JP2002191552A - Auxiliary tool for nasotracheal intubation tube - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide an auxiliary tool capable of speedily inserting a tube by easily viewing a vocal cords in nasotracheal intubation using a fiber scope. SOLUTION: This auxiliary tool consists of such a curved flexible cylindrical body 20 as can be inserted from the nostril of a patient along the curve of a nasal cavity. The body 20 is long enough to reach the neighborhood of an epiglottis from the nostril of the patient when it is inserted to the patient and the fiberscope can be put through it. The body 20 can be taken out from the patient while being torn after it is inserted to the patient and the fiberscope is put through it.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to an auxiliary device for nasal intubation, and more particularly to an auxiliary device for quickly performing nasal intubation as a means for securing a nasal airway in the medical field.

[0002]

2. Description of the Related Art Nasal intubation, which is one of the methods for securing the airway, is a technique for securing the airway by passing an intubation tube from the nostril to the bronchus of a person. This procedure is often limited to some extent by the time taken to secure the airway. Up to now, there are a fiberscope-assisted method, a laryngoscope and a McGirr forceps-assisted method as a nasal intubation method using an assisting device. Of these, it is common to use a fiberscope to assist a patient who cannot open the mouth or a patient who cannot flex the neck.

In a fiberscope-assisted nasal intubation method conventionally performed, as shown in FIG. 1A, a fiberscope 2 is passed through the lumen of an endotracheal tube 1 and fixed at the root of the fiberscope 2. Then, FIG.
As shown in (b), the fiberscope 2 is inserted from the nostril 4 of the patient 3 and the epiglottis 5 and the vocal cords 6 are searched by lever operation. When the vocal cords 6 are visible, the fiberscope 2 is inserted into the trachea 7, and the endotracheal tube 1 is inserted into the trachea 7 using the fiberscope 2 as a guide. The airway can be maintained by the endotracheal tube 1 thus inserted.

[0004]

However, the nasal intubation method using a fiberscope as described above (fiberscope intubation method) requires a relatively inexperienced person to take time to find the epiglottis and vocal cords. Is not unusual, and even a skilled person sometimes takes time. In addition, the visual field may be impaired by nasal discharge or the like while the fiberscope passes through the nasal cavity. Such time-consuming operations can be painful and risky even in normal times. In emergencies, more rapid intubation is needed. It is very important to reduce pain and to perform nasal intubation quickly.

In order to solve such a problem, the present invention provides an assisting device capable of promptly seeing a vocal cord and performing intubation in a nasal intubation method using a fiberscope. With the goal.

[0006]

SUMMARY OF THE INVENTION The present inventors recall a member for guiding a fiberscope to make it easier to find the vocal cords, and after the vocal cords are found by the fiberscope through the guide member, The present inventors have found a method of promptly taking out the guide member and inserting the endotracheal tube into the trachea, and have reached the present invention. The present invention provides such a guide member as a nasal intubation aid.

That is, the present invention relates to an assisting device for insertion through a nostril of a patient for nasal intubation performed by using a fiberscope. It is made of a flexible tubular body. The tubular body has a length such that it extends from the nostril of the patient to the vicinity of the epiglottis when inserted into the patient, and allows a fiberscope to pass therethrough. The tubular body can be inserted into a patient, passed through a fiberscope, then removed from the patient and separated from the fiberscope. In a preferred embodiment of the present invention, the tubular body can be removed from a patient while tearing.

In a preferred aspect of the present invention, the tubular body has a cut or a groove from one end or the vicinity of one end to the other end or the vicinity of the other end, whereby the cut or the cut is formed. It can be removed from the patient while tearing along the groove.

