• 专利附录
  • 专利说明
  • 权利要求
  • 类似技术
  • 同族专利
  • 引用文献
  • 法律状态
  • 优先权
    • 专利摘要:
    11 ABSTRACT A fixture for immobilizing an arm of a patient for insertion of a catheter for coronaryinvestigation and intervention. The fixture comprises a fixture board (14) for insertion under amatress (14) carrying a patient. The fixture board is provided With a link (12) for attaching anarrn holder (11) to a fixture board (14). The arrn holder (11) arranged adjacent an elboW of thepatient and comprises an arrn support (21) and a belt (22) for attaching the arrn to the arrnsupport. In addition, a Wrist holder (23) is attached to the arrn holder (11) for supporting theWrist. The Wrist holder may be sterilized and disposable. An instrument table (17) isconnected to said fixture board (14) via a link (16). (Fig. 6 to be published together With the abstract)
    公开号:SE1430049A1
    申请号:SE1430049
    申请日:2014-04-02
    公开日:2015-10-03
    发明作者:Hampus Bergenudd；Per Ekdahl
    申请人:All Of It Scandinavia Ab；
    IPC主号:
    专利说明:

    TITLE: FIXTURE FOR ARMFIELD OF INVENTIONThe present invention relates to a fixture for an arrn of a patient. The f1xture isespecially intended to be used during X-ray investigation and evaluation and during possibleballoon expansion of coronary vessels of the heart and similar medical treatments.
    BACKGROUNDHeart deceases are the most common cause of death in the Westem World.
    The most common heart decease is coronary artery obstruction. The coronary arteriesprovide oxygenated blood to the heart muscle itself. Obstructions result in less blood flow,often resulting in angina pectoris, which is chest pain due to ischemia, i.e. a lack of bloodsupply, thus a lack of oxygen supply of the heart muscle, generally due to obstruction orspasm of the coronary arteries.
    In order to confirm coronary vascular decease, the coronary vessels are exposed toX-ray investigation, which today is considered to be the “Golden Standard”. If obstructions orconstrictions are found, such constrictions may be treated by balloon expansion or surgery,such as by-pass surgery, or by other methods. Obstructions, such as blood clots, may bedissolved by introduction of suitable agents.
    The X-ray investigation and evaluation and other interventions may be performed byinserting a catheter via arteria femoralis or via arteria radialis and advancing the catheter tothe area under investigation or for medical intervention.
    When the investigation or insertion of a catheter takes place via the radial artery, itmay be convenient for the physician to use the right arm of the patient lying in a supineposition, since the physician almost always is placed at the right side of the patient.
    When the right arm is used and the physician is arranged at the right side of thepatient, the arm should be placed along the abdomen in a relaxed position. If the right arm isplaced in this position, the palm of the hand is norrnally faced downward or inward towardsthe abdomen and the radial artery at the wrist is not easily available. The arm needs to berotated about 90 degrees around its symmetry axis and the wrist should be tumed backward toexpose the inner wrist portion, where the radial artery is most easily available. There is a needfor a fixture for obtaining such a position.
    Reference is made to patent publication WO20l3/089608Al, which discloses af1xture for immobilization of a left arm of a patient.
    A similar problem is encountered during plebotomy procedures as disclosed inUS70559l0B2. In order to immobilize the arm, there is provided an arrnrest assembly, whichincludes an arrnrest platform with hand and elbow extensions. The assembly is mounted to aswivel base unit that tilts, tums and rotates under the control of a single load control knob toperrnit placement of a patient's arrn in several positions as needed to draw blood. The swivelbase unit is mounted on the distal end of a cylindrical riser that can be raised and lowered to adesired elevation by a single load control lever supported by a base securing device that isadapted to be secured to different types of surfaces configurations.
    However, the arrnrest mount of US 7055910B2 is made of metal and cannot be usedin an environment in which X-ray equipment should be used. In addition, there is requiredsome type of support for medical equiment to be used during the treatment.
