GB2377383A

GB2377383A - An instrument for causing a dilation of the trachea opening

Info

Publication number: GB2377383A
Application number: GB0111718A
Authority: GB
Inventors: Sushil Prakash Ambesh
Original assignee: SANJAY GANDHI POST GRADUATE IN
Current assignee: SANJAY GANDHI POST GRADUATE IN
Priority date: 2001-05-14
Filing date: 2001-05-14
Publication date: 2003-01-15
Anticipated expiration: 2021-05-14
Also published as: FR2825612B1; FR2825612A1; GB0111718D0; DE10126732A1; GB2377383B

Abstract

An instrument for causing a dilation of the trachea opening. The instrument comprises a pair of shaft member d and c, each having a distal and proximal end. The shafts d and c are pivotally held h to each other. The distal end of each shaft has a co-operating jaw e and f with a longitudinal groove g. A limiting means m is provided in the proximity of the distal end of both shafts for limiting the insertion of the jaws into the trachea. Handles a and b are provided at the proximal end of the shafts. A scale o is also provided in the proximity of the proximal end of one of the shafts c to provide a reading of the size opening of the trachea.

Description

FIELD OF INVENTION

This invention relates to an instrument for causing a dilation of the trachea opening so as to allow an introduction of a cannula.

BACKGROUND OF INVENTION

Percutaneous tracheostomy is a procedure where an opening is made in the anterior wall of the trachea to pass a desired size tracheostomy tube. A number of kits or techniques for the formation of elective or emergency percutaneous tracheostomy are described but many of these are associated with secondary injuries to the soft tissue and are even associated with life threatening complications. Commonly, an elective or emergency percutaneous tracheostomy is performed using a skin incision, puncturing the anterior tracheal wall with the cannula on needle, passing a guidewire through tracheal cannula and then formation of tracheal stoma on guidewire either in a gradual fashion using a number of dilators of increasing diameter or in a single step dilation using the tracheostomy forceps. The tracheostomy forceps used for percutaneous has been described in European patent no. 00505390B1 and US patent no. US05279285. The technique, though, claimed to be for rapid and single step dilation of tracheal stoma, commonly requires multiple dilation of tracheal stoma before a desired size tracheostomy tube can be introduced. The forceps used to form the percutaneous

tracheostomy lacks the measurement quality and hence the accuracy in formation of desired size stoma. Therefore' it is commonly associated with under or over splitting of inter tracheal ring membrane and hence an inappropriate size of stoma formation. On the other hand there is no guiding mark on the forceps to check its length of insertion in tracheal lumen for splitting the inter tracheal ring membrane. Therefore, the use of these forceps is associated with inadvertent tracheal tissue injuries, particularly when a less experienced physician or a trainee is performing the procedure.

OBJECTS OF THE INVENTION

An object of this invention is to propose an instrument for causing a dilation of the trachea opening which obviates the disadvantages associated with the instrument of the prior art.

Another object of this invention is to propose an instrument for causing a dilation of the trachea opening which provides an accuracy in the size and formation of the trachea stoma. Still another object of this invention is to propose an instrument for causing a dilation of the trachea opening which provides an accuracy in the insertion of the instrument in the tracheal lumen.

Yet another object of this invention is to propose an instrument for causing a dilation of the trachea opening which allows a percutaneous tracheostomy in a patient to be performed more speedily and with more simplicity.

A further object of this invention is to propose an instrument for causing a dilation of the trachea opening which significantly reduces the risk of secondary injury.

BRIEF DESCRIPTION OF THE INVENTION

According to this invention there is provided an instrument for causing a dilation of the trachea opening comprising a pair of shaft members pivotally held to each other, each of said shaft members having a jaw at the distal end co-operating with each other for causing an opening of the trachea opening, a handle at the proximal end of each shaft so as to cause an opening or closing of the jaws, the jaws having co-operating faces with a respective longitudinal groove with an entry and exit location for passage of a wire, lateral protuberances provided away but in the proximity of the terminal end of said jaws so as to define a limiting means for the insertion of the jaws into the trachea opening and thereby prevent a secondary injury, a scale provided in the proximity of the proximal end of one of said shafts to provide a reading of size opening of the trachea.

DESCRIPTION OF:INVENTION WITlI REFERENCE TO THE

ACCOMPANY ING DRAWINGS

Further objects and advantages of this invention will be more apparent from the ensuing description when read in conjunction with the accompanying drawings and wherein:

Fig. 1 shows a first embodiment of this tracheostomy forceps according to this invention; and Fig. 2 shows a second embodiment of this tracheostomy forceps according to this invention Referring to fig. 1, the instrument of the present invention comprises a pair of handles (a & b) provided at the proximal end of shafts (c & d), each of which have jaw end (e & f) with a co-operating face. The face of each jaw has a groove (g). The two shafts (c and d) are held to each other at their intermediate ends through a pivot (h). When the jaws are in closed position, the groove (g) forms a passage with entry point (i) and exit point (j).

In the proximity of handles (a & b), shafts (c & d) have co-operating ratchet parts ( k & 1) which enable the instrument to be locked with the jaws in a closed or dilated position.

The passage thus formed allows threading of the guidewire through the entry point (i).. In this embodiment the instrument is constructed in such a way that moving the handles together moves the jaws together. The external side of each jaw has a rounded protuberance (m & n) at the level of exit point (j) of the passage Below this point the jaw ends are curved along their length at an angle of 70 to 80 .

