SUCTION APPARATUS*

VICTOR CARABBA, M.D., P.A.C.S.

NEW YORK CITY

T HE vaIue of suction as a therapeutic procedure in surgery, has been defi- niteIy estabIished. The great contri-

bution of Wangensteen’ in the use of suction in the relief of intestina1 distention is a noteworthy exampIe. The other sur- gica1 conditions in which suction can be empIoyed are: stomach drainage, duodena1 drainage, biIiary drainage, and suprapubic drainage.

AI1 of the apparatus used since 1917 for sIow suction in surgica1 conditions have been vacuums produced by water siphons. MechIing,2 in 1917, described the earIiest suction apparatus. The apparatus con- sisted of tanks revoIubIy supported on a frame and arranged one above the other with a means of permitting the fluid of one tank to pass to the other tank to cause a vacuum in one of the tanks. FeIsen,3 in 1918, described a suction apparatus for thoracentesis. The apparatus consisted of a hermeticaIIy cIosabIe liquid reservoir, adapted to contain a partia1 fiIIing of Iiquid and an air space above the IeveI of the fluid. A vent in the bottom of the bottIe permitted gravity drainage of the bottIe with resuIting suction produced in the air space above. TuttIe, in Igrg, patented an apparatus which used the same principIe as that of FeIsen, but was Iafger and more compIicated in its detaiIed mechanism. Bethune,” in 1921, patented a reversibIe doubIe container vacuum pump so con- nected that, when fluid passed from the upper to the Iower container, a vacuum was produced above the IeveI of the Iiquid in

the upper container. Gaynor and WheeI- wright,6 in 1935, reinvented the apparatus described by Bethune, adding a more eIaborate vaIve mechanism. Wangensteen earIier described his simpIe water siphon suction device.

One of the principa1 objects of the pres- ent apparatus is to provide an improved vacuum siphon apparatus, wherein air, rather than water, is empIoyed for the purpose of producing the reIativeIy Iow vacuum, which is necessary to provide a proper order of drainage.

Another object is to suggest an improved suction apparatus which is smaI1 in size and readiIy movable, Iight in weight and easiIy operated. The device wiI1 function for a considerabIe period of time without any attention on the part of the operator, and is readiIy controIIabIe as to the amount of fluid which is drawn from the body.

The suction device comprises a coIIection bottIe of suitabIe size, the bottIe having a pair of AexibIe ducts Ieading therefrom, one of such ducts Ieading to the patient and the other to a somewhat Iarger bottIe, preferabIy spherica in shape and contain- ing an infIatabIe bag. A tube Ieads into the bag, the opposite end of the tube having means for connection with a conventiona air pump. The tube aIso has a pIuraIity of vaIves or petcocks in the Iine of flow of ffuid passing through it. One of the pet- cocks is of conventiona form and the other is formed with an aperture in the vaIve, so that a sIight flow of fluid may take pIace even when it is cIosed. This

* From New York University College of Medicine and Third SurgicaI Division BeIIevue Hospital, Arthur M. Wright, M.D., Director.

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668 American Journal of Surgery Carabba-Suction Apparatus JUNE. 1938

aperture shouId be Iarge enough to permit about 30 C.C. of air to pass through per

naturaIIy ceases, due to the equaIization of pressures. If the duct from the coIIection

minute. bottIe is to be Ieft in the patient afterward,

FIG. I. A side elevation of the device, partiaIIy in section.

The bag (Fig. 2) is inflated by a con- ventiona1 pump to a point where it more or Iess compIeteIy fiIIs the spherica vesse1, after which both vaIves are cIosed. When the device (Fig. 3) is to be used, the first mentioned vaIve is opened, thereby per- mitting 30 C.C. of air to pass out of the bag per minute. In so doing, a partia1 vacuum is created in the Iarger vesse1 which is con- nected to the coIIection bottle by a fIexibIe duct. Within three or four minutes, the air in the coIIection bottIe is withdrawn to a point wherein the suction becomes effective and ffuid is withdrawn from the patient.

The suction continues as Iong as there is fluid in the cavity of the patient, or as Iong ‘as there is air in the cavity at a pressure in excess of atmospheric pressure. When the air in excess of atmospheric pressure, and the fluid have been with- drawn from the cavity, the suction quite

no further air wiI1 pass from the inffated bag unti1 the suction again begins to function.

The device (Fig. I) is mounted on a vertica1 support (I o), which is made from tubing of suitabIe diameter to provide the desired strength, in a socket (I I) at its Iower end, the socket in turn being secured to an eIongated SubstantiaIIy rectangular base (12). A “T” fitting (13) is mounted at the upper end of the vertica1 support (IO). The “T” carries horizonta1 tubuIar members 14 and 15, the tube (14) sup- porting the reIativeIy smaIIer coIIection bottIe (16), and the tubing (15) supporting the Iarger, spherica1, vacuum-producing bottle (17).

