RU2405586C1 - Nasal drug delivery system for tamponade - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: invention refers to medicine, namely to otorhinolaryngology and can be used for treating epistaxis. A nasal drug delivery system for tamponade comprises a through-hole catheter and a fixation ligature. The catheter is made of PVC pipe of the diametre 3 mm and length 6 to 10 cm. A tail end of the catheter is sealed and has one through perforation to deliver the fixation ligature. A leading end of the catheter is 5 mm wider and contains two perforated ears to deliver the fixation ligature. In the middle, the catheter comprises 8 perforations of the 1 mm diametre at 5 mm from each other. A mandrin is integrated inside the tube.

EFFECT: invention provides multiple drug impregnation of nasal tampons for treating epistaxis and prevents tampon from falling back into the epipharynx.

2 dwg

Description

The invention relates to medicine, namely to otorhinolaryngology, and can be used to treat nosebleeds.

There are several ways to create drugs that accelerate the formation of blood clots, a “depot” for tamponade of the nasal cavity due to nosebleeds. Their essence boils down to impregnation of tampons (gauze, cotton, lyophilized peritoneum) in medicines before the introduction of tampons into the nasal cavity (Volkov A.G., Boyko N.V., Kiselev V.V. Epistaxis // Publishing House Dzhangar, 2002. - 276 p .; Soldatov I.B. Guide to otorhinolaryngology. - M., "Medicine", 1994. - P.232; Babiyak V.I., Nakatis Y.A. Clinical otorhinolaryngology. - Publishing house "Hippocrates", 2005 - S.241-245).

The disadvantage of these methods is the rapid leaching of drugs from tampons with poured blood and natural physiological secretions of mucus, which sometimes makes these "depots" ineffective.

The use of catheterization of anatomical cavities and organs using two-channel tubes, in which there is a channel for supplying drugs and a channel for removing spent drug solution, is also known. Such methods of treatment are used in surgery for drainage of the abdominal cavity (Sidorenko Yu.S., Spitsky A.Yu. “Method for catheterization of the abdominal cavity.” Patent of the Russian Federation №2000107715 from 12.27.200; Savchenko Yu.P., Starkov N.K., Eloso VP “A method for draining the abdominal cavity with peritonitis.” RF patent No.200008313 of 01.20.2002, etc.), gynecology (N.V. Lazareva “Device for the administration of drugs into the uterine cavity." Certificate for useful model No. 80116 dated January 27, 2009), urology (Veroman V.Yu. et al. “Device for irrigation of the cavity system of the kidneys and bladder.” Patent RF №2111016 dated 05/20/1998), otorhinolaryngology (Korvyakov B.C. et al. “A method for prolonged flow-suction drainage of middle ear cavities in the postoperative period in patients with chronic otitis media”. RF Patent No. 2359649 dated 06/27/2009), etc.

The main disadvantage of the known devices and method of treatment is the inability to create a “depot” of the drug, which will be removed with active or passive aspiration through the channel to remove the spent drug solution.

A prototype is known - a device for administering drugs and a method for its use (RF Patent No. 2267336 dated 01/10/2006) containing a catheter with through holes and a fixing ligature.

But this prototype has the following disadvantages. Firstly, the installation of this device requires an endoscopic technique, which for the most part is absent in the ENT departments, and especially polyclinic rooms. In addition, the application of tamponade is required not only in the ENT departments and clinics. Since bleeding can be a symptom of a hypertensive crisis, coagulant blood diseases, a consequence of an overdose of anticoagulants, etc., doctors of therapeutic hospitals do not own a nose endoscopy, and waiting

An ENT specialist will be fraught with blood loss. Another disadvantage of this device is that it does not allow you to fix the back end of the tampon at the level of the choan, and from practice it is known that spontaneous dip of the tampon into the nasopharynx is very frequent, which reduces the effect of tamponade and provokes nausea.

The inventive device for the introduction of drugs into the nasal cavity with tamponade is new and is not described in the literature.

The aim of the invention is the multiple impregnation of swabs of the nasal cavity with medicinal substances in the treatment of nosebleeds and the prevention of the absorption of tampons into the nasopharynx.

The object of the invention is achieved in that the device comprises a catheter made of a polyvinyl chloride tube with a diameter of 3 mm, a length of 6 to 10 cm, its rear end is sealed and has one through perforation hole through which the locking ligature is held, the front end of the catheter is expanded to 5 mm and contains two ears with a perforation hole in each, through which a fixing ligature is passed, and in the middle part of the catheter there are eight through perforations with a diameter of 1 mm, located at a distance 5 mm from each other, and inside the tube is a mandrin.

