JP2620250B2 - Catheter assembly - Google Patents

Description

DETAILED DESCRIPTION OF THE INVENTION [Industrial application] The present invention relates to mucus, secretions and other deposits (hereinafter referred to collectively as "secretions") from trachea, endotracheal tube and tracheostomy tube. ), And more particularly to a suction catheter with a distal balloon. An object of the present invention is to provide a catheter having an improved tip structure and a suction control structure capable of effectively removing secretions and reducing the possibility of trauma during the removal operation. The invention also relates to the use of such a catheter. A suction catheter with a distal balloon is used when used with a "Y" shaped connector having a self-sealing diaphragm assembly when the positive end expiratory pressure of the lung ("PE
EP ").

[Prior Art] Tracheobronchial secretions in endotracheal or tracheostomy tubes are usually removed by aspiration. This method of passing the suction catheter through the tracheostomy tube is particularly tacky for secretions,
It has no effect if adhered to the wall of the tube. Also, despite careful attention, this method causes complications. These complications include mucosal damage, bleeding and erosion of the tracheal mucosa. These disadvantages also occur in patients who are not involved in lung disease.

United States Patent 3,965,901 to Penny et al.
The publication describes a catheter having an opening on the side of the distal end. These openings are intended to improve the effectiveness of the catheter and reduce damage to tissue. U.S. Pat. No. 4,240,433 to Bordow describes a sharp-tipped fluid suction needle with an inflatable balloon. The balloon can be deployed inflated between the sharp tip of the needle and the internal organ during aspiration, which can minimize the movement of the sharp needle, thereby reducing the risk of accidental puncture.

Another disadvantage of the suction method described above is that the lung PEEP cannot be maintained. During mechanical ventilation of a patient, the usual treatment is to use PEEP, where the ventilator applies a certain amount of pressure during the expiratory phase of ventilation. It is desirable not to lose the positive pressure created by the lungs during ventilation.

Pulmonary PEEP can generally be lost in the two steps of the suction procedure described above. First, PEEP can be lost during insertion of the catheter into the endotracheal tube. Positive pressure can be lost by exposing the inside of the tube to atmospheric pressure. Various sealing means for maintaining pressure have been proposed. One means is a slidable balloon surrounding the catheter. Place the catheter,
The opening is then closed by sliding the balloon relative to the opening. A disadvantage of this sealing method is that the user must manually move the slidable balloon to form a seal. Another sealing device is described in Grimes U.S. Pat. No. 4,416,273.
This patent includes a method for inserting and withdrawing a catheter.
A connector valve assembly for holding PEEP is described. Check valves are used to prevent loss of positive pressure.

Second, positive pressure can be lost when aspiration is performed on the catheter to aspirate bodily fluids. In extreme cases, conventional suction catheters can destroy the lungs due to the negative pressure created by suction.

A catheter with a distal balloon for a male urethra, including the prostate, is disclosed. Generally, such catheters
It is disclosed for use in injecting or removing fluid from a particular portion. One or more balloons have been used to isolate the part to be treated. These catheters do not disclose means of controlling suction to ensure that the downstream portion of the treatment section is not exposed to reduced pressure. Control of these forces in the male urethra is less important than in the endotracheal tube. When inserted into the endotracheal tube,
It is significant that the lungs are destroyed by suction applied through the catheter.

Another problem that is not an issue with male urinary tract treatment catheters is the removal of secretions adhering to the walls of the passages or tubes to be cleaned. Male urethral secretions, such as pus, are not firmly attached to the surface on which they reside. Therefore, male urinary catheters generally include suction as a suitable means for secretion removal. Since the secretions are firmly attached to the wall of the endotracheal tube, the secretions of the endotracheal tube cannot be easily removed by suction.

