GB2368289A

GB2368289A - Medico-surgical retainers

Info

Publication number: GB2368289A
Application number: GB0118847A
Authority: GB
Inventors: Eric Pagan; Paul Benjamin Ridout
Original assignee: Smiths Group PLC
Current assignee: Smiths Group PLC
Priority date: 2000-08-08
Filing date: 2001-08-02
Publication date: 2002-05-01
Anticipated expiration: 2021-08-02
Also published as: GB0118847D0; GB0019300D0; GB2368289B

Abstract

A retainer 1 for holding an elongate member, such as an endotracheal tube 20, in place where it emerges from the mouth is fitted in the mouth between the tongue and the oral cavity. The retainer may have one or two blades 16 that fit between the tongue and the oral cavity. A forward part 10 has two posts 12 defining a gap or slot 11 through which the endotracheal tube 20 extends and to which it is secured. The retainer 1 may include a conformable material such as a dental impression material further to help it securely in the mouth.

Description

MEDICO-SURGICAL RETAINERS This invention relates to medico-surgical retainers.

The invention is more particularly concerned with retainers for retaining in place an endotracheal tube or similar device extending through a patient's mouth.

Endotracheal tubes are used to supply gases to and from the trachea of a patient. The patient end of the tube is located in the trachea below the vocal folds and often has an inflatable cuff or balloon, which forms a seal between the outside of the tube and the trachea.

The machine end of the tube projects through the patient's mouth where it may be left open or connected to a ventilation system. The machine end of the tube is usually fixed in position by means of adhesive tape wrapped around the tube where it emerges from the mouth, the tape being secured around the head of the patient. Alternatively, a flange extending from a coupling may be used, which is attached with the machine end of the tube and fastened by means of a tape wrapped around the patient's head. These prior arrangements may work satisfactorily in some circumstances for short periods but, in prolonged use, they often lead to skin damage, especially around the mouth. Similar problems exist with other devices extending through the mouth, such as feeding tubes, sensor cables or the like.

It is an object of the present invention to provide an alternative retainer for retaining in place a device extending through the mouth of a patient.

According to one aspect of the present invention there is provided a retainer comprising a first member shaped to locate between a surface of the tongue and a surface of the oral cavity and a retainer member arranged to retain an elongate device extending through the mouth of the patient.

The retainer member may be located on a forward member positioned forwardly of the tongue and the forward member may have a portion shaped to fit over the lower teeth.

The first member may be a blade adapted to locate between a side of the tongue and gums on one side of the oral cavity. The first member may be adapted to locate beneath the tongue.

The retainer member may include two upwardly-projecting members between which the elongate member is arranged to project. Alternatively, the retainer member may have a slot within which the elongate member is arranged to extend. The slot preferably has an opening of reduced width, the retainer including a resilient member arranged to displace the elongate member to one side of the opening. The retainer may have a tab arranged to project forwardly between the teeth. The retainer may be an integral plastics moulding. The first member may be bifurcated into two fingers arranged to extend along opposite sides of the tongue. The first member may include a conformable material adapted to conform to surfaces of the oral cavity. The conformable material may be selected from a group comprising: foam, gel and mouldable material. Alternatively, the conformable material may be a foam compressed by a sealed bag that can be opened to air to allow expansion of the foam. The first member may be of crescent shape having two prongs adapted to locate on either side under the tongue, the retainer including a support arm projecting forwardly from the first member and supporting a retainer member in the form of a clamp of generally U shape. The first member may include a plurality of recesses distributed over its surface and containing a conformable material such as a dental fixative or dental impression material. The first member may be a sack containing a conformable material, the retainer member being attached with an upper surface of the sack.

According to another aspect of the present invention there is provided an assembly of an elongate medical device secured with a retainer according to the above one aspect of the invention.