[0009]

DESCRIPTION OF THE PREFERRED EMBODIMENTS FIGS. 2 (a), (b), (c),
(D) and (e) show specific examples of the nasal intubation aid according to the present invention. The nasal intubation assistance device 20 includes both ends 21 and 2
Reference numeral 2 denotes an open tubular body (tube body). One end 2
1 has a somewhat widened opening. The shape of the opening having some extent has a meaning such as preventing the tubular body from entering the nasal cavity, but an opening having no extension may be used. A typical example of a widened opening is a trumpet. The other end 22 is cut diagonally, but need not be cut diagonally. The opening at the other end 22 is oval or circular. The internal cavity is also circular or oval. The obliquely cut other end 22 facilitates insertion. In the tubular body, a portion between one end 21 and the other end 22 is a cylindrical body having an inner diameter and an outer diameter that are substantially constant. Its inner diameter is large enough to be easily passed by a fiberscope, and is typically 6 m for an average adult.
m to 9 mm. Its outer diameter is large enough to be inserted into the nasal cavity and pharynx through the patient's nostrils, and typically 8 mm to 14 mm for an average adult. The thickness (wall thickness) is typically 1 mm to 3 mm. In addition, the tubular body constituting the nasal intubation aid 20 is
To be able to insert along the curve of the nasal cavity from the patient's nostrils,
It has a curved shape and is flexible and preferably elastic. It is preferable that the cylindrical body along the curvature of the nasal cavity can be easily inserted into the nasal cavity and has appropriate hardness, elasticity and flexibility that does not damage the nasal mucosa. The degree of curvature of the curved shape may be in accordance with a general standard of curvature of the nasal cavity. The tubular body is typically made of polyvinyl chloride, is flexible and has appropriate elasticity under the above thickness, but may be made of other materials. The tubular body has a length that extends from the nostril of the patient to the vicinity of the epiglottis when inserted into the patient, and is typically 100 mm to 200 mm. This length is preferably slightly shorter than the length from the nostrils to the vocal cords. In addition, since the shape and size of the nasal cavity and pharynx vary depending on the age, physique, etc. of the patient,
The dimensions such as the inner diameter, the outer diameter, the thickness, and the length of the cylindrical body can be appropriately set according to the dimensions. Therefore, it is preferable to provide various sizes so as to cope with individual differences.

One end 21 of the cylindrical body is provided with two holes 23 at opposing positions (180 ° symmetrical positions in a circular opening).
It is convenient for use when the and 24 are provided. In this case, cuts 25 and 26 extend from the holes 23 and 24 to the other end 22, respectively. The cuts 25 and 26 are formed continuously to the other end 22 along the longitudinal direction of the tubular body. Therefore, two notches 2
5 and 26 are provided at substantially 180 ° symmetrical positions on the cylindrical body, respectively. 3, the cuts 25 and 26 are formed at a predetermined depth from the inner wall 27 of the cylindrical body. The depth of the cuts 25 and 26 can be appropriately set within a range that does not reach the outer wall 28, and is deep enough to easily tear the tubular body when necessary, but in the operation of inserting the tubular state into the nasal cavity, Preferably, it is of a degree that does not tear easily. Cut 25
And 26 have a depth of, for example, 10 /
It can be set to 100 or more and 95/100 or less. If an appropriate force is applied to the tubular body (for example, a force that holds one end 21 with both hands and vertically tears the tubular body therefrom), cuts 25 and 26 are easily torn, and therefore, nasal intubation aid 20 Can be easily torn in its longitudinal direction along the cuts 25 and 26. In addition,
If holes 23 and 24 are provided in one end 21 of the tubular body, the role of notifying the user of the positions of cuts 25 and 26 and stopping the cuts so that the cuts do not spread from there until use. It is convenient to use.

In the above-mentioned nasal intubation aid, the cuts are provided at two places of the tubular body. However, as long as the tubular body can be torn and removed from the patient and separated from the fiberscope, Where to make the cuts,
One or three or more locations on the cylindrical body may be used. Further, in the nasal intubation aid, a cut is formed continuously from one end to the other end, but an intermittent cut may be formed in the tubular body depending on the properties of the material.
Furthermore, when forming an intermittent cut, the cut may be deep to the thickness of the tubular body, that is, the cut may be penetrated from the inner wall to the outer wall. In addition, instead of forming a cut from the inner wall (that is, forming a cut inside the tubular body), the above-mentioned nasal intubation assisting tool forms a cut from the outer wall (that is, outside the tubular body). Notch from the inner wall is easier to use from the viewpoint of handling.

