EP0793520A2 - Luftöhrenüberwachungsadapter und dessen gebrauch - Google Patents
Luftöhrenüberwachungsadapter und dessen gebrauchInfo
- Publication number
- EP0793520A2 EP0793520A2 EP94928135A EP94928135A EP0793520A2 EP 0793520 A2 EP0793520 A2 EP 0793520A2 EP 94928135 A EP94928135 A EP 94928135A EP 94928135 A EP94928135 A EP 94928135A EP 0793520 A2 EP0793520 A2 EP 0793520A2
- Authority
- EP
- European Patent Office
- Prior art keywords
- catheter
- monitoring
- combination
- patient
- adapter
- Prior art date
- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Withdrawn
Links
Classifications
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
- A61M16/04—Tracheal tubes
- A61M16/0463—Tracheal tubes combined with suction tubes, catheters or the like; Outside connections
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
- A61M16/04—Tracheal tubes
- A61M16/0402—Special features for tracheal tubes not otherwise provided for
- A61M16/042—Special features for tracheal tubes not otherwise provided for with separate conduits for in-and expiration gas, e.g. for limited dead volume
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
- A61M16/04—Tracheal tubes
- A61M16/0486—Multi-lumen tracheal tubes
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
- A61M16/08—Bellows; Connecting tubes ; Water traps; Patient circuits
- A61M16/0816—Joints or connectors
- A61M16/0833—T- or Y-type connectors, e.g. Y-piece
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
- A61M16/04—Tracheal tubes
- A61M16/0434—Cuffs
- A61M16/0445—Special cuff forms, e.g. undulated
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
- A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
- A61M16/0003—Accessories therefor, e.g. sensors, vibrators, negative pressure
- A61M2016/0027—Accessories therefor, e.g. sensors, vibrators, negative pressure pressure meter
Definitions
- the present invention is concerned with an airway monitoring adapter and monitoring catheter.
- the present invention provides for variable positioning of a monitoring device and makes it possible to monitor, for instance, distally to a tracheal tube positioned in said patient.
- the present invention is concerned with a process for tracheally suctioning a patient along with monitoring distally of a tracheal tube.
- the present invention is also concerned with a suction catheter equipped with the airway monitoring adapter.
- suctioning has been achieved by removing the ventilation equipment, thereby interrupting the patient's assisted ventilation, and inserting, such as into the trachea and bronchi, a catheter which in turn is connected to a vacuum source. After the fluid is removed via the catheter by application of the vacuum, the ventilation equipment is reattached to the patient and the ventilation is resumed.
- This ventilation suction catheter system includes a catheter tube; a cross-piece connecting member for connection to an endotracheal tube, and also for connection to a ventilating apparatus; a means for connecting a vacuum located at the end opposite to that nearest the patient; a control valve to control the suction; and a protective sleeve located between the cross-piece and the member for connecting to the vacuum.
- Closed ventilation suction catheter systems make it possible to continue the ventilation, while at the time, applying suction to remove undesired accumulated fluid from a patient.
- ARDS Adult Respiratory Distress Syndrome
- the conventional ventilatory support mode is volume- controlled ventilation with applied positive end expiratory pressure (PEEP) .
- PEEP positive end expiratory pressure
- I:E inverse inspiratory: expiratory
- PAP peak airway pressures
- MAP mean airway pressure
- auto-PEEP auto-PEEP
- the typical manner for monitoring the MAP and PEEP for a given patient is to monitor the pressure in the circuit tubing and use this for clinical judgment. This is so, even though there is data that suggests that the airway pressure needs to be monitored at the tip or distally of the tip of the tracheal tube. Moreover, there are some modes of ventilation which do not allow the lung pressure to equilibrate with the circuit pressure at the end of the expiration phase before the inspiration phase occurs and delivers another volume of air to the lungs. This difference in pressure is called auto-PEEP (or intrinsic PEEP) .
- This auto-PEEP pressure can be monitored via a pressure monitoring lumen in a specialty endotracheal (ET) tube.
- ET endotracheal
- these tubes are the Mallinckrodt with monitoring line and the Sheridan ET C0 2 .