    SUMMARY OF THE INVENTIONAccordingly, an object of the present invention is to mitigate, alleviate or eliminateone or more of the above-identified deficiencies and disadvantages singly or in anycombination.
    In an aspect, there is provided a fixture for being attached to an arrn of a patient,comprising: an arrn holder arranged adj acent an elbow of the patient and comprising an arrnsupport and a belt for attaching the arrn to the arrn support and a wrist holder attached to thearrn holder for supporting the wrist, characterized by a link for attaching the arrn holder to afixture board intended to be arranged on a bed board for a patient. The fixture board maycomprise a plate intended to be inserted between said bed board and a matress, onto whichsaid patient is arranged. The plate may comprise a chamfered edge for making said insertionmore easy.
    In an embodiment, the distance between the arrn holder and the fixture board isadjustable. The link may comprise a first swivel joint arranged at said fixture board, a secondswivel joint arranged at said arrn holder and a link arrn for connecting said first and secondswivel joints. The length of the link arrn may be adjustable.
    In a further embodiment, the fixture may comprise an instrument table, which isconnected to said fixture board via a link.
    The fixture may be used in a percutanous coronary intervention procedure.
    BRIEF DESCRIPTION OF THE DRAWINGSFurther objects, features and advantages of the invention will become apparent fromthe following detailed description of embodiments of the invention with reference to thedrawings, in which:Fig. 1 is a perspective view of a bed on which a patient is arranged having his rightarrn imobilized by a fixture according to a first embodiment of the invention.
    Fig. 2 is a perspective view of a portion of Fig. 1 in an enlarged scale.
    Fig. 3 is a perspective view of the fixture during insertion between the bed and amatress arranged on the bed.
    Fig. 4 is a schematic plan view of a patient positioned on a bed.
    Fig. 5 is a schematic plan view similar to Fig. 4 with the arrn in a correct position.
    Fig. 6 is an exploded perspective view of a fixture according to a second embodimentof the invention.
    Fig. 7 is a perspective view of the fixture according to Fig. 6 in a mounted position.
    Fig. 8 is a detail view of the arrn fixture portion of a second embodiment.
    Fig. 9 is another detail view of the arrn f1xture portion of a third embodiment.
    Fig. 10 is an exploded view in perspective of a fixture link used in the embodimentof Fig. 1 to 3.
    DETAILED DESCRIPTION OF EMBODIMENTSBelow, several embodiments of the invention will be described. These embodimentsare described in illustrating purpose in order to enable a skilled person to carry out theinvention and to disclose the best mode. However, such embodiments do not limit the scopeof the invention. Moreover, certain combinations of features are shown and discussed.However, other combinations of the different features are possible within the scope of theinvention.
    When a catheter should be inserted during X-ray investigation and possible balloonexpansion of coronary vasculature of the heart, the most common way to insert such acatheter has up to now been insertion into the femoral artery, since the femoral artery issuff1ciently large and extends directly to the aortic arc and subsequently to the coronaryarteries. However, since the femoral artery is large, there is also a concomitant risk of bloodleakage complications.
    As an altemative, the use of the radial artery in the arrn has been suggested. Thephysician is norrnally placed at the right side of the patient and has a heavy lead apron inorder to shield the physician from X-rays. Thus, it may be convenient for the physician to usethe right arrn of the patient.
    The embodiments shown below are intended to be used at the right arrn of thepatient. However, the f1xture may altematively or additionally be used at the left arrn of thepatient.
    Fig. 1 shows a patient 1 lying on a bed board 2 in a supine position. The bed board 2is supported by a large stand 3, which may be fixed in position, for example screwed to thefloor. The bed board 2 is made of a thin board of a X-ray-transparent material. The bed board2 is suspended by the stand 3 so that the bed board extends freely out from the stand. Thus,the bed board 2 with a patient 1 can be exposed to X-rays so that the insertion of a cathetercan be monitored in real time.
    A heavy lead protection shield 18 is attached to the stand 3 and may be folded to aposition below the bed board in order to protect the lower portion of the physician from X-rayradiation.