The drawbacks of aspiration can be avoided by removing secretions by resection. Excision can be performed by using a catheter with a distal balloon. An arterial embolectomy catheter marketed as Fogarty ™ can be used. The balloon is deflated and inserted into the endotracheal tube. When the desired position is reached, the balloon is inflated until it contacts the side of the endotracheal tube. With the balloon inflated, the catheter is withdrawn from the endotracheal tube. When pulling up the catheter, secretions attached to the wall of the endotracheal tube are exfoliated due to the balloon being in contact with the tube wall. This is commonly referred to as "squeegee" action. The squeegee effect is particularly useful for removing secretions from the endotracheal tube that are firmly attached to the tube wall. As the balloon is raised, secretions collect at the proximal end of the balloon. The accumulated secretions are removed when the balloon is removed from the endotracheal tube.

A disadvantage of resection is the efficiency of secretion removal. Secretions cannot be removed until the balloon is completely withdrawn from the endotracheal tube. Thus, as the balloon is withdrawn, the efficiency and ease of secretion removal decreases as the concentration of secretions on the proximal side of the balloon increases.

[Constitution of the Invention] The present invention is intended to eliminate these disadvantages. The present invention provides a suction catheter with a distal balloon and a method of using such a catheter to more efficiently and safely remove secretions from the trachea, endotracheal tube and tracheostomy tube. The catheter of the present invention is uniquely designed to take advantage of both excision and suction.

Another advantage of the present invention is that the use of a suction catheter with a distal balloon in combination with a "Y" shaped connector having a self-sealing diaphragm assembly allows the PEEP of the patient's lung to be retained. In order to maintain the pressure of the endotracheal tube, the seal must be maintained throughout. The self-sealing diaphragm assembly of the present invention retains its sealing capability throughout catheter insertion and removal. To ensure that the interior of the tube is not exposed to environmental pressures, there is no need to bother with sealing means that need to be manipulated by the user.

A third advantage of the present invention is that the operator can control the transmission of suction pressure through the catheter. The operator can ensure that suction is not applied to the distal end of the catheter until after the balloon is inflated and seals the downstream portion of the balloon.

The present invention relates to a method and apparatus for removing and aspirating body secretions from the trachea, endotracheal tube and tracheostomy tube. The device comprises a hollow elongated tube having a distal and a proximal end. The distal end is inserted into the endotracheal tube to be cleaned. The tip of the distal end is round and soft so as not to damage the tissue. In addition, the device comprises an inflatable membrane, sometimes called a balloon, located at the distal end. The long hollow tube is typically made from a suitable material such as polyvinyl chloride. The inflatable membrane is made from a flexible material such as latex.

The cannula provides fluid communication at its distal end to the inside of the inflatable membrane. The inflatable membrane can be attached to the outer wall of the distal end of the long tube or directly to the distal end of the cannula. Proximal to the inflatable membrane is an opening in the long tube wall that provides fluid communication between the inside and outside of the tube. Mucus and other secretions
Suction can be achieved through these openings.

The proximal end of the long tube, ie, the end that is not inserted into the body cavity, is connected to a source of negative pressure. Negative pressure is provided by conventional methods known in the art. The finger control is at the proximal end of the long tube so that the operator can control the transmission of suction applied to the distal end of the tube.

The proximal end of the cannula is connected to a positive pressure source that can supply sufficient pressure to inflate the inflatable membrane. This positive pressure source is typically a syringe.

The catheter is inserted into the endotracheal tube while the inflatable membrane is deflated. Do not close the finger control,
Avoid applying suction to the distal end of the catheter.
After reaching the desired location, the inflatable membrane is inflated until the membrane contacts the wall of the endotracheal tube. Next, the catheter is pulled up from the endotracheal tube, and secretions are exfoliated from the tube wall by a squeegee action between the balloon and the tube wall.
As secretion accumulates proximal to the inflatable membrane, it is removed by suction through an opening in the catheter wall. Suction can be performed by placing a finger on the finger control part and closing that part.

In another aspect of the invention, a catheter is used in combination with a connector assembly, typically referred to as a "Y" shaped connector, to maintain lung PEEP during ablation and aspiration with a distal balloon catheter. . The first end of the connector assembly is tightly connected to an endotracheal or tracheostomy tube. The second end of the "Y" shaped connector assembly aligned with the first end has a self-sealing diaphragm assembly. Preferably, the diaphragm assembly has three diaphragms in series. Each diaphragm has a sliced opening. The sliced openings are arranged so that each slice is preferably angularly offset from the adjacent diaphragm by about 60 °. Misalignment of the sliced opening is important to maintain a pressure-retainable seal during insertion and removal of the catheter. Diaphragms are typically made from latex. The third end of the connector assembly is connected to a normal exhalation source that ventilates the lungs.

