Transfusion apparatus

TRANSFUSION

APPARATUS*

VICTOR CARABBA, M.D. NEW YORK CITY

S

INCE the introduction of bIood transfusion as a therapeutic measure in medicine innumerabIe types of trans-

FIGS. 1-3.

fusion devices have been deveIoped. The majority have proved either impractica1, too compIicated or too expensive and as a resuIt have faIIen into~discard. As a resuIt of this the medica profession rightfuIIy has questioned the introduction of new devices of this type. With these past experiences in mind it is with trepidation the device to be described is presented. of construction, the The simpIicity the ease and safety of inexpensiveness, * From the Third

SurgicaI

operation, its durabiIity and its construction which Iends itseIf to easy cIeansing and steriIization have promoted its presentation to the medica profession. The embodiment (Fig. I), as at present preferred, incIudes a cyIindrica1 casing or barre1 member (I 7), constructed of suitabIe meta and having an aperture ( 18) extending from its upper surface through substantiaIIy three-fourths of its Iength. The aperture is desirabIy provided with an enIarged portion (rg) at its upper end, the upper edge of the body member having an inwardIy beveIIed portion (20). The Iower end of the casing is provided with a smaI1 IongitudinaI aperture (21) for a purpose to be described Iater. Two transverse apertures (22 and 23) are made in the casing member directIy opposite each other, the former aperture, in the present embodiment, being substantiaIIy x inch beIow the Iatter. The apertures are provided with enIarged threaded portions (22’ and 23’) adjacent to the outer surface of the casing, nippIes (24 and 25) being engaged in the enIarged the nippIes carrying threaded portions, suitabIe rubber tubes (26 and 27), hereafter described as the outIet and intake tubes, respectiveIy, these tubes Ieading to the needIes (not iIIustrated) which are inserted in the veins of the recipient and donor respectiveIy. A vaIve member or pIunger (30) is accurateIy fitted within the aperture (18) in the casing (I 7) and is adapted for Iongitudina1 reciprocating movement. The vaIve member or pIunger is provided with a Iongitudina1 aperture (31) throughout the Iength, a nippIe (32) being secured within this aperture.’ The nippIe is preferably made from a soIid piece of round materia1 and has a IongitudinaI aperture (33) driIIed

Division,

554

BeIIevue

HospitaI,

N. Y.

NEW SERIES

VOL.

XIX.

No.

3

Carabba-Transfusion

from its upper terminus through slightly over three-fourths of its Iength, the upper portion of the nippIe having externa1

FIG. 4. Operation

of instrument: intake or aspiration stroke. See Figure I.

threads (34). A transverse aperture (35) is drilled through the center of the vaIve member and through the nippIe, the (33) in the valve longitudinal aperture member terminating at the point where the transverse aperture passes through. The vaIve member is prevented from rotative movement by means of a stop pin (36, Fig. 2) secured at the upper end, the stop pin passing into a IongitudinaI sIot (37) on the inner surface (18) of the casing (17). movement of the vaIve The upward member is Iimited by means of a thumbscrew (38) having a threaded portion (39) and being mounted in a supporting pIug (40) having a threaded Iongitudinal aperture (41). The supporting pIug is provided with a reduced threaded portion (42) at the inner end which is engaged in a threaded aperture (43) in the casing adjacent to the sIot (37). Thus, when the vaIve member is drawn upwards, as described later, to the point

Apparatus

American

Journal

of Surgcr,v

_” * 333

where the transverse aperture (33) is aligned with the aperture (23) in the casing, further upward movement is arrested by

FIG. 5. Operation

of instrument: output stroke. See Figure 3.

or emptying

the stop pin (36) engaging the inner terminus of the thumb screw (38). When the vaIve member is forced downwards to the Iower end of the IongitudinaI aperture (18) in the casing the transverse aperture (35) is aIigned with the Iower aperture (22) in the casing. Inasmuch as the vaIve member is fitted very snugIy within the aperture (18) in the casmg, the hoIe (21) at the Iower end is provided in order to aIIow the air within the Iower end of the chamber to pass out in the vaIve member readiIy when the vaIve member is moved downwards. The folIowing means are empIoyed for securing the syringe in firm engagement with the nippIe (32) on the vaIve member. A u-shaped, spring metal cIamp (45), having inwardIy turned upper end portions carried by a circuIar (46) 5 is pivotaIIy internaIIy threaded nut (47) having a threaded coIIar (48) at its lower end to engage the lower surface of the clamp.

556

American Journal of Surgery

Carabba-Transfusion

The vaIve member, as described before, fits snugIy within the casing, aIthough not so tightIy as to impair the very easy sIiding

FIG.