    The part of the bed board which supports the head and the upper portion of the bodyof the patient must be free from any metal parts. Thus, the bed board is made of carbon fibersand plastics material, so that a sufficently stiff bed board is obtained.
    The bed board has no edges which can support an arm fixture of the type used in theprior art US7055910B2. Thus, a new type of fixture is required.
    Fig. 1 shows a first embodiment of an arm fixture. The fixture comprises an armholder 11, which is attached to a first swivel joint 13 by a first link 12. The first swivel joint13 is attached to a board 14. Moreover, the fixture comprises an instrument table 17, which isattached to a second swivel joint 15 via a second link 16. The second swivel joint 15 is alsoattached to the board 14. The board 14 is inserted between the bed board 2 and a matress 4arranged on the bed board 2. In addition, a protecting sheet 5 may be arranged on the matress.
    The arm fixture according to the first embodiment is shown in more detail in Figs. 2and 3. The arm holder 11 comprises an arm support portion 21 provided with an adjustablebelt 22, arranged to encircle an arm 6 adjacent an elbow of the arm in order to immobilize thearm on the arm support portion 21. In addition, a wrist support portion 23 is insertable in a slit24 of the arm holder 11. The wrist support portion 23 comprises an angled outer portion 25provided with a belt or tape 26. The angle is arranged at the outer side of the wrist 7 of thearm and the tape 26 is arranged around the hand above the thumb 8 as shown forimmobilizing the hand to the wrist support portion 23. Thus, the wrist will be arranged in anangled position with an open angle, whereby the arteries at the inner side of the wrist will beexposed to the physician.
    The wrist support portion 23 is the only part, which needs to be sterilized. The wristsupport portion 23 may be provided as a disposable product, which is used only one time andthen discarded. The other parts of the embodiment can be cleaned in an aseptic way as ispractice in a hospital.
    As shown in Fig. 3, the bed board 2 is provided with a matress 4. The bed board 2and the matress are norrnally provided with friction material so that the matress will retain itsposition on top of the bed board 2. Such friction material makes it practically impossible toinsert the fixture board 14 between the bed board and the matress, especially if a patient islying on the matress.
    The fixture board 14 may be made of a non-friction material, which will enable thefixture board 14 to be inserted between the bed board and the matress.
    In another embodiment, the matress is provided with an area lacking said frictionmaterial. The area without friction material is arranged in the position, wherein the fixtureboard 14 is to be inserted.
    In a further embodiment, there is arranged a sheet between the matress and the bedboard in the postion, wherein the fixture board 14 is to be inserted. The sheet may be a doublesheet, like a pillowcase. The fixture board 14 is inserted inside the pillowcase.
    In these embodiments, the fixture board 14 is insertable between the bed board andthe matress even in the situation when a patient is lying on the matress. In addition, the fixtureboard is moveable in the longitudinal direction in order to adapt the board and the arrn holder11 in a predeterrnined position.
    The fixture according to the embodiment is used in the following manner, see Fig. 2.When a patient is in need of an arrn fixture, the fixture board 14 is inserted between the bedboard 2 and the matress 4 as indicated in Figs. 2 and 3. Then, link 12 and the arrn holder 11are arranged in a position, in which the arrn support portion 21 is positioned adj acent anelbow of a patient. The link 12 is tightened so that the position of the arrn holder 11 becomesfixed and the belt 22 is tightened around the arrn. The link 12 may be further adjusted duringthis procedure.
    Then, the wrist holder 23 is inserted in the slit 24, or may have been arranged in theslit from the start. The wrist holder is adjusted to a predeterrnined position with the angleopposite the wrist and the tape 26 is arranged around the hand. Now the position according toFig. 2 has been obtained. Finally, the instrument table 17 is arranged in a predeterrninedposition, preferably in a horizontal position and is covered by a sterile cloth. The patient isnow ready for treatment.