In use, the catheter is inserted through a self-sealing diaphragm assembly. The assembly provides a seal to the catheter tube and protects the inside of the endotracheal tube from exposure to atmospheric pressure. Therefore,
No positive pressure is lost inside the endotracheal tube. The respiratory tract is not removed because the catheter is inserted through another part. The finger control is open and suction is not transmitted through the catheter. Apply suction only after the inflatable membrane is inflated and sealed against the wall of the endotracheal tube. Since the opening for suction is on the proximal side of the inflatable membrane, positive lung pressure is not lost due to suction.

Other advantages of the present invention will be understood from the following description of preferred embodiments.

FIG. 1 is a side view of a catheter of the present invention inserted into an endotracheal tube.

To illustrate the preferred embodiment of the present invention, FIG. 2 shows a catheter 10 using the principles of the present invention. Catheter 10
Has a cannula 11 with an inflatable membrane 12 attached to its distal end, and a long tube 13 surrounds the cannula 11. The long tube 13 may be of any suitable construction and is for aspirating secretions of the trachea, endotracheal tube or tracheostomy tube. Preferably, the structure is a semi-rigid long tube 13.

As shown in FIG. 2, the long tube 13 has a distal end with a closed soft tip so as not to damage the body tissue.
With 21. Proximal to distal end 21 are openings 22 and 23 in the wall of tube 13. Only two openings are shown for illustration. The number of openings may be varied as needed. The proximal end 25 of the long tube 13 provides fluid communication with a normal source of suction. Transmission of the suction force to the openings 22 and 23 is controlled by operating a control portion (for example, a control port) 24 as described below. Long tubes 13
Preferably has a round cross section and a uniform area. To facilitate insertion, the long tube 13 may be formed into a bent configuration by any suitable method known in the art.

The cannula 11 extends along a long tube 13. The cannula 11 can be attached to the long tube 13 in various ways, some of which are described herein. One method is to secure the cannula 11 to the long tube 13 at the proximal and distal points. The second method is to adhere or weld the cannula 11 to a long tube by a conventional method. A third method is to use a cannula as shown in FIGS.
This is a method of embedding 11 in the wall of a long tube 13. The cannula 11 preferably has a uniform cross-sectional area.

The inflatable membrane or balloon 12 is attached to the wall of a long tube 13 as shown in FIG. The inflatable membrane 12 attaches on both its proximal side 31 and its distal side 32. The expandable membrane 12 is preferably made from an expandable material such as latex. The inflatable membrane remains deflated until a positive pressure is applied. The material of the inflatable membrane is sufficiently flexible to permit inflation and contact with the wall of the body tract, such as the endotracheal tube 14 where the catheter is located. The inflatable membrane remains deflated until a positive pressure is applied. The proximal end 35 of the cannula 11 is attached to a positive pressure source 33. Typically, this positive pressure source 33 is a syringe.

The distal end 26 of the cannula 11 comprises an opening for fluid communication between the cannula 11 and the inside of the inflatable membrane 12. As mentioned earlier, the distal end 21 of the long tube 13 is closed and has a soft tip so as not to damage body tissue. No fluid communication is possible through the distal end 21.

In another embodiment of the present invention, as shown in FIG. 5, an inflatable membrane 12a is attached to the distal end of cannula 11a at junction 41. The joint 41 can be formed by sealing between the inflatable membrane 12a and the cannula 11a. Sealing is conventional in the art. Alternatively, the expandable membrane 12a and cannula 11a may be a unitary structure that does not require a seal. Distal end 21a has an opening that provides fluid communication between the inside and outside of long tube 13a. Secretions can be inhaled via the distal end 21a during the inhalation operation described below.