6. Parts of instrument, showing simpIicity of struction,

ease of operation

coti-

and cleansing.

movement. When the handIe (14) or the piston rod (I 3) of the syringe is drawn outwards to fiI1 the syringe, this outward movement first draws the vaIve member to the position shown in Figure I (the cross channel, 35, is adjacent the inIet port or aperture, 23) by virtue of the fact that the vaIve member sIides far more easiIy than does the piston in the syringe. In other words, the initia1 outward movement of the handIe (14) does not change the position of the piston in reIation to the syringe, but rather draws the entire syringe, to which the vaIve member is secured, outward, thereby cIosing the outIet port or aperture to the syringe, and opening the without specia1 effort, inIet aperture, thought or concern on the part of the operator. Likewise, when the syringe is fiIIed and the piston is forced inwards to expe1 the fluid, the initia1 movement of the handIe causes the piston to move forwards to the

Apparatus

MARCH,1933

position shown in Figure 3, wherein the cross channe1 (35) is adjacent to the outIet port or aperture (22). It wiI1 be seen that no specia1 effort is required to manipuIate this nove1 two-way vaIve structure, apart from the norma manipuIation of the syringe. It wi!I be appreciated that the instrument may be readiIy steriIized by first reIeasing the thumb screw and removing the vaIve member or pIunger from the casing and then pIacing the parts within the steam or hot water. The instrument may then be pIaced in a steriIe packet and kept in readiness for use. When the device is to be used for a transfusion the vaIve member (30) is introduced into the casing (I 7) and the thumb screw tightened. The nozzIe (IO) of the syringe is pIaced in the upper end of the nippIe (32) and the spring cIamp which engages the flange on the head of the syringe is tightened secureIy. The rubber tube (26) connected with the outIet nipple (25) is pIaced in a container of steriIe norma saIine soIution. The casing is then heId in one hand in a manner that the syringe and pIunger of the instrument are not touched by the hand hoIding the casing. The handIe on the piston of the syringe is then grasped with the other hand and operated as the usual hypodermic syringe. On the upstroke of the piston in the syringe the sIiding vaIve member of the device automaticaIIy connects with the intake tube and saIine soIution is introduced into the syringe. On the down stroke of the piston in the syringe the vaIve member moves forward, thereby cIosing the passage into the intake tube and aligning the transverse aperture (35) with the outIet tube. In this fashion the entire system (instrument and tube) is MIed with saIine soIution and a11 of the air expeIIed. HoIding the casing upwards makes for the more rapid expuIsion of the air. Once the system is fiIIed with saIine soIution the rubber tubing secured to the intake nippIe is connected with the needIe in the vein of the donor and the tubing

NEW SERIES VOL. XIX,

No.

Carabba-Transfusion

3

secured to the outIet nippIe is connected with the needIe in the vein of the recipient and the syringe operated as aheady described. The operation wiI1 invariabIy go on smoothly unIess the needIe in the veins become disengaged or pIugged or unIess the syringe becomes “sticky,” which sometimes results when the piston is sIightIy worn. In this event, the tubingisdisengaged from the veins of the donor and recipient and the apparatus washed in saIine soIution or a clean syringe substituted. It is advisable in this connection to have a second

CONCLUSION SUMMARY

OF

DR.

Apparatus

American

Journ:~L 01 Surg:rry

5

j7

compIete apparatus in reserve to take care of such occurrences, however infrequent, in order that the transfusion may be unbroken. The same technique may be empIoyed in autotransfusion and in the infusion of intravenous soIutions. For aspiration of the chest, peritonea1 or joint cavities the apparatus is operated as an ordinary hypodermic syringe. 1 1 Demonstrated before CIinicaI Conference of New York Surgical Society, 1932. Patents applied for by New York University.

TRUSLOW’S

ARTICLE*

for the maintenance of permanent crippIes. The physician shouId SympatheticaIIy but authoritativeIy guide the crippIe and his friends away from the inadequateIy equipped cure-aI1; he may be more optimistic with the potentia1 or the actua1 crippIe; he shouId point the way to adequate preventive and reconstructive treatment. The crippIe is, in great measure, a needIess IiabiIity.

Some congenita1 defects, certain diseases, injuries from accident and postura1 and occupational factors tend toward deformity. Most deformity and much existing disabiIity is needIess. Prevention of deformity and scientific reconstruction for existing deformity is greatIy needed. Costs, better distributed in prevention and treatment wouId be far Iess than present totaIs *Continued from

p. ~$2.