Near the locking arrangement, a scale (o) is transversely provided in the shaft (c). The numbers are engraved on both surfaces of the scale that represent the size of the numbers of the tracheostomy tube on one edge, and dilation of stoma in mm on the other edge.

The ratchet (1) has a pointer (p) extending downwardly to provide a reading on both sides of scale (s). When the ratchets are in closed position, the jaw ends are closed and the free end of the scale traverses through a slit (q) in the shaft (d). When the handles are moved apart the jaw ends open, which is guided with the sliding of pointer (p) on the scale. The jaw ends beyond the protuberances (m,n) are made in such a fashion that when opened, the outer width is nearly equal at any given point and therefore provides known dilation represented on the scale. The protuberances (m,n) perform the function of a limiting means to limit the insertion of the jaw ends into the trachea opening and mark the measured dilation of stoma.

Fig. 1 also shows an alternative embodiment of the instrument and with particular reference to the scale (o). A plurality of holes (z) spaced from each other are provided on one end of scale (o). Such holes can receive any suitable locking means such as a locking pin. Thus, and as by way of example, if a 7 mm diameter slit is required, the jaws (e,f) are opened till the scale (o) shows a reading of 7 mm, and a locking pin is then inserted into a hole (z) for locking the instrument at 7 rnm Alternatively, the graduations (o) can be avoided an instead the graduation are provided against holes (z). Thus, the jaws (e,f) can be opened to the required measurement, as provided on the scale and which can then be locked by a locking pin.

Fig. 2 shows an alternative embodiment of the tracheostomy instrument according to this invention, and comprises two shafts (c & d) pivoted at a point (h) in such a way that when the handles (a & b) are moved together the jaw ends ( e & f) are moved apart. The face of the each jaw has a groove (g). A metallic strip (r) between the shafts keeps the ratchet parts (k & I) apart and the jaw ends (e & I) closed. When the jaw ends are in closed position there extends a passage with entry point (i) and exit point (j). The passage thus formed allows threading of the guidewire through the entry point (i). The external side of each jaw end has a rounded protuberance (m & n) at the level of exit point (j) of the passage. Protuberances (m & n) work in the same manner as described in fig. 1. The jaw ends ( e & f) are curved at around 70 to 80 angle along their length to provide the safety during the procedure.

Bringing the handles ( a & b) together enables the sliding of the ratchet parts (Al) in increasingly locked position while the jaw ends are passively opened in the increasing order. Near the locking arrangement, a scale (o) is held transversely to shaft (c). The numbers are engraved on both surfaces of the scale that represent the size or the number of the tracheostomy tube on one edge and dilation of stoma in mm on the other edge.

The ratchet (I) has a pointer (p) extending downwardly to provide a reading on the scale.

When the handles are brought together, the scale traverses through the slit (q) and the pointer (p) moves on the scale. The jaw ends open and the dilation of tracheal stoma is guided with the sliding of pointer (p) on the scale. The shaft (c) is spring loaded by a resilient strip (u).

Claims

WE CLAIM:

1. An instrument for causing a dilation of the trachea opening comprising a pair of shaft members pivotally held to each other, each of said shaft members having a javv at the distal end co-operating with each other for causing an opening of the trachea opening, a handle at the proximal end of each shaft so as to cause an opening or closing of the jaws, the jaws having co-operating faces with a respective longitudinal groove with an entry and exit location for passage of a wire, lateral protuberances provided away but in the proximity of the terminal end of said jaws so as to define a limiting means for the insertion of the jaws into the trachea opening and thereby prevent a secondary injury, a scale provided in the proximity of the proximal end of one of said shafts to provide a reading of size opening of the trachea.

2. An instrument is claimed in claim 1, wherein the shaft members (c,d) are pivoted

together such that moving the handles (a,b) together moves the jaws (e,f) together 3. An instrument as claimed in claim 1, wherein the scale has graduations, the other of said shaft having a pointer to transverse over said scale and thereby provide a reading of the trachea stoma.

4 An instrument as claimed in claim 3, wherein the scale has a plurality of holes spaced from each other for receiving a locking pin.

5. An instrument as claimed in claim 4, wherein said graduations are provided with said holes.

5. An instrument as claimed in claim 1, wherein the shaft members (c,d) are pivoted together such that by moving the handles (a,b) together the jaws (e,f) move apart.

7. An instrument as claimed in claim l comprising a resilient strip having one end to bear against a shaft.

8. An instrument as claimed in claim l comprising a ratchet member provided with each shaft, said ratchet members extending inwardly and engageable with each other to facilitate a locking action.

9. An instrument as claimed in any one of the claims 1-6 wherein the jaws have a curved surface extends downwardly from said protuberances.

10. An instrument as claimed in one of the claims 1-6 wherein one of said shaft (c) has a transversely fitted scale (o) marked on both the sides with upper border (t) in tracheostomy size and lower border (s) in mm dilation of stoma.

An instrument as claimed in claim 7, wherein the other shaft (d) has a slit (q) to allow free traverse for the scale (o) during the movement of members (c,d).

12. An instrument as claimed in one of the claims 1-8, wherein one ratchet (1) has a pointer (p) towards the scale (o) which moves on the scale during the movement of members (c,d) and provided a reading of the opening of jaws (e,f) in size of the tracheostomy tube or dilation of the stoma.

13. An instrument as claimed in any one of the proceeding claims wherein the jaws (e,f) are tapered towards their distal ends.