- the major problem employing such is that the patients are not going to be initially intubated with a specialty tube because intubation normally occurs prior to the onset of ARDS. After the onset of ARDS, these patients are so unstable that a tube change could introduce serious complications. Therefore, this is not usually allowed by the attending physician.
- Hamilton Ventilator Company who sells a ventilator with PC-IRV mode, recommends the use of a Portex Jet Ventilator Adaptor, which provides a depth adjustable airway pressure monitoring catheter. This provides the necessary monitoring means distally to the tracheal tube without changing the tracheal tube to a specialty tube with monitoring capabilities.
- the drawback that is associated with this adaptor is the inability to suction the patients' lungs of mucous without breaking the circuit. Breaking the circuit in order to suction can be detrimental to these severely compromised patients (e.g., desaturation and tachycardia).
- the present invention is concerned with an airway monitoring adaptor and monitoring catheter that makes it possible to overcome the above problems associated with the prior art.
- the present invention provides for variable positioning of a monitoring device and makes it possible to monitor distally to a tracheal tube positioned in a patient. Furthermore, the present invention permits a patient to be ventilated, tracheally suctioned and monitored distally to the tracheal tube, without interruption of the ventilation or suctioning.
- the present invention is concerned with a monitoring catheter and a monitoring adapter.
- the monitoring adapter includes a conduit for receiving a first catheter, a conduit having exterior threads located on an interior wall of the adapter, and communicating with the interior of the adapter, guide means within the interior of the adapter for directing a second catheter towards the center of the adapter, a collar having interior threads that mate with the exterior threads on the conduit, and for housing a compression slug, so that tightening of the threaded collar is capable of sealing and anchoring the second catheter.
- the present invention is also concerned with a suction catheter that comprises a catheter tube suitable for insertion into a patient; a patient connecting member mounted so as to surround the catheter tube in the vicinity of the distal end of the catheter tube, wherein the distal end is suitable for insertion into a patient.
- the catheter also includes the above described airway monitoring adapter connected to the patient connecting member in the vicinity of the distal end of the catheter tube, and positioned so as to surround the catheter tube.
- a vacuum connection member is located in the vicinity of the proximal end of the catheter tube.
- a protective sleeve surrounds at least the majority of the length of the catheter tube, and extends between the patient connecting member. The protecting sleeve is adapted to permit the distal end of the catheter tube to be extended from the protective sleeve into a patient, and be withdrawn from the patient.
- the present invention is also concerned with a method for monitoring distally to a tracheal tube positioned in a patient.
- the method of the present invention comprises interposingventilating/aspirating apparatus between the lung/airway system of a patient, and a ventilator; causing the ventilator and the ventilating apparatus to involuntarily cycle influent ventilating gas to the lungs of the patient, and to remove effluent gas from the patient through a tracheal tube; selectively introducing an aspirating catheter into the airway/lung system to remove secretions from the lungs of the patient, without disconnection of the ventilating apparatus; selectively positioning a monitoring catheter into the ventilating/aspirating apparatus distally of the tracheal tube to provide airway monitoring, without disconnection of the ventilating apparatus, or interruption of either the ventilating or aspirating steps.
- Figure 1 is a schematic diagram of the suction catheter of the present invention.
- Figure 2 is a schematic diagram of the airway monitoring adaptor and monitoring catheter assembly of the present invention.
- Figure 3 is a cross-section of a monitoring adapter pursuant to the present invention.
- FIG. 1 is a schematic elevation of a suction catheter equipped with an airway monitoring adapter pursuant to the present invention.
- the suction catheter 21 can be connected through legs 15 and 12 of the cross-shaped piece 11 through airway monitoring adapter 40 and endotracheal or tracheostomy connector 41 and endotracheal or tracheostomy tube 42 to a patient.
- Leg 13 of the cross-piece is connected to a T-shaped adapter 43, which in turn is connected to ventilator 46, via conduits 44 and 45, and adapters 46 and 47, respectively.
- the connecting piece 11 can be provided with a swivel mechanism.
- the adapter 40 may include swivel means, for instance, swivel means located in the vicity of the proximal end of the adapter.
- the proximal ends of various elements are understood as the ends nearest the vacuum source 49, and the distal ends are understood to be those ends nearest the patient.
- the suction catheter 21 includes a catheter tube 2, a vacuum connection member 1, and a protective sleeve 3.
