GB2084023A - Tracheotomy apparatus - Google Patents

Abstract

A removable tracheostomy obturator 44 of soft, plastics material, has a plug 45 at one end connected by a flexible strap 49 to a cap 48 at the other end, and is provided with windpipe means 51 to permit the patient to breathe freely while a tracheostomy tube is being inserted. The windpipe means 51 may be air passages 52 and 54 in the plug 45 and in the cap 48 or may be a continuous, air conduit 55 of a soft plastics material extending from a blunt, terminal tip 59 in front of the plug, through the tube 21 and cap to ambient atmosphere. The tube 21 has ears 33 and 34 at its rear end for use in securing the tube to the neck of the patient. Each ear 33 and 34 has a relatively inflexible portion 42 and 43 proximal the tube 21 forming a bridge over the incision in the neck and providing a suspended fixation of the tube. <IMAGE>

Description

SPECIFICATION Tracheostomy apparatus This invention relates to tracheostomy apparatus.

The invention is more particularly concerned with tracheostomy tubes, obturators for tracheostomy tubes and tracheostomytube devices including such obturators.

It has heretofore been proposed to provide an instrument for performing a tracheostomy operation, the instrument comprising a tube, or cannu la, of arcuate configuration and an incisor assembly fitting within the tube. The incisor assembly has previously comprised a handle, or knob, at the rear, machine end of the tube, a head having a cutting blade projecting from the forward, patient end of the tube and a rod connecting the knob to the cutting head.

Exemplary of such devices are the instruments disclosed in U.S. Patent Specification No. 2,873,742 to Shelden of Feb. 17, 1959; U.S. Patent Specification No. 2,865,374 to Brown of Dec. 23,1958; and U.S.

Patent Specification No. 3,384,987 to Brummelkamp of Mar. 21, 1968.

The use of sharp cutting blades at the forward end of a tracheal tube in order to make, or enlarge, an incision as the tube is inserted, has been found to have serious disadvantages because the sharp point, or blades, inserted in the front of the trachea may perforate, or damage, the opposite side of the trachea or perforate the gullet lying behind the trachea. Similarly, even more damage could occur in the use of a sharply pointed, hollow needle of hard metal for making the initial incision into the trachea and the subsequent withdrawal of the needle for further insertion of the hard cutting edge tip of a trocar, as taught in the Brummelkamp patent specification.Such instruments are believed to no longer be accepted in modern surgical practice and have become obsolete in favour of tracheal tubes and obturators of soft plastic, inserted, after the incision has been made, by a suitable tracheal spreader.

It has also been proposed to provide a tracheal tube, or guide conduit with an inner expander element telescopically arranged therein for enlarging the incision in the neck. The element having a ball at the tip for attachment of a hollow tubular leader.

Such an apparatus is disclosed in U.S. Patent Specification No. 3,511,243 to Toy on May 12, 1970.

Apparatus for sealing the oesophagus and providing artificial respiration is disclosed in U.S. Patent Specification No. 3,683,908 to Tantrimudalige et al on Aug. 15, 1972 wherein a curved tube with a cuff is introduced through the mouth, there being a small bore, stomach washing tube extending along the main tube with the outer end connected to a supply of washing water.

None of the above patent specifications disclose a tracheostomy tube with an obturator removably positioned therewithin, the obturator having a valve plug affixed by a strap to a valve cap, and made of relatively soft material free of sharp cutting edges or sharp guide tips and which is provided with air passages permitting the patient to breathe while the device is inserted into the trachea.

According to one aspect of the present invention there is provided a tracheostomy tube device comprising a hollow tube of arcuate configuration provided with inflatable cuff means close to one end and unitary obturator means removably located within the bore of said hollow tube, wherein said obturator means has: a plug with a forward nose of streamlined configuration arranged normally to project a predetermined distance beyond the one end of said tube so as thereby to seve as a guide tip, cap means covering the other end of said tube, having a shank fitting within said outer end of the tube and a flexible strap integrally connecting said plug with said cap means and extending within said tube for unitary withdrawal of said obturator means, and wherein said obturator means has windpipe means of a soft flexible plastics material independent of said strap, arranged for conducting air from forwardly of said nose through said tube to the rear of said cap means such that the patient can breathe freely while said tube device, with said obturator means in place, is being inserted through an incision well down into the trachea of the patient.

The windpipe means of the obturator means permitts the patient to breathe freely during insertion of the tube into an incision and into the trachea.

The windpipe means serves as an auxiliary windpipe for the patient and may consist of air passages in the plug and air passages in the cap means, and, or alternatively, may consist of a continuous, flexible air conduit extending from a flexible leader in advance of the plug, along the interior of the tube to a free end at the rear of the cap. The air passages in the valve plug are preferably a set of axially extending grooves in the exterior surface thereof and the air passages in the cap means are preferably axially extending apertures therein.

