JP2011030863A - Endotracheal tube introducer - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide an endotracheal tube introducer in which a medicine having requisite administrating minimum quantity such as a local anesthetic agent is needed, which is safety and economical, and in which medicinal solution can be simultaneously sprayed during ventilation when feeding oxygen. <P>SOLUTION: In tube insertion under voluntarily breathing which is carried out in the case it is difficult to introduce an endotracheal tube used for artificial breathing into a trachea, in the endotracheal tube introducer 1 used as an instrument for spraying medicinal solution such as the local anesthetic agent into a periphery of a pharynx, a larynx, and a trachea and as a tube insertion auxiliary tool of the endotracheal tube, a primary lumen whose front end is open for feeding oxygen to the trachea from a device capable of controlling the breathing and a secondary lumen whose front end is open for injecting medicinal solution are formed in a tube body 2 formed of a material suitable for a living body such as a nylon elastomer, and the front end opening of the secondary lumen comprises a plurality of spraying holes so as to be able to spray the medicinal solution to the periphery. <P>COPYRIGHT: (C)2011,JPO&INPIT

Description

  This invention is a self-breathing intubation performed when it is difficult to intubate an endotracheal tube used for artificial respiration, as a device for spraying a chemical solution such as a local anesthetic around the pharynx, larynx, and trachea. In particular, the present invention relates to an endotracheal tube introducer used as an intubation aid for an endotracheal tube, and particularly relates to a technique that enables spraying of a chemical and oxygen supply from different lumens simultaneously.

  In surgery, general anesthesia is often performed. Since this general anesthesia stops spontaneous breathing, artificial respiration is performed by inserting a tube into the trachea for the purpose of life support, and sending oxygen or anesthetic (medicine solution) into the lungs through the tube.

  To insert the endotracheal tube used for artificial respiration into the trachea, a laryngeal deployment is performed using a device called a laryngoscope that raises the epiglottis, and the tube is inserted while looking directly at the glottis. However, there are cases where it is difficult to check the glottis while using a laryngoscope, such as a patient with a head and neck disease or an obese patient, and it is impossible to intubate an endotracheal tube.

  For this difficult intubation case, an endotracheal tube introducer is used as an intubation aid for the endotracheal tube. The endotracheal tube introducer is a thin rod or tube having a thickness of about 5 mm, and the tube introducer is inserted into the trachea in advance to guide the endotracheal tube as a guide.

  If pre-diagnostic diagnosis shows that intubation of the endotracheal tube is difficult, perform tracheal intubation under spontaneous breathing to avoid risk (if the tracheal intubation fails, take time, as breathing is maintained) Retry possible). In this spontaneous breathing intubation, a local anesthetic is sprayed around the pharynx, larynx, and trachea for the purpose of avoiding the patient's pain and suppressing the swallowing reflex.

  For spraying such a local anesthetic, a medical sprayer as described in Patent Document 1 and a chemical spray tube as described in Patent Document 2 have been proposed.

  By the way, the endotracheal tube introducer currently marketed including the said patent documents 1 and 2 consists of a single lumen (main lumen). This single-lumen endotracheal tube introducer can inject anesthetic from the main lumen, but the main lumen is also used for emergency oxygen supply when a guidewire is passed or the patient has difficulty breathing. For this reason, there is a problem that the inner diameter is large (if the diameter is small, ventilation is not used), spraying of a local anesthetic is impossible, and a large amount of chemical is required for injection. In addition, due to the single lumen structure, chemical injection was not possible when a guide wire was inserted into the main lumen or during ventilation with oxygen supply.

  Therefore, as a result of repeated research through trial and error, the inventors have made it possible to inject an anesthetic efficiently by providing a sub-lumen smaller than the main lumen in the endotracheal tube introducer. It is desirable to apply evenly over the entire circumference, but since the anesthetic coming out from the liquid injection port of the 2-lumen introducer is released in a straight line, it is a software that reduces tissue damage when contacting the living tissue at the tube tip In addition to providing a tip, a plurality of holes are provided on the entire circumference of the soft tip, and it is found that the local anesthetic can be injected all around the hole by interlocking with the chemical injection port. Invented a 2 lumen type endotracheal tube introducer provided with a lumen for local anesthetic injection.