A groove 45 as shown in FIG. 4 may be formed in the cylindrical body instead of the cut. In this manner, by forming a portion having a smaller thickness in the tubular body than other portions, the tubular body can be formed into a shape that is easily torn. The position and depth of the groove can be set in the same manner as the above-described cut. Further, the groove may be formed continuously from one end to the other end of the tubular body, or may be formed intermittently. When forming the intermittent groove, the groove may be deepened to the thickness of the tubular body, that is, the groove may be penetrated from the inner wall to the outer wall. Further, the groove may be formed on the inner wall or the outer wall of the cylindrical body, but the formation on the inner wall is preferable in terms of handling.

Further, a notch 55 as shown in FIG. 5 may be formed at one end 51 of the cylindrical body instead of the notch or the groove. For example, by holding the one end 51 with both hands and applying a force to tear the tubular body therefrom, the tubular body can be torn vertically starting from the notch 55. Notch 55
Are preferably provided at two opposing positions on one end 51 of the cylindrical body. When the tubular body is made of a material that is easily torn, for example, when it is made of a directional resin molded body, a structure that is easily torn can be obtained even with such a notch 55.

Further, if the tubular body is formed of a material that is easily torn, it is not necessary to provide a portion that actively induces the tear as described above.

Although the cross-section of the nasal intubation aid described above is circular, the cross-section may be elliptical. The nasal intubation assistance device according to the present invention can be formed of various other resins having similar properties, in addition to polyvinyl chloride. By providing the cuts and grooves at or near the end of the tubular body, the tubular body can be easily torn. Further, the outer wall of the tubular body may be processed (for example, coated) so as to be easily inserted into the nasal cavity, and the inner wall thereof may also be processed (for example, coated) so as to easily insert the fiberscope. Processing). Hereinafter, a method of using the nasal intubation aid according to the present invention will be described with reference to the drawings.

The transnasal intubation aid 20 according to the present invention is inserted into the nasal cavity 60 as shown in FIG. 6 after, for example, applying a lubricant in advance. Thereby, airway obstruction due to subsidence of the tongue base can be prevented to some extent. Then, as shown in FIG. 7, a fiberscope assisted intubation procedure is performed. Fiberscope 2 passed through endotracheal tube 1
Is inserted from one end 21 of the nasal intubation assisting tool 20, passes through the hollow, comes out from the other end 22, and is inserted toward the vocal cord 6. When the vocal cords 6 are visible, the fiberscope 2 is further inserted into the trachea 7 as it is. Next, as shown in FIG. 8, the nasal intubation assisting tool 20 is removed from the nasal cavity 70 by tearing it to the left and right while pulling it out. The tearing of the nasal intubation aid 20 can be performed, for example, along a cut or a groove. Then, only the fiberscope 2 passed through the endotracheal tube 1 remains in the trachea 7 from the nostrils 4 as a guide. Once the nasal intubation aid 20 has been completely removed from the patient, normal fiberscope-assisted intubation can be performed thereafter. That is, the endotracheal tube 1 is inserted into the trachea 7 using the fiberscope 2 as a guide. By using the nasal intubation aid according to the present invention, the vocal cords can be found quickly,
The time required for nasal intubation of the endotracheal tube and the patient's pain are significantly reduced.

[0017]