    There is no metal parts in the arrn f1xture of the embodiment, but all details are madefrom plastics material, which are transparent to X-ray radiation. Thus, the insertion andadvancement of a catheter through the arrn artery can be monitored.
    Fig. 4 shows the patient 1 lying on the bed board matress 4 in a relaxed supineposition with the right arrn 6 resting at the side of the abdomen with the hand approximatelyat the waist.
    The palm of the hand is facing inward towards the abdomen, as appears from Fig. 4and the thumb 8 is directed towards the patient. Thus, the palm of the hand and the inner sideof the wrist 7 is facing inwardly, toward the abdomen and the radial artery is not convenientlyavailable.
    The expressions “inner” and “outer” are intended to mean positions at the normalarrn position. Thus, the inner side of the arrn is the side of the arrn norrnally facing theabdomen, for example in the position shown in Fig. 4. The outer side of the arrn is the portionof the arrn facing away from the abdomen. The inner side of the hand, i.e. the palm, is facingthe abdomen in the position shown in Fig. 4.
    As shown by arrow 9a in Fig. 4, the hand and the wrist 7 should be rotated about 90°around the symmetry axis of the arrn in order to expose the radial artery at the inner side ofthe wrist. In this position, the palm of the hand faces upward and is substantially parallel withthe abdomen and the thumb 8 faces outward, i.e. the palm of the hand is oriented in asubstantially horizontal direction when the patient is arranged in the supine position shown inFig. 4. In this position of the arrn and the wrist as shown in Fig. 5, the radial artery of the rightarrn is conveniently available for insertion of a catheter in the artery.
    In addition, the wrist should be turned so as to open the angle of the wrist, as shownby arrow 9b in Fig. 5. The expression “opening” the angle of the wrist is intended to meanthat the angle between the forearrn and the palm of the hand becomes larger than 180 degrees.In this way the radial artery will be conveniently available.
    As an alternative to the radial artery, the physician may use an ulnar artery, which isalso conveniently available.
    During use, the table 17 may be covered by a sterile surgical cloth, for example ofcotton. Then, the required instruments, such as peangs, forceps etc and medical devices, suchas canulas and hoses, etc are arranged at the table in order to be conveniently positioned to thesurgican.
    Fig. 6 shows the parts of the embodiment of Figs 1 to 3 in more detail. The fixtureboard 14 is substantially oval and rounded and may have a depth of about 40 cm and a lengthof about 20 cm. The inner side may be chamfered as shown by reference numeral 31 in orderto make it more easy to insert the fixture board. The fixture board may be provided with oneor serveral holes 32 in order to make the board lighter.
    The swivel joints 13 and 15 may be attached to the fixture board 14 by an adhesive.Altematively, small screws may be used, since such screws will not be interfering with anyX-ray picture that the physician might want to see.
    The links 12 and 16 may be of a conventional design, for example as shown in thepatent document US5845885A and shown in Fig. 10. Any type of link that is able toimmobilize the instrument table 17 and the arrn holder 11 in a desired position can be used.
    The instrument table 17 is provided with a swivel joint 41 attached to the bottom sideof the instrument table 17, by adhesive or by screws. The instrument table 17 is provided witha rim 42, which is arranged for preventing blood from dripping from the instrument table.Similar rims may be arranged at the side edges 43 and 44.
    As further shown in Fig. 6, the side facing the physician is provided with a shallowrecess, so that the physician is able to stand closer to the bed without contacting the board. Inthis manner, possible unintended dislocation of the board by the physician is avoided.
    The board 14 is provided with a relatively broad edge so that the board is easilygripped and arranged between the bed board and the matress.
    Fig. 7 shows the device according to the first embodiment in a mounted position.Thus, the instrument table 17 has been connected to the board 14 by arranging the link arrn 16connecting th swivel joint 15 of board 14 with the swivel joint 41 of the instrument table. Inthe same manner, the link arm 12 interconnects swivel joint 13 of the board 14 with theswivel joint 54 of the arrn holder 11.