длины. На переднем конце имеются два ушка (8) для удобства фиксации устройства в руках врача при проведении манипуляций. В обоих ушках имеется по одному перфорационному отверстию (6) для проведения фиксирующей лигатуры, фиксирующей передний конец трубки к марлевому тампону, что будет предотвращать выпадение устройства и тампонов из полости носа. В средней части катетера (2) имеются восемь сквозных перфорационных отверстий, расположенных на расстоянии 5 мм друг от друга, через которые введенное в устройство с помощью шприца лекарственное вещество будет поступать в полость носа, орошая марлевые тампоны, находящиеся в нем. Перфорационные отверстия расположены только в средней части катетера для того, чтобы не происходило лишнего выливания лекарственных веществ как в носоглотку, так и из преддверия носа. Внутри трубки находится мандрен (7), исключающий забивание трубки сгустком крови и слизи в тот момент, когда введение лекарственного веществ не производится. При необходимости введения лекарственного вещества мандрен удаляется, а после окончания манипуляции устанавливается на прежнее место. Мандрен имеет диаметр, соответствующий внутреннему диаметру трубки, занимает всю ее длину, а также выстоит на 1 см из нее для удобства извлечения перед введением лекарственного вещества.The proposed device is disposable and contains a catheter made of a PVC tube (Fig. 1) with a diameter of 3 mm, because a smaller diameter can contribute to clogging of it with blood clots or nasal mucus, a larger diameter will be a source of irritation of the nasal mucosa. The length of the device can vary from 6 to 10 cm and will correspond to the length of the nasal cavity. The end of the catheter, which will be inserted into the posterior part of the nasal cavity - the posterior end (1), is sealed, which is necessary so that the injected drug does not spill into the nasopharynx, but concentrates directly in the nasal cavity, creating a drug depot there. At the posterior end of the catheter there is a through perforation hole (5) with a diameter of 1 mm for holding a fixative ligature, which will fix nasal tampons located in the posterior sections of the nasal cavity. Fixation of the posterior ends of the tampon of the nasal cavity will prevent the spontaneous passage of tampons into the nasopharynx, which is quite common during tamponade, which is fraught with a deterioration in the mechanical effect of the manipulation and the appearance of the urge to vomit due to irritation of the nerve endings of the pharynx with the end of the swollen tampon. The front end of the catheter (3) is expanded to 5 mm to match the tip diameter of a standard medical syringe and takes

lengths. At the front end there are two ears (8) for the convenience of fixing the device in the hands of the doctor during the manipulation. In both ears there is one perforation hole (6) for holding a fixing ligature, fixing the front end of the tube to the gauze swab, which will prevent the device and tampons from falling out of the nose. In the middle part of the catheter (2) there are eight through perforations located at a distance of 5 mm from each other, through which the medicinal substance introduced into the device with a syringe will enter the nasal cavity, irrigating the gauze swabs located in it. Perforation holes are located only in the middle part of the catheter so that excessive pouring of drugs into the nasopharynx and from the vestibule of the nose does not occur. Inside the tube there is a mandrin (7), which excludes clogging of the tube with a blood clot and mucus at the moment when the drug is not administered. If necessary, the introduction of a medicinal substance, the mandrin is removed, and after the end of the manipulation is installed in its original place. Mandren has a diameter corresponding to the inner diameter of the tube, occupies its entire length, and also stands 1 cm from it for ease of extraction before drug administration.

The proposed invention is illustrated by drawings, where:

figure 1 is a General view of a device for introducing drugs into the nasal cavity with tamponade;

figure 2 - location of the device for the administration of drugs in the nasal cavity with tamponade.

A device (see figure 1) for the introduction of drugs into the nasal cavity with tamponade contains:

1 - rear end;

2 - the middle part;

3 - front end;

4 - through perforations of the middle part;

5 - through hole perforation of the rear;

6 - perforation hole of the ears;

7 - mandrin;

8 - ears;

9 - fixing ligature of the rear end;

10 - fixing ligature of the front end.