- the catheter tube 2 is a soft flexible tube made of, for instance, polyvinyl chloride, adapted to be inserted into a patient, such as into the trachea/bronchial tree of a patient for the purpose of removing fluid from the patient by employing a vacuum.
- the catheter tube 2 can be a multilumen catheter tube, such as that disclosed in U.S. Patent 5,073,164 to Hollister, et al., entire disclosure of which is incorporated herein by reference.
- the catheter tube can include one or a plurality of eyelets at its distal end to reduce occlusion.
- the catheter tube can include calibrations thereon to provide a reading of the depth of the insert into a patient.
- the catheter tube passes through cross-shaped piece 11 through a wiper seal (not shown) , located in the leg 15 of the cross-shaped piece 11, and surrounding the periphery of the catheter tube.
- the wiper seal can be made of a silicone rubber material.
- vacuum connection member 1 Located at the proximal end of the catheter tube is provided means for connecting the catheter to vacuum source 49, referred to as vacuum connection member 1. Such includes a bore of the same size as the outside diameter of the suction catheter tube.
- the vacuum connection means l is normally made of a relatively rigid material, such as SAN (polymer of styrene and acrylonitrile) .
- valve member 10 Also located between the vacuum connection means 1 and the catheter tube 2 is a valve member 10.
- the valve member 10 illustrated is a spool type valve, preferably made of butyl rubber.
- the valve is operated by manually applying a force to the top of the valve rubber member, whereby the top of the rubber member and the valve member 10 is pushed down, such that it no longer blocks the passage way in the catheter tube, and thereby suction can be applied.
- the valve Upon release of the manual force, the valve returns to its resting position.
- the rubber member 16 is retained in the valve body 18 of the valve member by an ultrasonically welded ring (not shown) .
- a protective sleeve 3 Located between the cross-shaped piece 11 and the valve member 10 is a protective sleeve 3 that surrounds at least the majority of the length of the catheter tube 2.
- the protective sleeve 3 is adapted to permit the distal end of the catheter tube to be extended from the protective sleeve into a patient, and to be withdrawn from the patient.
- the flexible protective sleeve is generally cylindrical in shape and is formed of a flexible, lightweight, translucent plastic material, such as a high clarity polyethylene with a typical thickness of about 0.002 inches.
- the diameter of the protective sleeve is typically about 1.5 to about 1.7 inches, when flattened.
- sleeve 3 The ends of sleeve 3 are adhesively secured to the leg 15 of the cross-shaped piece 11, and leg 18 of the suction valve assembly 1, respectively, via collars la. In assembling, the collars are twisted and threaded over externally threaded legs 15 and 18, respectively, with the ends of the protective sleeve 3, and an adhesive located between the collars and the threaded legs.
- a typical adhesive is polyvinyl chloride doped tetrahydrofuran.
- FIG. 2 is an elevation of the monitoring adapter 40 and monitoring catheter 50 in exploded view.
- the monitoring adapter 40 includes a fitting member 51 that provides connection between endotracheal fitting 41 and cross- shaped piece 11, and includes a conduit for receiving catheter 2 and the monitoring catheter.
- conduit 52 Located on an outer wall of monitoring adapter is conduit 52, having exterior threads 53 (see Fig. 3) .
- This conduit 52 is in communication with the interior of adapter 40.
- the conduit 51 is disposed at an angle A to the adapter. Typically, this angle is about 115 to about 155°, and more typically, about 135°.
- guide means for directing the monitoring catheter towards the center thereof is guide means for directing the monitoring catheter towards the center thereof.
- this means includes wall members 54 and 55 (see Fig.
- Walls 54 and 55 are disposed at an angle B to each other. Wall 54 intersects interior wall of the adapter at an Angle C. The sum of Angle B and Angle C is equal to or greater than 180° with Angle B typically 135° and Angle C typically 45°.
- a collar or compression housing 56 having interior threads (not shown) that mate with the exterior threads on the conduit is included. This collar include gripping means 57 for tightening and loosening such.
- compression housing When compression housing is tightened onto threaded conduit, it houses a compression slug 58 in such a manner that it is capable of sealing and anchoring catheter monitor 61 inserted therein.
