of 
partition 54 insures that this path followed by the effluent departs 
markedly from the path A followed by the fluid being injected through 
aperture 49, the circuitous path B carrying debris in the effluent 
initially downward into receptacle 24. Pin 33, cooperating with the 
circumferential ends of recess 51, limits the rotation of stem 28 to 
insure alignment of aperture 32 with either aperture 49 or 50 at the 
rotational extremes. 
Filter screen 64 prevents the flow of particulate matter into syringe 20, 
and the initially downward flow of effluent facilitates collection of 
debris in receptacle 24. If laboratory examination of a particulate sample 
is desired, collection receptacle 24 may be unscrewed from manifold 22, 
and base 68 removed from the bottom of the receptacle and used as a 
sealing cap, being attached to the top of the receptacle by threaded 
recess 74. 
It should be noted that the directional valve formed by stem 28 and cross 
conduit 46 need not be alternated between each compression and expansion 
of bulb 26. This feature is of advantage when it is desired to provide 
particularly vigorous agitation, as for instance to initially place in 
suspension particulate matter in the body cavity being cleansed or to 
clear a blockage in the resectoscope, both of which may best be 
accomplished by rapidly compressing and expanding bulb 26 with aperture 32 
opposite aperture 49. Then again, this feature may be used to clean 
accumulated debris off filter screen 64 be occassionally compressing bulb 
26 while aperture 32 is aligned with aperture 50. 
It will be understood that various changes may be made in the apparatus 
described without departure from the principles of the invention. For 
instance, the device can be made "left handed" by interchanging the 
positions of open end 47 and wall segment 48. Then again, bulb 26 may be 
of other shape than ovate (e.g., spherical), and, indeed, syringe 20 could 
even be a piston syringe with thumb and finger rings. Further, stem 28 
could be provided with a plurality of apertures so that commutation 
between apertures 49 and 50 in cross conduit 46 need not entail the 
rotation of an individual aperture in the stem between the two apertures, 
or it could be made to rotate independently of any motion of the syringe, 
being controlled for instance by a thumb-activated lever. Alternatively, 
syringe 20 may be held captive to manifold 22 by a threaded flange and 
nut, such as in a common plumbing union, by resiliently distortable 
O-rings, or the like, rather than by ring 34 and notch 52. Also, partition 
56 could be extended to contact the top of receptacle 24, and filter 
screen 64 could be incorporated into the receptacle to cover a segment of 
its top. Accordingly, it is intended that all matter contained in the 
above description and shown in the accompanying drawings shall be 
interpreted as illustrative and not in a limiting sense.