Installation of the device is as follows. With rhinoscopy, the depth of the nasal cavity is determined. Depending on the value obtained, a device with a length of 6 to 10 cm is selected. The posterior end of the catheter is fixed with a ligature to the end of the gauze swab, which will be used during tamponade of the nasal cavity. Using tweezers, the device, together with a gauze swab, is installed in the posterior part of the nasal cavity to the choan. As soon as the end of the device abuts against the back wall of the nasopharynx, it is pulled anteriorly by 1-2 cm, which will correspond to the opening of the choana. Next, a “classic” tamponade of the nasal cavity is made, after which the front end of the catheter, using the fixing ligature threaded through the perforated holes of the ears, is fixed to the front end of the gauze swab or tied around the patient’s head. It should be noted that the device in the nasal cavity should be located on the opposite side of the bleeding site to prevent blood clotting during drug administration, that is, if there is bleeding from the nasal septum, the device remains in one of the nasal passages if bleeding is from the nasal concha then the catheter is placed next to the nasal septum. After installing the device and tamponade of the nasal cavity, the administration of drugs is immediately carried out until the gauze swab is completely saturated. To do this, the mandrin is removed from the tube. After the introduction of drugs, the mandrin is re-installed in the device. Subsequently, the administration of drugs is performed as the rate of thrombosis, the presence of purulent discharge from the nasal cavity, etc., but not less than 2 times a day.

The device we developed allows us to repeatedly infuse tampons with medicinal substances (procoagulants, antiseptics, regeneration stimulants, etc.) with their introduction into the “epicenter” of tamponade. The second advantage of our device is the ability to fix the rear end of the tampon at the level of the choan, preventing the spontaneous passage of tampons into the nasal cavity.

The proposed device for administering drugs to the nasal cavity with tamponade has been used since January 2009 in the conditions of the ENT department of the Alexander Mariinsky Regional Clinical Hospital in Astrakhan and has been tested on 16 patients.

The following is the result of testing.

Patient B., born in 1941 (medical history No. 1207), was admitted to the ENT department of the Alexander Mariinsky Regional Clinical Hospital in Astrakhan on April 30, 2009 with complaints of recurring nosebleeds for 2 days. From the anamnesis, it became known that on April 28, against the background of an increase in blood pressure to 200 mm Hg. the patient experienced nosebleeds, about which he turned to the clinic at the place of residence, where the front tamponade of the nasal cavity was applied. But on April 30, against the background of tamponade, the patient experienced a relapse of bleeding, about which he turned to the emergency ENT care center of the Alexander Mariinsky Regional Clinical Hospital. With a diagnosis of recurrent nosebleed, the patient was hospitalized in the ENT department of the AIBEC.

After removal of the primary tamponade of the nasal cavity, the patient was reapplied with the front tamponade along with a device for administering drugs containing a catheter made of a polyvinyl chloride tube 3 mm in diameter, 8 cm long, its posterior end is sealed and has one through perforation through which the ligature is held fixing the rear end of the nasal swab, the front end of the catheter is expanded to 5 mm and contains two ears with a perforation hole in each, through which the ligature is held, I fix the front end of the catheter to the nasal swab, and in the middle part of the catheter there are eight through holes perforation 1 mm in diameter, located at a distance of 5 mm from each other, and inside the tube there is a mandrin that prevents clogging of the tube with a blood clot and mucus and is removed during drug administration substances. After the manipulation, the mandrel was removed from the tube and aminocaproic acid was introduced until the swabs were completely saturated, then the mandrin was installed in the lumen of the tube. Repeated administration of the drug was performed after 6 hours, given the continued impregnation of blood gauze tampons. A patient had nasal tamponade for 3 days, during which aminocaproic acid was injected into the nasal cavity 6 times to soak tampons. Relapse of bleeding in the patient was no longer observed. It should also be noted the absence of the entrapment of gauze tampons in the nasopharynx, which did not cause additional anxiety in the patient.

The following positive result was achieved: the patient stopped nosebleeds due to effective tamponade of the nasal cavity and repeated soaking of nasal swabs with medicinal substance, and the retention of tampons into the nasopharynx was prevented.

Claims (1)

A device for introducing drugs into the nasal cavity during tamponade, containing a catheter with through holes and a fixing ligature, characterized in that it contains a catheter made of a polyvinyl chloride tube with a diameter of 3 mm, a length of 6 to 10 cm, its rear end is sealed and has one through the perforation hole through which the fixation ligature is held, the front end of the catheter is expanded to 5 mm and contains two ears with a perforation hole in each, through which the fixation ligature is passed, and in the middle part Yeter 8 arranged through perforations of 1 mm diameter at a distance of 5 mm from each other, wherein the mandrel is inside the tube.

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