The catheter 10 shown in FIG. 2 formed by the method described above,
As shown schematically in FIG. 2, the expandable membrane 12 is inserted into a body cavity such as an endotracheal tube 14 in a deflated state.
The control portion 24 is open so that suction is not transmitted to the distal end of the catheter 10. Catheter 10 is an endotracheal tube
When the predetermined position 14 is reached, a positive pressure is applied inside the cannula 11 to expand the expandable membrane 12. Inflatable membrane 12
Are inflated until deformed by the wall of the endotracheal tube 14.

Secretions on the wall of the endotracheal tube 14 are removed by withdrawing the catheter 10 from the endotracheal tube 14 while the inflatable membrane 12 is inflated. Inflatable membrane 12 and endotracheal tube
Due to the squeezing action between the secretory material and the secretory material, secretions firmly attached to the wall are removed from the wall of the endotracheal tube 14.

Secretions that accumulate on the proximal side of the inflatable membrane 12 by pulling on the inflatable membrane are removed by aspiration through a long tube 13. A source of suction attached to the proximal end 25 of the long tube 13 is commonly known in the art. Suction is typically continuous from the proximal end 25. If suction at openings 22 and 23 of long tube 13 is not desired, finger control portion 24 is left open.
If suction at openings 22 and 23 is desired,
May be closed with the operator's finger. By closing, the suction force is transmitted to the openings 22 and 23 of the long tube 13. Once the secretion has been removed, it is drawn inside the long tube 13 through the openings 22 and 23.

The catheter 10 of the present invention may be used with a connector assembly, commonly referred to as a "Y" shaped connector assembly, as shown in FIG. 8, to maintain the PEEP of the patient's lungs. The distal opening 71 is placed tightly inside a body passage, such as the endotracheal tube 14, so that it can communicate with the inside of the tube 14, as illustrated in FIG. Side openings 72 provide fluid communication with the respirator that supplies oxygen to the patient. The proximal end opening 73 is an entrance into which the catheter 10 is inserted. The stopper 74 closes the opening 73 when the catheter 10 is not inserted. Diaphragm assembly
75 has three diaphragms. Each diaphragm has a sliced opening (ie, an elongated opening). As shown in FIG. 9, the sliced openings 76 to 78
Preferably, it is arranged so as to be angularly offset by about 60 ° from the opening of the adjacent diaphragm. This offset arrangement of the openings ensures that the openings are not aligned and that there is no fluid communication through the assembly. The sliced opening in the diaphragm assembly allows for the insertion of a catheter, but the distal end 81
Fluid communication between the and the proximal end 80. No.
FIG. 9a is an exploded view of the diaphragm assembly. Preferably, the diaphragms are as close together as possible to ensure a tight seal.

Single sliced openings 76-78 are shown in ninth
It is only shown in the figure. As shown in FIG. 10, each diaphragm may be a multiple slice (ie, may have multiple elongated openings). Diaphragm 76-78
Is flexible and can be made from a suitable material such as, for example, latex.

In use, the stopper 74 is removed from the opening 73 of the connector assembly 70. Catheter assembly 10
Is inserted through the opening 73 and the diaphragm assembly 75 as shown in FIG. When the catheter 10 is inserted, the expandable membrane 12 is deflated. When the catheter assembly 10 is inserted, the diaphragm assembly 75 seals around the catheter 10, and the diaphragm assembly 75
Prevents loss of positive pressure from the distal side 77 of the 75. After the catheter assembly 10 has reached the desired position, the inflatable membrane
Until the tube 12 contacts the wall of the endotracheal tube 14, the inflatable membrane 12
Inflate. In order to inhibit fluid communication from the proximal side to the distal side of the inflatable membrane 12, the inflatable membrane 12 is inserted into the endotracheal tube.
Seal against 14 walls.

After reaching the desired position, the secretion is removed and aspirated by the method described above. Inflatable membrane 12 with endotracheal tube 14
The PEEP is held in the patient's lungs as it is deformed and held by the walls of the patient. The sealing contact between the inflatable membrane 12 and the endotracheal tube 14 prevents suction applied to the lungs.