Several alternative endotracheal tube retainers according to the present invention, will now be described, by way of example, with reference to the accompanying drawings, in which: Figure 1 is a perspective view of a first form of retainer; Figure 2 is a perspective view of a second form of retainer; Figure 3 illustrates a modified version of the second form of retainer in use; Figure 4 is a perspective view of a modified version of the second retainer; Figure 5 is a perspective view of a third form of bifurcated retainer; Figure 6 is a perspective view of the third form of retainer in use; Figure 7 is a perspective view of a modified version of the third form of retainer; Figure 8 is a perspective view of a fourth form of retainer; Figure 9 is a perspective view of a fifth form of retainer; Figure 10 is a perspective view of a modified version of the fifth form of retainer; Figure 11 is a perspective view of a sixth form of retainer; and Figure 12 is a perspective view of a seventh form of retainer.

With reference first to Figure 1, the first form of retainer 1 is an integral, one-piece, moulded article of a soft, bendable plastics material. The retainer 1 comprises a forward member in the form of a block 10 of generally square section at its forward end having on its upper surface a concave channel 11 and two projecting posts 12 on either side. A horizontal tab 13 with a thumb grip 14 on its upper surface projects from the forward, vertical face 15 of the block 10. The rear side of the block 10 is extended into a single rearwardly-extending blade 16, which tapers to a reduced height along its length. The blade 16 is located to one side of the retainer 1, that is, to the left-hand side of the block 10 when viewed from the rear as in Figure 1. The outer, left-hand face 17 of the blade 16 is a substantially straight continuation of the vertical side of the block, whereas the opposite face 18 is curved along its length so that the tip 19 of the blade is narrow and pointed.

In use, the retainer 1 is inserted in the mouth of the patient so that the blade 16 locates between the gums and the tongue on the left-hand side of the oral cavity, pushing the tongue slightly over to the right-hand side of the cavity. The block 10 locates at the front of the oral cavity, just inside the front teeth, and the tab 13 projects outwardly between the teeth and the lips. An endotracheal tube 20 is retained in position by placing it to extend over the retainer 1 such that it lies on the channel 11 and passes between the posts 12. The tube 20 can then be tied to the tab 13 by means of a tape or the like to form an assembly of tube and retainer. The retainer may be inserted before or after intubation and provides a secure retention of the tube without the need for any external fixing about the head of the patient. The retainer of the present invention can also take various other forms.

With reference now to Figures 2 and 3, the second form of retainer 30 comprises a thin planar blade 31 on one side having a down-turned tip 32 at its rear end. At its forward end 33 the blade 31 joins with a vertical wall 34, which is curved to follow the line of the front teeth. An aperture 35 in the front wall 34 opens via a reduced width slot 36 on the upper edge of the wall and located to one side of the aperture. The retainer 30 is completed by a vertical side wall 37 extending rearwardly from the front wall 34 and joined with the lefthand edge of the blade 31. The side wall 37 tapers in height rearwardly to a minimum height at the rear end of the retainer. At its front end, the inner surface of the side wall 37 supports a resilient foam pad 38, which is located adjacent the side of the aperture 35. The dimensions of the aperture 35, slot 36 and pad 38 are such that an endotracheal tube 20 can be pushed down through the slot and is pushed over to the right by the pad so that the tube is securely located in the aperture. In use, the retainer 30 is inserted in the mouth with the blade 31 located under the tongue and with the side wall 37 extending between the inside of the gums and the left-hand side of the tongue.

Figure 3 shows a modified retainer 30'in position against the tongue 39. The retainer 30'is substantially the same as that in Figure 2 except that its tube-retaining aperture 35' opens on a vertical edge of the front wall 34'.

Figure 4 shows a retainer 40 similar to that in Figures 2 and 3 except that the blade 41 and side wall 42 is made as a separate component from the front wall 43. This enables the blade 41 and side wall 42 to be made of a different, softer material than the front wall. The retainer 40 of Figure 4 is also provided, as a part of the front wall 43, with a bifurcated base plate 44 having two short prongs 45 shaped to extend under the tongue on opposite sides.