    One or several triangular protrusions 33, 34 may be arranged at the board 14 asshown in Fig. 7. The protrusions 33, 34 do not prevent easy insertion of the board 14 beneaththe bed board 2 and the matress 4, but prevents unintentional Withdrawal of the board 14. Inaddition, the protrusions 33, 34 prevent dislocation of the board 14 in the laterial directionparallel to the bed length direction.
    The arrn holder 11 is shown in more detail in Fig. 8. The arrn holder 11 comprises asupport portion 21 provided with slits 52 for a belt. The support portion 21 is arranged in aholding portion 53 provided with a swivel joint 54 for connection to said link 12. The holdingportion 53 comprises the slit 24 for insertion of the wrist support portion 23. The wristsupport portion has an angle 55, which is intended to be arranged at the outer side of the wrist.The angle may be about 30 degrees. The tape 26 is arranged at the outer part of the wristsupport portion.
    The wrist support portion may be free to move in the slit 24. Altemativel, a lockingscrew (not shown) is arranged in the slit 24 for locking the wrist support portion in apredeterrnined position.
    The swivel joint 54 may be arranged more to the left as shown in Fig. 8 in order tobetter support the weight of the arrn. In another embodiment, the swivel joint is arranged inthe middel of the holding portion 53.
    It may be desired to move the arrn holder 11 back and forth along the arrn in order toadjust the arrn holder in relation to the position of the arrn of the patient. This can beperformed by moving the entire fixture board 14 back and forth. However, such movementscan be difficult to perform.
    In a further embodiment, the swivel joint 54 is arranged in a longitudinal groove 55arranged at the bottom side of the holding portion 53 as shown in Fig. 9. Additionally oraltematively, the swivel joint 13 in the fixture board 14 may be adjustable in the lengthdirection toward or away from the other swivel joint 15 and lockable in a predeterrninedposition. Additionally or altematively, the link 12 may have an adjustable length, for examplebeing telescopic.
    The fixture board 14 may be insertable in a pillowcase, as shown in Fig. 6. Thepillowcase 61 may have a width which is slightly larger than the length of the fixture board14. Altematively, the width of the pillowcase 61 may be larger as indicated by broken lines 62in order to allow some movement of the fixture board 14 in the length direction. Thepillowcase 61 is arranged between the bed board and the matress before the patient is placedon the matress. The pillowcase 61 may be made from a woven or non-woven material, such ascloth or may be made from thin boards of a rigid material, such as tree or plastics material.
    Fig. 10 shows a link arm, which may be used in the embodiments as describedabove. The link arrn comprises a left house portion 71 and a right house portion 72. The upperand lower ends of each house portion is provided with partly spherical recesses 73, 74, 75, 76,having the same radius as two spherical swivel joint balls 77 and 78. The swivel joint balls areattached to support plates 79 and 80, which are arranged to be attached (for example byscrews) to a device or member to be supported and interconnected by the link arm. The twohouse portions 71 and 72 are connected to each other by a screw 81 and a nut 82 and a washer83. A spring 84 keeps the two housing portions at a distance from each other. The recesses 73,74, 75 and 76 are arranged partly around the balls 77 and 78 when the screw 81 and the nut 82interconnects the house portions 71 and 72. When the nut 82 is tightened, the recesses arepressed against the balls and the link arm is locked in the adjusted position. The balls 77 and78 are provided with friction material. In addition, the recesses may be provided with frictionmaterial. The link arm may be manufactured by a plastics material, or partly or entirely in ametallic material.
    The embodiments disclosed above are intended to be used during Cardiovascular X-ray investigations and interventions in a Cath-Lab department of a hospital. As indicated byseveral researchers, the transradial, rather than the transfemoral, approach to precutanouscoronary intervention has become of great interest, see for example the article by Rao, SunilV. "The Transradial Approach to Percutaneous Coronary Intervention." Journal of theAmerican College of Cardiology 55.20 (May 18, 2010): 2187-95.
    There are other medical methods when it may be desired to immobilize the right armin the position shown, for example in emergency situations when fast and convenient accessto the arm artery is desired. Such a situation may be during ambulance transports.