  That is, the present invention solves the conventional problems as described above, and requires only a minimal amount of a chemical solution such as a local anesthetic, is safe and economical, and is used in ventilation where oxygen is supplied. In addition, an object of the present invention is to provide an endotracheal tube introducer capable of spraying a chemical solution simultaneously.

  In order to solve the above-mentioned problems, the invention according to claim 1 is directed to intubation under spontaneous breathing when the endotracheal tube used for artificial respiration is difficult to be inserted into the trachea. This is an endotracheal tube introducer that is used as a device for spraying chemicals such as local anesthetics and as an intubation aid for endotracheal tubes, and can be used for respiratory management in a tube body made of a material suitable for living organisms such as nylon elastomer. The main lumen of the tip opening for supplying oxygen to the trachea from a simple device and the sub-lumen of the tip opening for injecting the chemical solution are formed, and a plurality of tip openings of the sub-lumen are provided so that the chemical solution can be sprayed around It is characterized by being spraying holes.

  According to a second aspect of the present invention, in the endotracheal tube introducer according to the first aspect, a cap having a closed distal end wall and a peripheral wall is fitted to the distal end portion of the tube main body, and the main lumen is fitted to the distal end wall of the cap. An opening communicating with the tip opening is formed, and a plurality of spray holes are formed in the tip wall or / and the peripheral wall.

  According to a third aspect of the present invention, in the endotracheal tube introducer according to the second aspect, the formation position of the plurality of spray holes is an outer peripheral side position of the tip wall of the cap and / or an arbitrary position in the axial direction of the peripheral wall. It is characterized by that.

  According to a fourth aspect of the present invention, in the endotracheal tube introducer according to any one of the first to third aspects, the cross-sectional area ratio of the main lumen and the sub-lumen is 1: 0.0025 to 0.250. It is characterized by.

  According to a fifth aspect of the present invention, in the endotracheal tube introducer according to any one of the first to fourth aspects, the distal end portion of the tube body is bent at a predetermined angle that is an acute angle over a predetermined length. Features.

  The present invention is as described above, and according to the first aspect of the present invention, oxygen is supplied to the trachea from a device capable of breathing management to a tube body made of a material suitable for a living body such as nylon elastomer. A main lumen of the tip opening and a sub lumen of the tip opening for injecting the chemical solution are formed, and the tip opening of the sub lumen has a plurality of spray holes so that the chemical solution can be sprayed around, in other words, Since it is a double lumen compared to the conventional single lumen, it is possible to spray the chemical solution injected from the sub lumen through the plurality of spray holes and reduce the amount of the chemical solution to the minimum necessary amount. The risk of overdose can be avoided, and it is safe and economical. In addition, even when ventilating or supplying a guide wire to supply oxygen to the main lumen, it is possible to inject a chemical solution from the secondary lumen at the same time, and it is impossible to inject a chemical solution as before There is no concern.

  According to the second aspect of the present invention, since the plurality of spray holes are formed in the cap, it is not necessary to form the spray holes in the tube body, the structure of the tube body can be simplified, and the cost can be reduced. Can be produced. According to the third aspect of the present invention, the chemical solution can be sprayed from the spray hole over the periphery of the distal end portion of the tube body, and the anesthetic effect can be enhanced.

  According to invention of Claim 4, the quantity of the chemical | medical solution inject | poured from a sub lumen can be set according to the cross-sectional area ratio of a main lumen and a sub lumen. According to the invention described in claim 5, the endotracheal tube introducer can be more easily inserted by the bent tip portion.

BRIEF DESCRIPTION OF THE DRAWINGS It is the whole schematic which abbreviate | omitted a part of the length direction of the endotracheal tube introducer which shows one embodiment of this invention. It is an expanded sectional view which follows the line AA of FIG. It is an enlarged view of the front-end | tip part of an endotracheal tube introducer, (A) is a top view, (B) is sectional drawing. It is effect | action explanatory drawing which shows an example of use. It is effect | action explanatory drawing which shows an example of use. It is effect | action explanatory drawing which shows an example of use. It is an enlarged view of the front-end | tip part of the endotracheal tube introducer which shows another embodiment, (A) is sectional drawing, (B) is a side view seen from the front end side, (C) is line C- of (A). Sectional drawing which follows C, (D) is sectional drawing which follows the line DD of (A).

  Hereinafter, an endotracheal tube introducer according to an embodiment of the present invention will be described with reference to the drawings.