The third form of retainer 50 shown in Figures 5 and 6 is a single-piece moulding of generally horseshoe shape tapering in height from front to back and having a vertical peripheral wall 51 and a base 52 defining an upper cavity 53. The retainer 50 is bifurcated into two rearwardly-extending prongs 54 and 55 shaped to locate under either side of the tongue 39, with the front of the tongue lying on top of the retainer between opposite side parts 56 and 57 and the front section 59 of the wall 51. The front section 59 of the wall 51 has a clamping aperture 60 shaped to receive and grip the endotracheal tube 20. The cavity 53 on the upper surface of the retainer may contain a conformable material to fill any gap between the lower surface of the tongue 39 and the base 52. The peripheral wall 51 could be increased in height along the outer edges so as to locate against the hard palate forming the upper surface of the oral cavity.

Figure 7 shows a similar retainer 50'to that shown in Figure 5 except that the cavity 53'is on the underside of the base 52'.

Figure 8 shows a fourth form of retainer 80 formed as a single-piece plastics moulding. It has a base 81 of crescent shape providing two prongs 82 and 83 for location on either side under the tongue. The base 81 has a convex upper surface 84 from which projects a forwardly-curved support arm 85. The upper end of the support arm 85 supports a tube clamp 86 of generally U shape having two horizontal fingers 87, which can be resiliently deflected apart to receive and grip the endotracheal tube 20. The upper and lower surfaces of the upper and lower fingers 87 respectively each have a concave channel 88 shaped to receive the upper and lower front teeth of the patient. This provides protection for the tube 20 from biting.

The fifth form of retainer 90 shown in Figure 9 includes a plate 91 bent to provide a base plate 92 and a vertical front plate 93. The base plate 92 is bifurcated into two prongs 94, which, in use, extend along opposite sides under the tongue. The front plate 93 has an aperture 95 through which the endotracheal tube extends. The retainer 90 also includes flexible bag 96 containing a conformable material, such as a foam, gel or mouldable material like a putty or a dental impression material. The bag 96 is attached to the upper surface of the base plate 92 so that it conforms to the under side of the tongue and ensures that the tongue holds the retainer 90 in position. The bag 96 could be shaped to push the tongue over to one side.

Figure 10 shows a retainer 100 similar to that in Figure 9 except that the base plate 102 has a shallow, tapering side wall 103 along its left-hand side and that the retainer has a bag 106 of foam material located to one side on the base plate adjacent the side wall. The bag 106 communicates with a tube 107, which extends forwardly and is sealed at its opposite end 108, with the bag under reduced pressure so that the foam it contains is held compressed.

After installation in the oral cavity, the tube 107 is cut so that air can enter the bag 106, allowing the foam to expand.

Figure 11 shows the sixth form of retainer 110 with a base 111 bifurcated into two prongs 112 and with a front wall 113 having an aperture 114 to clamp onto the endotracheal tube. The forward surface of the front wall 113 has a rim 115 that fits over the lower front teeth and gums of the patient. The upper surface of the base 111 and the rear face of the front wall 113 have a number of recesses 116 distributed over the surface and containing a dental material 117, such as a dental fixative or impression material, so that this conforms with the under surface of the tongue and helps locate the retainer 110 securely in position. The retainer 110 may have a hollow interior containing the material 117, the recesses 116 being openings through which the material can ooze out.

Figure 12 shows a seventh, different form of retainer 120 provided by a sack 121 containing a gel or similar conformable material. The sack 121 is flexible and is shaped generally to the potential space within the oral cavity between the rear of the front teeth and the lower surface of the forward part of the tongue. The retainer 120 also includes a tube clamp 122 formed by a single piece of resilient plastics material comprising a flat base 123 and a curved retaining arm 124 projecting upwardly along one side of the base. The base 123 has an aperture 125 through which a part 126 of the gel sack 121 extends. The projecting part 126 of the sack 121 anchors the retainer 120 with the sack and also provides a cushion against which the endotracheal tube is clamped by the arm 124. In use, by conforming to the space between the tongue and oral cavity, the sack 121 locates securely in position so as to enable secure fixing of an endotracheal tube.

It will be appreciated that a retainer of the invention is not confined to use with an endotracheal tube but could be used to secure any elongate member extending through the mouth, such as a feeding tube, laryngeal mask airway, or a cable extending to a sensor.