The suction can be controlled by a three-way valve instead of the finger control as described above. The three-way valve prevents suction from being transmitted through the catheter 10 before the inflatable membrane 12 is inflated. Any suitable three-way valve used in the art can be used. Operation of the three-way valve ensures that PEEP is not lost by suction during insertion of the catheter 10.

It is also desirable to provide a safety mechanism to prevent aspiration by the operator 10 through the catheter 10 before the inflatable membrane 12 is fully inflated.
This safety mechanism can be supplied in a conventional manner known in the art.

After reaching the desired location, the secretion is removed and aspirated by the methods described above. Inflatable membrane 12 with endotracheal tube 14
The PEEP of the patient's lung is maintained because it is deformed and held by the wall of the patient. The sealing contact between the inflatable membrane 12 and the endotracheal tube 14 prevents inhalation from the lungs.

Having described preferred embodiments and uses of the present invention in detail, it is noted that these embodiments and uses can be varied and modified. The description of the present invention
The present invention is not limited to the present invention, but merely exemplifies preferred embodiments and methods of use of the present invention. Other catheters and methods of use with modifications or variations of the catheters and methods of use described herein are also encompassed by the present invention.

[Brief description of the drawings]

FIG. 1 is a side view of a catheter of the present invention inserted into an endotracheal tube, FIG. 2 is a cross-sectional view of the catheter of the present invention inserted into an endotracheal tube, and FIG. 3 is a line in FIG. FIG. 4 is a detailed cross-sectional view of the inflatable membrane of the preferred embodiment of the catheter, FIG. 5 is a cross-sectional view of another embodiment of the present invention, and FIG. FIG. 7 is a detailed cross-sectional view taken along line 6-6 of the figure, FIG. 7 is a cross-sectional view of a catheter of the present invention with a "Y" shaped connector assembly attached, and FIG. 8 is a "Y" shaped connector assembly. 9 is a detailed sectional view taken along line 9-9 of FIG. 8, FIG. 9a is an exploded view of the diaphragm assembly, FIG.
10 and 10a are cross-sectional views of another embodiment of the diaphragm assembly. 10 ... catheter, 11 ... cannula, 12 ... inflatable membrane, 13
... tube, 14 ... tracheal tube, 21 ... distal end, 22,23 ...
Opening, 24 ... finger control part, 25 ... proximal end, 26 ... distal end, 31
… Proximal end, 32… distal end, 33… positive pressure source, 35… proximal end, 41
… Joint, 70… connector assembly, 71,72,73… opening, 74… stopper, 75… diaphragm assembly, 76,77,78… sliced opening, 80… proximal end, 81… distal end.

 ──────────────────────────────────────────────────続 き Continued on front page (72) Inventor Bruce Dee Butler East Forteens Street, Houston, Texas, USA 07708 # 415 (72) Inventor Jeffrey Katz United States 77071, Texas, Houston, Apache・ Plume Drive No. 7539 (56) References JP-A-61-37254 (JP, A) JP-A-61-45776 (JP, A) JP-A-59-77865 (JP, A)

Claims (10)