  1 and 2, reference numeral 1 denotes an endotracheal tube introducer, which includes a tube body 2 made of nylon elastomer. The tube main body 2 has a total tube length of 700 mm and an outer diameter of 4 mm. Inside the longitudinal direction, there is a respiratory management lumen, that is, a main lumen 3 having a distal end opening for supplying oxygen to the trachea, and the lumen. A sub-lumen 4 having a small diameter and having a tip opening for injecting an anesthetic is provided in parallel. Here, the material of the tube body 2 is nylon elastomer, but other materials such as silicone rubber, vinyl chloride, PP, Duracon, PE, PA, and PC may be used as long as they are suitable for living bodies.

  A pipe 7 for a dedicated connector 6 connected to a ventilator (not shown) as a device capable of breathing management is detachably connected to the main lumen 3 at the proximal end of the tube body 2 so as to be detachable. Oxygen can be supplied to the main lumen 3 from the vessel or the like through the pipe 7 for the dedicated connector 6 and further to the trachea from the opening of the tip through the main lumen 3. Further, a pipe 9 for a syringe barrel 8 connected to a syringe or the like (not shown) is connected to the base end portion in a detachable manner so as to communicate with the sub-lumen 4. The anesthetic is passed through the syringe barrel 8 pipe 9 from the syringe or the like. Can be sprayed from the plurality of spray holes described later to the auxiliary lumen 4 and further via the auxiliary lumen 4. The pipes 7 and 9 are detachable because the dedicated connector 6 and the syringe barrel 8 are obstructive when the endotracheal tube is inserted from the proximal end portion of the tube body 2 and therefore need to be removed in advance. .

  The main lumen 3 has an inner diameter of about 2.5 mm so that jet ventilation and a guide wire capable of breathing management can be passed in an emergency. Further, since the auxiliary lumen 4 is used for injecting an anesthetic, it is not necessary to have such a size, but rather, the inner diameter is about 0.5 mm because the amount of the anesthetic is required to be suppressed. However, these numerical values of the inner diameter are only a preferable example, and any numerical value can be used as long as the cross-sectional area ratio of the main lumen 3 and the sub-lumen 4 is in the range of 1: 0.0025 to 0.250. Good. The cross-sectional areas of the main lumen 3 and the sub-lumen 4 are the areas when the tube body 2 is cut at right angles to its axis as shown in FIG.

  The distal end portion 2a of the tube main body 2 is bent at a predetermined angle θ °, here 35 °, from the proximal end position 20 mm from the distal end, and is easy to insert when passing through the vocal cord. The main lumen 3 and the sub-lumen 4 are opened as they are on the distal end surface of the tube main body 2, but the distal end opening surface has an obliquely cut shape as is clear from FIG. In this arrangement, the secondary lumen 4 is opened. A cap 11 made of the same soft material as that of the tube body 2 such as nylon elastomer, silicone rubber, urethane, or the like is fitted and fixed to the distal end portion of the tube body 2 including the notch opening surface.

  As shown in detail in FIGS. 3A and 3B, the cap 11 has a distal end wall 11a that closes and closes the distal end opening surface of the tube body 2, and a peripheral wall 11b that is integral with the wall. The tube body 2 is fitted from the end opening to the distal end portion. An opening 12 communicating with the lumen is formed in the same size in the tip wall 11a facing the main lumen 3 of the tube body 2. Further, the distal end wall 11a of the tube main body 2 faces the sub lumen 4 and a small gap between the front end opening and the front end wall 11a is formed at a position adjacent to the front end opening of the sub lumen 4 and a part on the outer peripheral side. A plurality of spray holes 15 communicating with each other are formed, and the anesthetic can be sprayed around the tip from the spray holes. In this example, a total of six spray holes 15 are formed in one part on the outer peripheral side, one at a position adjacent to the distal end opening of the sub lumen 4. The spray hole 15 is formed with a sufficiently small diameter, and the anesthetic injected from the distal end opening of the sub-lumen 4 is sprayed from the plurality of spray holes 15 once entering the small gap between the distal end wall 11a. The

  The operation of the endotracheal tube introducer 1 configured as described above will be described with reference to FIGS.

