JP2003235978A - Reverse tube insertion set - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a reverse tube insertion set for more quickly and securely inserting a trachea insertion tube to the trachea in comparison with a bronchus fiber in a case of a patient hard to insert the tube into the trachea, and as a result, for securing breathing. <P>SOLUTION: This reverse tube insertion set is formed of a syringe needle, a guide wire, and the trachea insertion tube. The guide wire has a diameter possible to pass through a hollow part of the syringe needle. <P>COPYRIGHT: (C)2003,JPO

Description

Detailed Description of the Invention

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a retrograde intubation set for easily inserting the distal end of an endotracheal intubation tube into a patient who has a difficulty in inserting an air supply tube.

[0002]

2. Description of the Related Art Usually, for patients who have difficulty breathing by themselves, an intubation tube for the trachea is inserted into the trachea from the mouth to supply oxygen and the like. However, depending on the patient, the trachea becomes narrow or bends in the pharynx. In some cases, the distal end of the tracheal intubation tube cannot be inserted. If the insertion of the tracheal intubation tube fails, the tracheostomy is performed, but the tracheostomy has a problem that it imposes a heavy physical burden on the patient. A laryngeal mask is used as an alternative to this, but bronchial fibers are used when air supply is still insufficient.

[0003]

However, in such a situation, it is necessary to ensure breathing promptly, and even for patients who have a relatively difficult time to insert the intubation tube for the trachea into the trachea, more quickly than the bronchial fiber, and There has been a demand for a retrograde intubation set that can be reliably inserted, and thus ensure breathing.

[0004]

The present inventors have arrived at the present invention as a result of intensive studies in view of such circumstances. That is, the gist of the present invention consists of an injection needle, a guide wire that can pass through the hollow portion of the injection needle, and an intubation tube for the trachea, which is inserted into the trachea through the injection needle and then pulled out from the oral cavity. , A retrograde intubation set that pulls the distal end of the tracheal insertion tube into the trachea with the guidewire.

[0005]

BEST MODE FOR CARRYING OUT THE INVENTION In the present invention, an injection needle is used to insert a guide wire into the trachea, and the guide wire reaches the oral cavity from the trachea through the pharynx and then intubates for the trachea. The distal end of the tube is inserted into the tube, attached to the proximal end of the tube, and then the guide wire is pulled back from the needle side to guide the distal end of the tracheal intubation tube into the trachea. The intubation tube for trachea is used to send air from the ventilator to the lungs via the trachea and return exhaled air from the lungs to the ventilator. The retrograde intubation set of the present invention will be described while explaining how to use the retrograde intubation set of the present invention with reference to the drawings. In FIG. 1, the injection needle 1 is inserted into the trachea 11, and the guide wire 2 is pushed in to make the oral cavity 12
It is a figure which shows the state taken out from. Although the injection needle 1 only shows the needle portion in FIG. 1, it usually has a holder portion. Although not shown in the figure, when inserting the injection needle into the trachea, attach a cannula to the outside of the injection needle, insert the cannula into the trachea, and remove the injection needle as described below. It is preferable to remove the injection needle while leaving it. The injection needle 1 is a thyroid cartilage 13 of the throat.
It is inserted into the trachea 11 from between the and the cricoid cartilage 14.
The guide wire 2 has a diameter capable of passing through the hollow portion of the injection needle 1, and any material used as a medical guide wire can be used. The guide wire 2 is the trachea 1 from the injection needle 1.
1 and is pushed through the pharynx until its tip reaches the oral cavity 12. At this time, it is preferable that the tip of the guide wire is not sharp so as not to damage the trachea 11 and the pharynx. When the tip of the guide wire 2 comes out of the oral cavity 12, the injection needle 1 may be pulled out. The injection needle 1 may be extracted from the other end of the guide wire 2 that remains outside.

In FIG. 2, the distal end of the guide wire 2 is inserted into the tube 3 through the hole at the distal end of the tracheal intubation tube 3, and the ventilator connector 4 at the proximal end of the tracheal intubation tube 3 is inserted through the tube. Attached to or near the edge of
FIG. 3 is a diagram in which the guide wire 2 is pulled from the guide wire insertion portion 5 and the tracheal intubation tube 3 is fed to the throat. FIG. 3 shows that the distal end 6 of the tracheal intubation tube 3 has reached the trachea 11. It is a figure which shows a state. The tracheal intubation tube 3 has a connector for connecting a ventilator at the proximal end,
Diameter 5 for inserting the distal end into the trachea to supply and exhaust air
It is a tube of about 5.5 mm. As for the length of the guide wire 2, even if an operation such as pulling out the distal end from the oral cavity 12 and inserting it into the tracheal intubation tube 3 is performed, the guide wire 2 that has come out from the guide wire insertion portion 5 remains sufficiently. The length is not particularly limited, but may be about 70 cm, for example.