- the compression slug 58 can be made from rubber (polyisoprene) .
- the monitoring catheter When loosened, the monitoring catheter can be positioned as desired.
- a steel washer 59 to a protective sleeve 60 is provided around the monitoring catheter 61 and is secured thereto by an o-ring 62 or by a plastic snap fit.
- the protective sleeve 60 can be made of the same material as the protective sleeve 3 employed around catheter 2.
- the protective sleeve 60 surrounds at least the majority of the length of the monitoring catheter 61.
- the monitoring catheter 61 is then connected to a pressure monitor, either stand alone or one that is integral to the ventilator.
- the monitoring of the pressure distally or at the tip of the endotracheal tube, as achieved by the present invention is quite important.
- such is used to determine the patients work of breathing (WOB) .
- WB patients work of breathing
- the present invention can be used to sample the gases in the airway for compositional analysis. This permits the sampling at the level of the carina so that sample dilution is minimized.
- a 3-way stop lock can 63 be connected to the proximal end of the monitoring catheter via female even adapter 64 to permit purging of the monitoring catheter 61.
- the monitoring adapter can also be used as a means for delivering medicaments to the patients lungs.
- medication can be deposited directly into the lungs. This can be achieved by a syringe or by a metered dose inhalation canister.
- the proximal connector can be designed to accept both a standard luer and the stems from a MDI canister (see alternate connecter 65 in Figure 2) .
- a major advantage is that the medicament is directly installed into the lungs, as contrasted to other delivery systems, whereby drug is released into the circuit, so that the majority thereof is deposited on the walls of the circuit, on connectors, and on the inside of the endotracheal tube, rather than in the patient.
Landscapes
- Health & Medical Sciences (AREA)
- Pulmonology (AREA)
- Emergency Medicine (AREA)
- Engineering & Computer Science (AREA)
- Anesthesiology (AREA)
- Biomedical Technology (AREA)
- Heart & Thoracic Surgery (AREA)
- Hematology (AREA)
- Life Sciences & Earth Sciences (AREA)
- Animal Behavior & Ethology (AREA)
- General Health & Medical Sciences (AREA)
- Public Health (AREA)
- Veterinary Medicine (AREA)
- Endoscopes (AREA)
- Sampling And Sample Adjustment (AREA)
- Medical Preparation Storing Or Oral Administration Devices (AREA)
Applications Claiming Priority (3)
Application Number | Priority Date | Filing Date | Title |
---|---|---|---|
US12156793A | 1993-09-16 | 1993-09-16 | |
PCT/US1994/010433 WO1995008356A2 (en) | 1993-09-16 | 1994-09-14 | Airway monitoring adapter and use thereof |
US121567 | 1998-07-23 |
Publications (2)
Publication Number | Publication Date |
---|---|
EP0793520A4 EP0793520A4 (de) | 1997-09-10 |
EP0793520A2 true EP0793520A2 (de) | 1997-09-10 |
Family
ID=22397537
Family Applications (1)
Application Number | Title | Priority Date | Filing Date |
---|---|---|---|
EP94928135A Withdrawn EP0793520A2 (de) | 1993-09-16 | 1994-09-14 | Luftöhrenüberwachungsadapter und dessen gebrauch |
Country Status (5)
Country | Link |
---|---|
EP (1) | EP0793520A2 (de) |
JP (1) | JPH09502894A (de) |
AU (1) | AU7728894A (de) |
WO (1) | WO1995008356A2 (de) |
ZA (1) | ZA946814B (de) |
Families Citing this family (5)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US6579254B1 (en) * | 2000-06-19 | 2003-06-17 | Portex, Inc. | Medication adapter and method for use thereof |
US6575944B1 (en) | 2000-06-19 | 2003-06-10 | Portex, Inc. | Adapter for localized treatment through a tracheal tube and method for use thereof |