  If intubation of the endotracheal tube is difficult due to preoperative diagnosis, it is necessary to urgently secure an airway in parallel with spraying a local anesthetic around the pharynx, larynx, and trachea to suppress swallowing reflex etc. There is. In such a case, the endotracheal tube introducer 1 is inserted into a predetermined portion of the trachea. In this case, first, the tube body 2 is inserted into the oral cavity from the distal end portion 2a side, The position is located at a predetermined site suitable for spraying anesthetic. When it is confirmed that it is located at a predetermined position, a ventilator is connected to the dedicated connector 6 on the proximal end side, and a syringe filled with a predetermined amount of anesthetic is connected to the syringe barrel 8. Alternatively, these instruments may be connected in advance.

  After that, when the plunger of the syringe is quickly pushed, the anesthetic attempts to exit from the tip opening through the auxiliary lumen 4, but the tip opening is once blocked by the tip wall 11a of the cap 11. After being stopped in the small gap and compressed, it is sprayed from the plurality of spray holes 15 of the leading end wall 11a communicating therewith. As is apparent from FIG. 3 (B), the spray is directed from the direction in which the spray hole 15 intersects the axis of the tube body 2 and from the outer periphery to the outward direction, so that the spray range of the local surface is wide. An anesthetic effect can be exerted quickly and effectively. During the spraying of the anesthetic, oxygen necessary for the patient to breathe is supplied from the ventilator, and oxygen is sent to the trachea from the opening 12 communicating through the main lumen 3. Thereby, an airway is secured and breathing is managed.

  As described above, the endotracheal tube introducer 1 has two lumens of the main lumen 3 and the sub-lumen 4, so that the anesthetic is injected from the sub-lumen 4 even while oxygen is supplied from the main lumen 3. Because it is possible to do so, it does not mean that anesthetic injection cannot be performed as before. In other words, since there was only one lumen type in the past, it was not possible to inject an anesthetic at the same time when ventilating with oxygen or inserting a guide wire. In the endotracheal tube introducer 1, it becomes possible to inject an anesthetic at the same time even during ventilation and the like, which is extremely easy to use.

  In addition, since the auxiliary lumen 4 for injecting the anesthetic is made of a smaller diameter than the main lumen 3 for supplying oxygen, it does not consume a large amount of the anesthetic during the injection of the anesthetic as before, and is economical. In addition, since the injection is in the form of a spray, it can be sprayed over a considerable range and is efficient.

  When the endotracheal tube introducer 1 finishes the role of respiratory management in an emergency and is replaced with an endotracheal tube used for artificial respiration, a pipe 7 to which a dedicated connector 6 is attached and a pipe 9 to which an injection cylinder 8 is attached. Then, as shown in FIG. 4, the endotracheal tube 17 is inserted into the tube body 2 of the endotracheal tube introducer 1 serving as a guide from the proximal end side of the tube body 2 and inserted along the tube body 2. As shown in FIG. 5, when the endotracheal tube 17 is intubated to some extent, spraying of the anesthetic is stopped. Then, in a state where the distal end of the tube main body 18 of the endotracheal tube 17 has passed the vocal cords and entered the trachea, the balloon 19 provided at the distal end portion of the tube main body 18 is inflated to place the endotracheal tube 17 in the position. The endotracheal tube introducer 1 in the endotracheal tube 17 is pulled out from the proximal end side and removed. FIG. 6 shows this state, and thereafter, the endotracheal tube 17 serves to supply oxygen to the patient instead of the endotracheal tube introducer 1.

  As described above, the endotracheal tube introducer 1 enables quick intubation in cases where intubation is difficult. By helping to connect the patient to the ventilator as quickly as possible, the patient's condition due to hypoxia deteriorates. Can be prevented.

  FIG. 7 shows an endotracheal tube introducer according to another embodiment. The endotracheal tube introducer 21 is different in the shape of the tube body and the cap, and in the formation position of a plurality of spray holes provided in the cap. The other configurations are the same as those of the embodiment described above. That is, the distal end opening surface where the main lumen 23 and the sub-lumen 24 of the tube body 22 are open is not obliquely cut as in the above-described embodiment, and is cut at right angles to the axis. A cap 31 made of the same material as that of the tube main body 22 is fitted and fixed to the distal end portion of the tube main body 22 having such a shape.