The guide wire is preferably provided with a marker whose distance from the tip can be recognized at a predetermined position from at least the tip. This marker is 1
The color may change every 0 cm, or a convex portion that can pass through the inside of the injection needle 1 may be provided at a predetermined position.
For example, when the marker 17 is attached to the length from the tip of the guide wire to the position corresponding to the guide wire insertion portion of the larynx via the oral cavity, the guide wire is inserted until the marker 17 comes to the guide wire insertion portion. At this time, the tip of the guide wire goes out of the oral cavity, and the guide wire is inserted to a position where the guide wire can be sufficiently held after passing the intubation tube for trachea through the guide wire. If is not near the mouth, it bends somewhere, indicating that it is not inserted properly. With the marker 17 in the guide wire insertion part,
Pass me through the guide wire through the tracheal intubation tube, connect the tracheal intubation tube to the artificial respiration circuit, try artificial ventilation, and if carbon dioxide inhalation can be confirmed on the exhalation gas monitor, at least the tip of the tube is Confirmed to be located in the pipe. After confirming the carbon dioxide gas exhalation at this position, the marker 17 is removed. Also, the marker 17
If the marker 16 is provided at a position close to the proximal side of the guide wire for several cm from the guide wire, the guide wire is advanced to the position of the marker 16 into the trachea, and the guide wire is slackened in the trachea. The intubation tube can be reliably advanced into the trachea. These markers 1
If 6 and 17 consist of convex parts, this position may be different depending on the patient, so the marker can be moved to a different position or can be attached / detached, and retrograde of guide wire insertion and tracheal intubation tube insertion. It is preferable that the marker is firmly fixed to the guide wire so that the marker does not drop out or move during the intubation operation. With this configuration, it is possible to quickly determine that the guide wire has been inserted to an appropriate depth, facilitate the insertion of the tracheal intubation tube, and quickly secure the airway in an emergency. It will be possible.

A vein or arterial puncture needle with a guide wire can be preferably used as a combination of the guide wire and the injection needle. In the case of this injection needle alone, for example, 1
An example is 8G safro.

As shown in FIG. 1, when the tip of the guide wire 2 is curved in a hook shape, the trachea 11 and the pharynx are not damaged when the guide wire is pushed forward, and the hook-shaped tip is It is preferable because it can be hooked and fixed to the edge of the ventilator connector 4 at the proximal end of the tracheal intubation tube 3. In this case, it is preferable that even if the hook is elongated, it can pass through the inside of the injection needle 1 while maintaining at least the hook shape.

When the distal end 6 of the tracheal intubation tube reaches the tracheal side of the guide wire insertion portion 5, the marker 17 is removed, the guide wire 2 is loosened, and the guide wire 2 is advanced to the marker 16 to push in the tracheal intubation tube 3. The distal end of the guide wire 2 attached at or near the edge of the ventilator connector 4 at the proximal end of the tracheal intubation tube 3 is pulled to guide the guide wire insertion portion 5, the trachea 11, and the tracheal intubation tube 3.
The intubation of the tracheal intubation tube is completed by removing it through the. After that, the ventilator connector may be connected to the ventilator for artificial respiration.

Intubation tube 3 for trachea used in the present invention
Any tube can be used as long as it is usually used by intubating the trachea.However, with a normal tube, the distal end is caught in the glottal part due to a change in the positional relationship between the tube and the guide wire. It often damages the glottis and prevents intubation. As shown in FIG. 4, the distal end 6 of the endotracheal intubation tube is rounded so that there is no corner, and a guide wire small hole 7 is provided at the tip thereof.
A tracheal intubation tube 3 having an air supply side hole 8 on the conical side surface is preferably used. Small hole for guide wire 7
Is a small hole through which the guide wire 2 can pass and penetrates to the proximal end of the tracheal tube 3. The insufflation side hole 8 provided on the conical side surface is a relatively large hole that penetrates to the proximal end of the tracheal intubation tube 3 so that air or oxygen comes out from here when connected to a ventilator. It is preferable that a plurality of, for example, three, be provided on the conical side surface. The guide wire small hole,
As shown in FIG. 4B, the tracheal intubation tube 3 is preferably provided at a position displaced from the center of the tracheal intubation tube 3 when viewed from the distal end 6 side. In this tracheal intubation tube, the guide wire is passed through the protruding tip and the position of this guide wire small hole is displaced from the center, so that the tracheal intubation tube can easily pass through the glottis, and The positioning of the tracheal intubation tube with respect to the wire becomes clear, and the insertion of the tracheal intubation tube becomes smooth and accurate.

Further, as shown in FIG. 4 (a), it is preferable to have an inflatable balloon 9 provided in the vicinity of the air supply opening at the distal end of the tracheal intubation tube.