(57) [Claims] 1. A catheter assembly having a proximal end and a distal end for removing secretions by removal or suction from a trachea, endotracheal tube or tracheostomy tube, comprising: (a) a catheter; The distal end is adapted to be inserted into the opening at the proximal end of the trachea, endotracheal tube or tracheostomy tube and positioned in the tube.
A proximal end extending outside the opening at the proximal end of the tube and adapted to connect to a source of negative pressure; (b) located at or near the distal end of the catheter An inflatable balloon that is capable of inflating a portion of the longitudinally extending opening of the tube to substantially fill the portion; (c) one or more at least one of which is positioned proximate a proximal end of the balloon. A wall of the catheter providing fluid communication between the exterior and interior of the catheter, and (d) a cannula connected at its distal end to the balloon. And a cannula extendable along the catheter and connectable to a suitable pressure source for inflating the balloon at the proximal end, and (e) transmitting suction to the distal end of the catheter. Control Catheter assembly having a control portion on the wall near the proximal end of the catheter that can be closed and opened for closing. 2. A "Y" having a distal end opening, a side opening and a diaphragm assembly aligned with the proximal end opening.
"-Shaped" connector assembly, wherein the catheter is positioned around the catheter between the opening and the control portion such that the catheter passes through two end openings of the "Y" -shaped connector. The opening is adapted for connection to the proximal end of the tube, the side opening is adapted for connection to a breathing apparatus, and the diaphragm assembly is adapted to be connected to the proximal end opening and to the side. Mounted in a “Y” shaped connector between the opening and the catheter and “Y”
"Y" to seal the annular portion between the """shaped connector
The catheter assembly according to claim 1, further comprising a shaped connector assembly. 3. The method according to claim 2, further comprising three diaphragms having sliced openings offset from each other.
The catheter assembly according to any one of the preceding claims. 4. The catheter assembly of claim 1, wherein the inflatable balloon is mounted on and around the catheter. 5. The catheter assembly according to claim 1, wherein the inflatable balloon is connected to the distal end of the cannula, the distal end of the cannula extending beyond the distal end of the catheter. 6. The catheter assembly according to claim 1, wherein the cannula is embedded in the wall of the catheter. 7. A catheter assembly having a proximal end and a distal end for removing secretions by resection or suction from within a trachea, endotracheal tube or tracheostomy tube, comprising: (a) a catheter; The distal end is adapted to be inserted into the opening at the proximal end of the trachea, endotracheal tube or tracheostomy tube and positioned in the tube.
A proximal end extending outside the proximal end opening of the tube and adapted to connect to a source of negative pressure; (b) disposed at or near the distal end of the catheter An inflatable balloon capable of inflating a portion of a longitudinally extending opening of the tube to substantially close the portion; (c) one or more in which at least one is disposed proximate a proximal end of the balloon A wall of the catheter providing fluid communication between the exterior and interior of the catheter, and (d) a cannula connected at its distal end to the balloon. A cannula, which is connectable to a suitable pressure source for inflating the balloon at the proximal end and extending along the catheter, and (e) transmitting suction to the distal end of the catheter. To control A control portion on the wall near the proximal end of the catheter that can be closed and opened; and (f) a "Y" having a distal end opening, a side opening and a diaphragm assembly aligned with the proximal end opening. "-Shaped connector assembly, wherein the catheter has a" Y "shaped connector between the opening and the control portion.
Is disposed around the catheter so as to pass through the two end openings, the distal end opening being adapted for connection to the proximal end of the tube, and the side opening being connected to the respirator. And the diaphragm assembly can be connected in a “Y” shape between the proximal end opening and the side opening.
Attached in the shape connector, the catheter and “Y”
A catheter assembly comprising a "Y" shaped connector assembly attached to said tube adapted to seal an annulus between said "Y" shaped connector. 8. A catheter assembly for removing secretions by removing or aspirating from a trachea, an endotracheal tube or a tracheostomy tube, comprising: (a) a distal end and a proximal end which can be inserted into a human; An endotracheal tube and a tracheostomy tube, the distal end of which is configured to provide access to mucus in the trachea or lungs to receive a catheter from outside the patient's mouth. A tube extending to the proximal end, wherein the inner surface of the tube is adapted to slidably receive an elastic balloon, (b) a catheter, the distal end of which comprises: Adapted to be inserted into the proximal end of the trachea, endotracheal tube or tracheostomy tube and positioned in the tube, the proximal end being outside the opening at the proximal end of the tube (C) distal to the catheter An inflatable balloon disposed at or near the tube and capable of inflating to the wall of the tube to form a slidable seal therewith; (d) fluid communication between the interior of the catheter and the interior of the tube; At least one opening in the wall of the catheter proximate the proximal end of the balloon, which can provide: (e) a cannula connected to the balloon at its distal end; A cannula connectable to a suitable pressure source for inflation and extending along the catheter; and (f) a wall near the proximal end of the catheter that controls the transfer of suction to the distal end of the catheter. A catheter assembly having a control portion. 9. The catheter assembly of claim 8, wherein the inflatable balloon is mounted on and around the catheter. 10. The catheter assembly according to claim 8, wherein the cannula is embedded in the catheter wall.