  The cap 31 has a distal end wall 31 a that closes and closes the distal end opening surface of the tube body 22, and a peripheral wall 31 b that is integral with the wall, and is fitted to the distal end portion of the tube body 22 from the proximal end opening. The tip wall 31a is thick and has a shape in which the tip side protrudes with a roundness. Such a rounded shape is safe because it hardly damages the living body as compared to a rounded and angular shape. An opening 32 communicating with the main lumen 23 of the tube main body 22 is formed in the tip wall 31a of the cap 31 with the same diameter. A plurality of spray holes 35 communicating with the sub lumen 24 of the tube main body 22 are formed on the outer peripheral side of the tip wall 31a of the cap 31 and the peripheral wall 31b, and an anesthetic is supplied from the spray hole to the tip of the tube main body 22. It can be sprayed around.

  That is, an annular recess 36 that communicates with the sub-lumen 24 is formed in the distal end wall 31a of the cap 31 that is in close contact with the distal end opening surface of the tube body 22, and this recessed portion is provided on the outer peripheral side of the distal end wall 31a of the cap 31. The annular hole 37 communicates with the plurality of spray holes 35 and also extends along the axial direction of the cap 31, and the annular holes are provided at predetermined intervals in the axial direction of the peripheral wall 31 b of the cap 31. The spray holes 35 are communicated with each other. Therefore, when the anesthetic liquid is injected from the auxiliary lumen 24, the anesthetic is sprayed from the plurality of spray holes 35 in the tip wall 31a through the annular recess 36, and the other from the plurality of spray holes 35 in the peripheral wall 31b. Sprayed, that is, the anesthetic can be sprayed all around the tip of the tube body 22 where the cap 31 is located.

  It should be noted that the arrangement of the main lumens 3 and 23 and the sub-lumens 4 and 24, the size of the diameter, the lumen shape, and the like shown in the above embodiments are merely preferred examples. Needless to say, it is also possible. Further, the caps 11 and 31 are not essential, and in some cases, the spray holes 15 and 35 may be formed directly on the tube bodies 2 and 22 so that the caps are not used. Furthermore, although each embodiment showed the example which bent the front-end | tip part of the tube main bodies 2 and 22, this bending is not necessarily required.

DESCRIPTION OF SYMBOLS 1 Tube introducer 2 Tube body 2a Tip part 3 Main lumen 4 Sub lumen 6 Dedicated connector 7, 9 Pipe 8 Syringe 11 Cap 11a Tip wall 11b Perimeter wall 15 Spray hole 17 Endotracheal tube 18 Tube body 19 Balloon 21 Tube introducer 22 Tube body 23 Main lumen 24 Sub lumen 31 Cap 31a Tip wall 31b Peripheral wall 32 Open hole 35 Spray hole 36 Annular recess 37 Annular hole

US Patent Patent Abstract (Publication No. 2003/0172934) Japanese Patent No. 3652216

Claims (5)

As a device for spraying a chemical solution such as a local anesthetic around the pharynx, larynx, and trachea in intubation under spontaneous breathing when it is difficult to intubate the endotracheal tube used for artificial respiration into the trachea, and the endotracheal tube An endotracheal tube introducer used as an intubation aid for
In the tube body made of a material suitable for a living body such as nylon elastomer, a main lumen of the tip opening for supplying oxygen to the trachea from a device capable of breathing management and a sub lumen of the tip opening for injecting a chemical solution are formed. An endotracheal tube introducer characterized in that a tip opening of the sub-lumen has a plurality of spray holes so that a chemical solution can be sprayed around.   The endotracheal tube introducer according to claim 1, wherein a cap having a closed tip wall and a peripheral wall is fitted to the tip of the tube body, and an opening communicating with the tip opening of the main lumen is formed in the tip wall of the cap. An endotracheal tube introducer characterized in that a plurality of spray holes are formed in the tip wall and / or the peripheral wall.   The endotracheal tube introducer according to claim 2, wherein the formation position of the plurality of spray holes is an outer peripheral side position of the tip wall of the cap or / and an arbitrary position in the axial direction of the peripheral wall. Deusa.   The endotracheal tube introducer according to any one of claims 1 to 3, wherein the cross-sectional area ratio of the main lumen and the sub-lumen is 1 to 0.0025 to 0.250. .   The endotracheal tube introducer according to any one of claims 1 to 4, wherein a distal end portion of the tube body is bent at a predetermined angle that is an acute angle over a predetermined length.

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