This is because even if the retrograde intubation set having the above-mentioned configuration is used and operated as described above, the vicinity of the distal end of the tracheal intubation tube 3 is caught at the branch portion of the trachea 11 and the esophagus 15, The tracheal intubation tube 3 may not be inserted any further. FIG. 5 is a view showing a state in which the balloon is inflated in a state where the distal end of the intubation tube for trachea is caught at the branch portion of the trachea 11 and the esophagus 15. Even if the proximal end of the tracheal intubation tube 3 is connected to an artificial respirator at that position and air is supplied, the air supply flows into the esophagus side, so that there is a problem that the air cannot be sufficiently supplied to the lung. Therefore, if the balloon 9 is inflated at that position to block the branch portion of the esophagus and trachea and supply air,
Since the air supply opening is located on the trachea side of the closed part, when the air is supplied by the artificial respirator, all the air flows to the lung side, so that sufficient artificial respiration can be performed. Since a normal air supply tube with a balloon is separated from the balloon by 5 to 10 mm, even if the balloon is inflated when it is caught between the trachea and the esophagus, the branch part of the trachea and the esophagus is blocked so that it is opened only on the trachea side. On the other hand, when the distal end of the balloon 9 is provided so as to contact the end of the air supply opening 8 as shown in FIG. 4, only the trachea from the ventilator is difficult. It is possible to inflate.

[0014]

The retrograde intubation set of the present invention comprises an injection needle,
It has a simple structure such as a guide wire and an intubation tube for the trachea, and since an emergency doctor and anesthesiologist can always carry around in the hospital, it has a feature that it can immediately respond to an emergency. Endotracheal intubation, which competes for a minute, is often required in an emergency, but if endotracheal intubation is not performed promptly due to difficult intubation, death or planting is not uncommon. Intubation with difficult intubation may be attempted with a laryngeal mask or fiberscope, but in some cases facilities may not be available, and in cases where ventilation with a mask is not sufficient, direct treatment of the trachea should be performed immediately. If you don't get it, you'll miss it. When the retrograde intubation set of the present invention is used, the guide wire is sent from the trachea side to the oral cavity simply by piercing the trachea from the throat with the injection needle, and the end of the guide wire from the oral cavity is attached to the tracheal intubation tube and pulled back. The feature is that it is possible to insert into the trachea even in the case of a patient who could not be easily inserted into the trachea without inserting into the esophagus. When a marker is attached to a predetermined position of the guide wire, it is possible to confirm when the distal end of the inserted tracheal intubation tube has come to a predetermined position, and one of the tips is conically narrowed, and the tip portion thereof is Using a tracheal intubation tube with a wire small hole and an air supply side hole on the side surface of the conical portion makes the operation easier, and more accurately positions the distal end of the tracheal intubation tube. I can know. Further, using an endotracheal intubation tube in which an inflatable balloon is provided so that the distal end of the balloon is almost in contact with the end of the conical portion of the endotracheal intubation tube whose one end is conically narrowed, By inflating the balloon at the bifurcation of the trachea and esophagus, even for patients who have difficulty inserting the tube into the trachea,
It has a feature that it can supply air and inhale only in the trachea.

[Brief description of drawings]

FIG. 1 is a view showing a state in which an injection needle is inserted into the trachea, a guide wire is pushed in, and the guide wire is taken out from the oral cavity.

FIG. 2 is a diagram showing a state in which an intubation tube for trachea is being sent to the throat by pulling a guide wire.

FIG. 3 is a view showing a state in which a distal end of an intubation tube for trachea has reached inside the trachea.

FIG. 4 is a view showing an example of a distal end of an endotracheal intubation tube. (A) is the side view, (b) is a front view of a tip.

FIG. 5 is a view showing a state where the balloon is inflated in a state where the distal end of the intubation tube for trachea is held at the bifurcation of the trachea and the esophagus.

[Explanation of symbols]

1: Injection needle, 2: Guide wire, 3: Tracheal intubation tube, 4: Ventilator connector, 5: Guide wire insertion part, 6: Tracheal intubation tube distal end, 7: Small guide wire hole, 8 : Side hole for air supply, 9: balloon, 11: trachea,
12: oral cavity, 13: thyroid cartilage, 14: cricoid cartilage, 15:
Esophagus, 16, 17: markers

Claims (5)

[Claims] 1. An injection needle, a guide wire that can pass through a hollow portion of the injection needle, and an intubation tube for trachea,
A retrograde intubation set in which the distal end of the tracheal insertion tube is pulled into the trachea with the guide wire after being inserted into the trachea through the injection needle and pulled out from the oral cavity. 2. The retrograde intubation set according to claim 1, wherein the guide wire is provided with a marker whose distance from the distal end can be recognized at a predetermined position from at least the distal end. 3. An intubation tube for a trachea, one end of which is narrowed in a conical shape, the small hole for wire is provided at the tip end thereof, and an air supply side hole is provided on a side surface of the conical portion. The retrograde intubation set according to claim 1 or 2, wherein. 4. The retrograde intubation set according to claim 3, wherein when the tracheal intubation tube is viewed from the distal end side, the wire small hole is provided at a position displaced from the tube center. . 5. An inflatable balloon is provided such that the distal end of the balloon is substantially in contact with the end of the conical portion of the tracheal intubation tube whose one end is conically narrowed. Item 3. The retrograde intubation set according to item 3.