Claims

CLAIMS 1. A retainer comprising a first member shaped to locate between a surface of the tongue and a surface of the oral cavity and a retainer member arranged to retain an elongate device extending through the mouth of the patient.
2. A retainer according to Claim 1, wherein the retainer member is located on a forward member positioned forwardly of the tongue.
3. A retainer according to Claim 2, wherein the forward member has a portion shaped to fit over the lower teeth.
4. A retainer according to any one of the preceding claims, wherein said first member is a blade adapted to locate between a side of the tongue and gums on one side of the oral cavity.
5. A retainer according to any one of the preceding claims, wherein said first member is adapted to locate beneath the tongue.
6. A retainer according to any one of the preceding claims, wherein the retainer member includes two upwardly-projecting members between which the elongate member is arranged to project.
7. A retainer according to any one of Claims 1 to 5, wherein the retainer member includes a slot within which the elongate member is arranged to extend.
8. A retainer according to Claim 7, wherein the slot has an opening of reduced width and wherein the retainer includes a resilient member arranged to displace the elongate member to one side of the opening.
9. A retainer according to any one of the preceding claims including a tab arranged to project forwardly between the teeth.
10. A retainer according to any one of the preceding claims, wherein the retainer is an integral plastics moulding.
11. A retainer according to any one of the preceding claims, wherein the first member is bifurcated into two fingers arranged to extend along opposite sides of the tongue.
12. A retainer according to any one of the preceding claims, wherein the first member includes a conformable material adapted to conform to surfaces of the oral cavity.
13. A retainer according to Claim 12, wherein the conformable material is selected from a group comprising: foam, gel and mouldable material.
14. A retainer according to Claim 12, wherein the conformable material is a foam compressed by a sealed bag that can be opened to air to allow expansion of the foam.
15. A retainer according to any one of Claims 1 to 5, wherein the first member is of crescent shape having two prongs adapted to locate on either side under the tongue, wherein the retainer includes a support arm projecting forwardly from the first member and supporting a retainer member in the form of a clamp of generally U shape.
16. A retainer according to any one of the preceding claims, wherein the first member includes a plurality of recesses distributed over its surface and containing a conformable material.
17. A retainer according to Claim 16, wherein the conformable material is a dental fixative or dental impression material.
18. A retainer according to Claim 1, wherein the first member is a sack containing a conformable material and said retainer member is attached with an upper surface of said sack.
19. A retainer substantially as hereinbefore described with reference to Figure 1 of the accompanying drawings.
20. A retainer substantially as hereinbefore described with reference to Figure 1 as modified by Figure 2 of the accompanying drawings.
21. A retainer substantially as hereinbefore described with reference to Figure 1 as modified by Figure 3 of the accompanying drawings.
22. A retainer substantially as hereinbefore described with reference to Figure 1 as modified by Figure 4 of the accompanying drawings.
23. A retainer substantially as hereinbefore described with reference to Figure 1 as modified by Figures 5 and 6 of the accompanying drawings.
24. A retainer substantially as hereinbefore described with reference to Figure 1 as modified by Figure 7 of the accompanying drawings.
25. A retainer substantially as hereinbefore described with reference to Figure 1 as modified by Figure 8 of the accompanying drawings.
26. A retainer substantially as hereinbefore described with reference to Figure 1 as modified by Figure 9 of the accompanying drawings.
27. A retainer substantially as hereinbefore described with reference to Figure 1 as modified by Figure 10 of the accompanying drawings.
28. A retainer substantially as hereinbefore described with reference to Figure 1 as modified by Figure 11 of the accompanying drawings.
29. A retainer substantially as hereinbefore described with reference to Figure 1 as modified by Figure 12 of the accompanying drawings.
30. An assembly of an elongate medical device secured with a retainer according to any one of the preceding claims.
31. An assembly according to Claim 30, wherein the elongate medical device is an endotracheal tube.
32. Any novel and inventive feature or combination of features as hereinbefore described.