The tube may include integral oppositely disposed tie ears located close to its other end. The tie ears may each include an inner relatively flexible section located close to said tube and arranged to bridge the incision in the patient's throat so as to avoid twisting of said device, and each tie ear may include an outer relatively flexible section located away from said tube and arranged to conform to the shape of the neck of the patient when said device is tied around the neck of the patient.

A tracheostomy tube device and an obturator for such a device, both in accordance with the present invention, will now be described, by way of example, with reference to the accompanying drawings, in which: Figure 1 is a side elvation, with parts broken away, of a tracheal tube and obturator of the invention; Figure 2 is a rear elevation of the device shown in Figure 1; and Figure 3 is a side elevation of the preferred form of the obturator of the invention.

As shown in the drawings, the tracheostomy tube device 20 of the invention includes a hollow tube 21, of arcuate, or curved, configuration, formed of a disposable, relatively soft material 22, such as a plastics material, and having a wall 23, an interior or axial bore 24 a forward end 25 and a rear end 26. The wall 23 of the tube 20 is free of apertures except that there is an inflatable cuff 27 of well known type close to the forward, patient end 25 which is inflatable through an aperture 28 via a small-bore, flexible tube 29, and a valve 31, all in a known manner.

A pair 32 of integral, oppositely disposed ears 33 and 34 are located proximate the rear, machine end 26 of tube 21. each formed of plastics material 35.

The distal portions 36 and 37 each have tie holes 38 and 39 for ties 41 by which the tracheostomy tube 21 may be held in place around the neck of a patient.

The distal portions 36 and 37 of the ears 33 and 34 are relatively flexible but the proximal sections 42 and 43 are relatively inflexible.

Thus when the tracheal tube 21 is in place with the forward end 25 well down into the trachea of a patient and the rear end 26 projecting from the incision the proximal portions 42 and 43 of the ears form a relatively rigid, but soft, central support which bridges overthe incision and is not subject to twisting, distortion, or deformation.

The obturator 44 of the invention, is best shown in Fig. 3, and includes a tapered, streamlined valve plug 45 which has a rearward portion 46 that closely but slidably, fits within the bore 24 of the forward end 25 of the tube 21, and which has a forward streamlined nose portion 47 normally projecting from the tube 21 to serve as a guide tip. The valve plug 45 of the tracheostomy tube obturator 44 preferably includes a valve cap 48 covering the rear end 26 of the tube 21, the cap having a shank 40 fitting in the bore 24 and being affixed to the plug 45 by a flexible element 49 such as a plastic strap, integral with plug and cap. After making an incision in the neck of a patient, the tube 21, with the obturator 44 positioned therewithin, and with the guide nose 47 projecting in advance of the forward end 25, is inserted into the trachea.It will be seen that during such insertion of conventional previous tracheostomy devices, the windpipe, ortrachea, of the patient will be blocked, and the patient will gasp, become unduly alarmed and struggle for breath all to the dangerofthe operation and discomfort of both patient and surgeon.

In this invention windpipe means 51 is provided consisting of air passages, in the plug 45 and air passages in the cap 48. Preferably the air passages in the plug consist of at least one axially extending groove 52 in the exterior surface 53 of the plug 45 and at least one axially extending aperture 54 in the cap 48.

The obturator 44 with its windpipe means 51 is formed of a relatively soft, disposable plastics material such as nylon, polystyrene orthe like and it is free of any sharp points, sharp metallic cutting edges or other incision making blades.

Windpipe means 51 may also be provided by a small bore, flexible plastic, air conduit 55 extending from a flexible, limp, guide leader portion 56 through the centre of the plug 45, thence along the interior bore 24 of tube 21 out through aperture 57 in valve cap 48 to an open terminal end 58. Thus air for patient breathing may pass freely from the open terminal forward tip 59 of conduit 55, in advance of plug 45 to the open terminal rear end 58 rearward of the cap 48 in the ambient atmosphere.

The conduit 55 is thus available for suction of the contents of the trachea or for introduction of gase-, ous or liquid fluids, while also performing its auxili ary windpipe function and proving a flexible leader, or guide 56 for the tracheal tube and obturator.

The tip 59 of conduit 55 and the surface 53 of tapered plug 45 are blunt and of soft material so that they are not likely to damage the trachea. The tapered plug 45 is preferably of "olive" shape, that is, of oval section, and the elongated conduit, or catheter, 55 is preferably slidably received in the aperture 61 in the tip 55 and slidably received in the aperture 57 in the cap 48 that the length of the flexible leader, or guide, 56 can be adjusted. The leader 56 ranges in length from two to five inches.

The portion 62 extending beyond the valve cap 48 to the end 58 is usually about five inches in length and may be connected via a conventional suction valve to a specimen collecting bottle.