ATE487507T1 (de) | 2005-09-21 | 2010-11-15 | Marina-Mor Trodler | Vorrichtung zur fixierung eines atemwegsschlauchs an einem patienten |
JP5518700B2 (ja) | 2007-06-04 | 2014-06-11 | エシコン・エンド−サージェリィ・インコーポレイテッド | カニューレとともに使用するための内視鏡用咬合阻止器 |
US8444627B2 (en) * | 2008-12-31 | 2013-05-21 | Kimberly-Clark Worldwide, Inc. | Respiratory manifold with bridge |
Citations (5)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US4723543A (en) * | 1983-01-24 | 1988-02-09 | Beran Anthony V | Endotracheal tube connector |
US4825859A (en) * | 1987-03-11 | 1989-05-02 | Ballard Medical Products | Neonatal closed system for involuntary aspiration and ventilation and method |
US4838258A (en) * | 1987-10-26 | 1989-06-13 | Gibeck-Dryden Corporation | Gas sampling lumen for breathing system |
WO1991001771A1 (en) * | 1989-08-04 | 1991-02-21 | Nellcor Incorporated | Improved airway adapter with purge means |
US5073164A (en) * | 1990-05-02 | 1991-12-17 | Hollister William H | Suction catheter |
Family Cites Families (11)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US4393873A (en) * | 1980-03-10 | 1983-07-19 | Nawash Michael S | Gastrostomy and other percutaneous transport tubes |
US4419094A (en) * | 1981-06-08 | 1983-12-06 | The Kendall Company | Suprapubic catheter system |
US4569675A (en) * | 1983-09-12 | 1986-02-11 | Infusaid Corporation | Transcutaneous infusion system |
US4668222A (en) * | 1984-05-25 | 1987-05-26 | Thermedics Inc. | Percutaneous access device with removable tube |
US4593681A (en) * | 1985-01-18 | 1986-06-10 | Soni Prasanna L | Stabilizing device for use in arthroscopic and endoscopic surgery |
US5020534A (en) * | 1985-01-23 | 1991-06-04 | Pell Donald M | Endotracheal tube apparatus and method |
US5009227A (en) * | 1989-09-21 | 1991-04-23 | Nieuwstad Peter P | Endotracheal tube holder |
US5062420A (en) * | 1990-09-18 | 1991-11-05 | Walter Levine | Sealed swivel for respiratory apparatus |
US5146913A (en) * | 1991-03-04 | 1992-09-15 | Asphendiar Khorsandian | Holder and lock for oro-intubation |
US5257973A (en) * | 1992-02-05 | 1993-11-02 | Raul Villasuso | Sealing sleeve and method for laparoscopy |
US5251616A (en) * | 1992-07-23 | 1993-10-12 | Wisconsin Alumni Research Foundation | Adjustable tracheostomy tube assembly |
-
1994
- 1994-09-05 ZA ZA946814A patent/ZA946814B/xx unknown
- 1994-09-14 WO PCT/US1994/010433 patent/WO1995008356A2/en not_active Application Discontinuation
- 1994-09-14 AU AU77288/94A patent/AU7728894A/en not_active Abandoned
- 1994-09-14 EP EP94928135A patent/EP0793520A2/de not_active Withdrawn
- 1994-09-14 JP JP7509840A patent/JPH09502894A/ja not_active Expired - Lifetime
Patent Citations (5)
Publication number | Priority date | Publication date | Assignee | Title |
---|---|---|---|---|
US4723543A (en) * | 1983-01-24 | 1988-02-09 | Beran Anthony V | Endotracheal tube connector |
US4825859A (en) * | 1987-03-11 | 1989-05-02 | Ballard Medical Products | Neonatal closed system for involuntary aspiration and ventilation and method |
US4838258A (en) * | 1987-10-26 | 1989-06-13 | Gibeck-Dryden Corporation | Gas sampling lumen for breathing system |
WO1991001771A1 (en) * | 1989-08-04 | 1991-02-21 | Nellcor Incorporated | Improved airway adapter with purge means |
US5073164A (en) * | 1990-05-02 | 1991-12-17 | Hollister William H | Suction catheter |
Non-Patent Citations (1)
Title |
---|
See also references of WO9508356A2 * |
Also Published As
Publication number | Publication date |
---|---|
EP0793520A4 (de) | 1997-09-10 |
ZA946814B (en) | 1996-11-05 |
WO1995008356A3 (en) | 1995-04-20 |
WO1995008356A2 (en) | 1995-03-30 |
JPH09502894A (ja) | 1997-03-25 |
AU7728894A (en) | 1995-04-10 |
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