According to the conventional method, it may be difficult to obtain a visual field due to nasal discharge and bleeding in the nasal cavity and structures such as the upper, middle and lower nasal cavities before the vocal cords are found. In addition, if the patient moves back and forth through the nasal cavity with a fiberscope many times, the patient may become afflicted in the case of an awake patient, and may cause epistaxis. Beginners and trainees are confused by structures such as the nasal cavity, or their nasal discharge obstructs their visual field, making it impossible to know the current location of the fiberscope, and inserting the fiberscope many times without finding the target vocal cords And may come out. Also, as I repeatedly put in and out to confirm the position and wipe out the nasal discharge that adheres to the fiber scope and hinders the field of view, the operation damages the nasal mucosa and causes nasal bleeding, and it is difficult to find the vocal cords Sometimes it becomes a skilled person. Awake patients are forced to endure the pain and discomfort rubbing the nasal cavity over and over with a fiberscope. There is also a method in which nasal intubation is performed after the patient has fallen asleep after giving general anesthesia first, but in this case, a plurality of human hands are required since the patient is assisted with artificial respiration such as mask ventilation. Furthermore, since the patient's spontaneous breathing has been stopped, if ventilation can be performed well, if ventilation is difficult, time is further restricted. In addition, under the mask ventilation support, there is no spontaneous breathing as long as the airway is not secured, so if the nose bleeding causes so-called “sagging” (saliva or blood entering the airway), the respiratory condition deteriorates. Later, it could be a distant cause such as pneumonia. In such cases, it is necessary to find the vocal cords as soon as possible and secure the airway. Time is invaluable in maintaining the airway, and in an emergency it can affect survival and neurological outcomes (eg, hypoxic encephalopathy).

Although the nasal intubation aid according to the present invention is thicker than a fiberscope and has a thickness similar to that of an endotracheal intubation-like tube intended for insertion, it can be inserted into a nasal cavity for several seconds regardless of who inserts it. Can be inserted. Since the nasal intubation aid according to the present invention needs to be inserted only once, there is almost no epistaxis. Then, when the assistant according to the present invention is inserted and peeped through a fiberscope therein, the vocal cords can be seen almost directly below. At that time, since the fiberscope passes through the tube, the sight is not obstructed by nasal discharge before finding the desired vocal cords, and the trouble and time loss such as pulling up the fiberscope, wiping it neatly, and looking again are reduced. . Thus, with the aid of the present invention, the fiberscope allows the epiglottis and vocal cords to be easily located almost directly below the inserted tube, thereby reducing the time required for transnasal airway access, It can reduce patient distress and increase safety.

[Brief description of the drawings]

FIG. 1 is a schematic diagram illustrating a nasal intubation method using a fiberscope.

2A is a front view, FIG. 2B is a side view, FIG. 2C is a side view, FIG. 2D is a perspective view, and FIG.

FIG. 3 is an enlarged view showing a cross section of the nasal intubation aid shown in FIG. 2;

FIG. 4 is a schematic sectional view showing another embodiment of the nasal intubation aid according to the present invention.

FIG. 5 is a perspective view showing another embodiment of the nasal intubation aid according to the present invention.

FIG. 6 is a schematic view illustrating an embodiment using the nasal intubation aid according to the present invention.

FIG. 7 is a schematic view illustrating an embodiment using a nasal intubation aid according to the present invention.

FIG. 8 is a schematic diagram illustrating an embodiment using a nasal intubation aid according to the present invention.

[Explanation of symbols]

1 endotracheal tube, 2 fiberscope, 3 patients, 4 nostrils, 5 epiglottis, 6 vocal cords, 7 trachea, 20
Nasal intubation aid, 21, 51 end, 22 other end, 2
3,24 holes, 25,26 cuts, 27 inner wall, 2
8 Outer wall, 45 grooves, 55 notches, 60 nasal cavity.

 ──────────────────────────────────────────────────続 き Continued on the front page F term (reference) 4C061 AA12 AA13 BB01 CC04 DD03 GG22 JJ03 4C167 AA15 BB03 BB07 BB11 BB31 CC15 DD10 GG10 GG36 HH08 HH30

Claims (2)

[Claims] 1. A tool for insertion through a nostril of a patient for nasal intubation using a fiberscope, which has a curved flexibility that can be inserted from a nostril of a patient along a curve of a nasal cavity. The cylindrical body has a length such that when inserted into the patient, it extends from the nostril of the patient to the vicinity of the epiglottis, and the fiber scope can be passed through it. And the tubular body can be removed from the patient and separated from the fiberscope after it has been inserted into the patient and the fiberscope has been passed therethrough,
Nasal intubation aid. 2. The cylindrical body has a cut or a groove from one end or the vicinity of the one end to the other end or the vicinity of the other end, whereby the tubular body is torn along the cut or the groove. The nasal intubation aid according to claim 1, wherein the nasal intubation aid can be taken out of the patient while being taken.