The wing-shape collar or flange 32, formed by the ears 33 and 34 with its central curved stiff portion 42, 43 provides a suspension type of stability to the tracheostomy tube without producing twisting or undue motion of the tube itself and provides stable points away from the surgical incision. In effect, a tripod support is created consisting of the inflated cuff 27, at the tube's forward end 25 within the trachea, and the two outer ends 63 and 64 of the stiffer proximal portions 42 and 43 for three points of stability. The tube is thus suspended at points far removed from the incision to prevent twist, prevent inadvertent ejection of the tube and otherwise stabilize the tube.

Claims (15)

1. A tracheostomy tube device comprising a hollow tube of arcuate configuration provided with inflatable cuff means close to one end and unitary obturator means removably located within the bore of said hollow tube, wherein said obturator means has: a plug with a forward nose of streamlined configuration arranged normally to project a predetermined distance beyond the one end of said tube so as thereby to serve as a guide tip, cap means covering the other end of said tube, having a shank fitting within said other end of the tube and a flexible strap integrally connecting said plug with said cap means and extending within said tube for unitary withdrawal of said obturator means, and wherein said obturator means has windpipe means of a soft flexible plastics material independent of said strap, arranged for conducting air from forwardly of said nose through said tube to the rear of said cap means such that the patient can breathe freely while said tube device, with said obturator means in place, is being inserted through an incision well down into the trachea of the patient.

2. A tracheostomy tube device according to ' Claim 1, wherein said windpipe means includes air passage means in the said plug, the bore of said tube, and air passage means in the said cap means of said obturator means.

3. Atracheostomy tube according to Claim 2, wherein said air passage means in said plug is an axially extending groove in the exterior surface of said plug.

4. A tracheostomy tube device according to any one of the preceding claims, wherein said windpipe means includes an elongate hollow conduit, having a forward portion extending a substantial distance in front of the nose of the plug of said obutrator means, said conduit extending from said plug along the interior of said tube alongside said strap and through an aperture in said cap means to a rear portion such that air can be exhaled or inhaled by a patient during a tracheostomy operation.

5. A tracheostomy tube device according to Claim 4, wherein said conduit is slidable in an aperture in said plug and is slidable in the aperture in said cap means.

6. Atracheostomy tube device according to any one of the preceding claims, wherein said windpipe means includes at least one axially-extending groove in the exterior face of said plug, the bore of said tube, and at least one axially extending air passage in said cap means.

7. A tracheostomy tube device according to any one of the preceding claims wherein said tube includes integral oppositely disposed tie ears located close to its other end.

8. A tracheostomy tube device according to Claim 7, wherein said tie ears each include an inner relatively inflexible section located close to said tube and arranged to bridge the incision in the patient's throat so as to avoid twisting of said device, and wherein each tie ear includes an outer relatively flexible section located away from said tube and arranged to conform to the shape of the neck of the patient when said device is tied around the neck of the patient.

9. Tracheostomy obturator means of plastics material for use with a tracheostomy tube having an axial bore, said obturator means comprising: a plug affixed by a flexible strap to cap means, and windpipe means of plastics material arranged to conduct airthrough said plug along the axial bore of said tube and through said cap means so as to permit the patient to breathe freely when said obturator means is in place within a tracheostomy tube.

10. Tracheostomy obturator means of plastics material for use with a tracheostomy tube having an axial bore, said obturator means comprising: a guide nose of streamlined configuration having at least one axial air passage therein, cap means having at least one axial air passage therein, and a flexible strap integrally affixing said nose to said cap means so as thereby to enable said nose to project forwardly of said tube when said obturator is in place in said tube.

11. Tracheostomy obturator means according to Claim 10 including windpipe means offlexible material integral with said plug and said cap means arranged to permit the patient to breathe freely along the bore of the tube when said obturator means is in place within the tracheostomy tube during insertion into the patient's trachea through a neck incision.

12. A removable obturator for a tracheostomy tube, said obturator comprising: an olive-shaped plug having at least one axially extending air passage therethrough, cap means having at least one air passage therethrough, a strap affixing said plug and cap means, said plug and cap means both having a catheter passage independent of said strap for slidably receiving an elongate catheter extending from in front of said plug alongside said strap in said tube to the rear of said cap means such that said air passage and said catheter provide air venting means and such that the portion of said catheter in front of said plug serves to guide said tube into the trachea.

13. An obturator for a tracheostomy tube substantially as hereinbefore described with reference to Figure 3 of the accompanying drawings.

14. A tracheostomy tube device comprising a tracheostomy tube and an obturator according to any one of Claims 9 to 13.

15. A tracheostomy tube device substantially as hereinbefore described with reference to Figures 1 and 2 of the accompanying drawings.