    Another medical method may be the introduction of cold saline in the arm artery forcooling of the body as soon as possible after a brain injury, such as brain hemorrhage orstroke or a heart infarct. About 500 to 1000 ml cold saline is introduced in the body as soon aspossible to induce hypotherrnia.
    A further medical method in which the f1xture may be used is the localization anddissolution of clots or obstructions in other positions than the heart.
    In the embodiments, links comprising two swivel joints and a link arm are used.However, other types of links may be used, such as parallel connected link arms.
    In the claims, the term "comprises/comprising" does not exclude the presence ofother elements or steps. Furthermore, although individually listed, a plurality of means,elements or method steps may be implemented by e. g. a single unit. Additionally, althoughindividual features may be included in different claims or embodiments, these may possiblyadvantageously be combined, and the inclusion in different claims does not imply that acombination of features is not feasible and/or advantageous. In addition, singular references"a" Hdo not exclude a plurality. The terms , an", “f1rst”, “second” etc do not preclude aplurality. Reference signs in the clain1s are provided n1erely as a clarifying example and shallnot be construed as liniiting the scope of the clainis in any Way.
    Although the present invention has been described above With reference to specificen1bodin1ent and experinients, it is not intended to be lin1ited to the specific forrn set forthherein. Rather, the invention is lin1ited only by the acconipanying clainis and, otheren1bodin1ents than those specified above are equally possible Within the scope of theseappended clainis.
    权利要求:
    Claims (8)
    [1] 1. A fixture for being attached to an arrn of a patient, comprising:an arrn holder (11) arranged adj acent an elboW of the patient and comprising an arrnsupport (21) and a belt (22) for attaching the arrn to the arrn support; a Wrist holder (23) attached to the arrn holder (11) for supporting the Wrist;characterized by: a link (12) for attaching the arrn holder (11) to a fixture board (14) intended to be arranged on a bed board for a patient.
    [2] 2. The fixture according to claim 1, Wherein the fixture board (14) comprises a plateintended to be inserted between said bed board (2) and a matress (4), onto Which said patient is arranged.
    [3] 3. The fixture according to claim 2, Wherein said plate comprises a chamfered edge (31) for making said insertion more easy.
    [4] 4. The fixture according to any one of the previous claims, Wherein the distancebetween the arrn holder (11) and the fixture board (14) is adjustable.
    [5] 5. The fixture according to any one of the previous claims, Wherein said linkcomprises a first sWivel joint (13) arranged at said fixture board (14), a second sWivel joint(54) arranged at said arrn holder (11) and a link arrn (12) for connecting said first and second swivel j oints.
    [6] 6. The fixture according to claim 5, Wherein the length of the link arrn (12) isadjustable.
    [7] 7. The fixture according to any one of the previous claims, fiarther comprising aninstrument table (17), Which is connected to said fixture board (14) via a link (16).
    [8] 8. Use of a fixture according to any one of the previous claims in a percutanous coronary intervention procedure.
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    同族专利:
    公开号 | 公开日
    EP3125847B1|2019-01-30|
    WO2015152786A1|2015-10-08|
    EP3125847A1|2017-02-08|
    SE538464C2|2016-07-12|
    US10555830B2|2020-02-11|
    US20170020710A1|2017-01-26|
    EP3125847A4|2017-10-25|
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    法律状态:
    优先权:
    申请号 | 申请日 | 专利标题
    SE1430049A|SE538464C2|2014-04-02|2014-04-02|ARM FIXTURE|SE1430049A| SE538464C2|2014-04-02|2014-04-02|ARM FIXTURE|
    US15/300,857| US10555830B2|2014-04-02|2015-03-31|Fixture for arm during medical treatment|
    EP15773003.7A| EP3125847B1|2014-04-02|2015-03-31|Fixture for arm during medical treatment|
    PCT/SE2015/000019| WO2015152786A1|2014-04-02|2015-03-31|Fixture for arm during medical treatment|
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