The upper end of the coIIection bottIe is formed with the usua1 flange (19) which is supported by a substantiaIIy U-shaped collar (20) carried by the tube (14). A stopper (22), made of rubber or other

NEW SERIES VOL. XL, No. 3 Carabba-Suction Apparatus American ~o~rnat of surgery 669

suitable materia1, is pIaced in the upper ffange (3 I) at its upper end which I

end of the coIIection bottIe; the stopper is upon a circular coIIar (32) carried by formed with a pair of spaced IongitudinaI horizonta1 tube (15).

-ests the

FIG. 2. Bag being inflated, stopper disconnected in coIIection bottle.

FIG. 3. Stopper in collection bottte reptaced. Petcocks open, air escaping from bag to produce vacuum.

apertures (24), which contain inIet tubes A rubber stopper (34) within the c Ipen- (25). To one of these tubes is secured a ing of the bottIe (17) is provided wi ith a Iength of rubber tubing (26) which passes pair of spaced apertures (36). In or le of to the patient; the other, tube carries a these there is a short inIet tube (37) con- shorter Iength of rubber tubing (28) which netted with the rubber tube (28) and passes to the vacuum-producing bottIe extending into the bottIe (I 7) onIy a : short ( I 7). This bottIe is Iikewise provided with a distance beIow the stopper (34). The se cond

670 American Journal of Surgery Carabba-Suction Apparatus JUNE, rgs8

aperture in the stopper hoIds a somewhat Ionger tube (39) which extends downward

smaI1 quantity of air, about 30 C.C. to pass through per minute.

to a point adjacent to the Iower end of the bottIe.

To inflate the bag, the petcocks are

An infIatabIe rubber bag (42), having a opened and a conventiona pump with check-vaIve (not shown) is attached to the

reinforced opening (43), is mounted on the nippIe (65) on the vaIve (62). When the tube, the tube passing through it in such a bag is compIeteIy inffated, the vaIves are way that an air-tight sea1 is formed. The cIosed, the pump removed, and the device bag is of such size, that when inffated it is ready for use. compIeteIy fiIIs the spherica bottIe (I 7) in In use, the AexibIe tube is first con- which it is contained. In order to prevent nected with the patient and the vaIve in injury to the bag, a suitabIe stopper (45) is placed in the aperture at the Iower end

the petcock 62 opened, thereby permitting

of the tube. The tube aIso has severa approximateIy 30 c.c. of air to pass out of the bag per minute. In four minutes or

spaced apertures (47) in its side waIIs, so that air may pass from the tube into the

thereabouts, a sufficient quantity of the air is withdrawn from the coIIection bottIe

bag. Just above the bag there is an annuIar

(16), to cause the suction apparatus to become effective and start the withdrawa

gasket (50) with a centra1 aperture (51) of ffuid from the patient. through which the tube (39) passes. The When the fluid in the patient’s cavity gasket is of sIightIy greater diameter than has for the time being become exhausted, or the diameter of the neck of the bottIe in order to prevent the inffated bag from

when the air pressure within the cavity

coming in contact with the Iower end of the has been reduced to atmospheric pressure, the suction ceases by the equaIization of

tube (37). The coIIar (32) which supports the pressures within and without the the bottIe (17) is provided with upward device. It is not necessary, however, to shut extending boIts (54) on opposite sides, and the valve (62) at this time, since suction the boIts are provided with wing nuts (55). again begins to function as soon as more There is a meta cap (57) with a pair of spaced ears (58) on opposite sides at the

fluid has coIIected in the cavity.

upper end of the bottIe above the stopper REFERENCES

(34). The screws (54) pass between these I. WANGENSTEEN, 0. H. Rationalizing treatment in

spaced ears; the cap (57) is heId in firm acute intestinal obstruction. Surg., Gynec. ev Obst.,

engagement with the upper end of the 64 (Feb. 15) 1937.

bottIe by means of the wing nuts (55). 2. MECHLING, T. F. U. S. Patent 1,25o,g28. Vacuum-

Siphon.

The upper end of the tube (39) carries a 3. FELSEN, J. Apparatus for thoracentesis. U. S.

pair of petcocks (61) and (62), provided Patent I,284,630.

with vaIve handIes (63) and (64). One 4. TUTTLE, A. H. Suction apparatus for surgical use.

U. S. Patent 1,316,340.

petcock (62) is of the conventiona type 5. BETHUNE, C. W. Suction pump. U. S. Patent

and the other (61) is provided with a vaIve 19374,808.

(not shown) which, when cIosed, permits a 6. GAYNOR, W’. C. T., and WHEELWRIGHT. New suc-

tion apparatus. Am. J. Surg., 30: 185 (Oct.) 1935.