JP6932374B2 - Fixed plate - Google Patents

Description

The present invention relates to a fixation plate used to secure an intubated tracheostomy tube to a patient.

The tracheostomy tube has a pair of laterally extending frames that are exposed to the outside of the patient in the intubated state. The intubated tracheostomy tube is secured to the patient by attaching various fixtures to the pair of frames and wrapping the fixture around the patient's neck. As such a fixture, a dedicated commercially available product called a cannula holder, a neck-wrapping strap, a neckband, or the like, a cotton tape for medical use, or the like is used.

A tracheostomy tube fixed to the patient using a fixture is connected to a connector exposed to the outside of the patient in an intubated state with a ventilator pipe. As an aid to prevent the ventilator pipe from coming off, it has a ring that fits externally into the tracheostomy tube connector, and a strap that wraps around the ventilator pipe to secure it. And a strap that wraps around the neck of the patient is known (Patent Document 1).

U.S. Patent Application Publication No. 2005/0161047

When the tracheostomy tube is fixed to the patient, it is generally sufficient to fix the tracheostomy tube using the pair of frames and various fixtures described above. However, for example, if the tracheostomy of the patient hangs below the midline, the distance between the patient's neck and frame will be greater than usual, and if the patient has abnormal hypertonia. The patient's posture changes. Then, the tracheostomy tube cannot be sufficiently fixed by using the fixture, and there is a possibility that unintended misalignment or extubation may occur.

Therefore, an object of the present invention is to provide a fixing plate capable of sufficiently fixing a tracheostomy tube regardless of the body shape and posture of a patient.

The fixing plate of the present invention extends in the left-right direction with a pipe portion (101, 201) intubated by the patient, a connector (102, 202) connected to the end portion of the pipe portion and exposed to the outside of the patient. A tracheostomy tube (100, 200) with a pair of frames (103, 203) that can be used to fix the patient to the neck is intubated to cover the pair of frames. Fixing plates (1A to 1F) for fixing to the connector, through which connector through holes (2, 12) having a size capable of inserting the connector are formed, and a size capable of inserting each of the pair of frames. A pair of frame through holes (3, 13) are formed on both sides of the connector through hole in the left-right direction so that the pair of frames can be pulled out from the back side to the front side and inserted at the same time. At least four fixing member through holes (4, 14, 5, 15) is formed.

According to this fixing plate, the fixing plate is combined with the tracheostomy tube by inserting each of the pair of frames into the through hole for the frame with the connector of the tracheostomy tube inserted into the through hole for the connector. Then, with the fixing plate combined with the tracheostomy tube, the fixing member can be attached to at least four fixing member through holes and fixed to the patient using the fixing member. As a result, the tracheostomy tube is fixed to the patient with a fixing plate supported by at least four support points, so that the patient's body shape and posture are compared with the fixing method in which the tracheostomy tube is fixed to the patient's neck with only a pair of frames. The tracheostomy tube can be sufficiently fixed independently of the patient.

In one aspect of the fixing plate of the present invention, the four fixing member through holes are left and right in a pair of upper through holes arranged on the left and right in the upper portion and a lower portion located below the pair of upper through holes. It may include a pair of arranged lower through holes. According to this aspect, the tracheostomy tube is attached to the patient on the upper side and the lower side by attaching the fixing member to each of the pair of upper through holes, while attaching the fixing member to each of the pair of lower through holes. Each can be fixed. For example, since the upper side can be fixed to the patient's neck and the lower side can be fixed to the patient's chest using fixing members, the tracheostomy tube can be fixed more reliably than fixing only to the patient's neck.

In this embodiment, the pair of upper through holes are formed in the shape of elongated holes extending linearly, and the long side is formed so as to face diagonally upward, and the pair of lower through holes are linear. It may be formed in the shape of an elongated hole extending in the direction of the long side so that the long side side faces diagonally downward. When the fixing member is a band-shaped member, the tracheostomy tube is fixed to the patient because it is easy to guide the fixing member diagonally upward and diagonally downward with the tracheostomy opening as the center. It becomes easy.

In one aspect of the fixing plate of the present invention, each of the pair of frame through holes is formed in an elongated shape curved in an arc shape toward the side of the connector through hole, and is used for the pair of frames. One of the pair of frames is inserted into one of the through holes, the other of the pair of frames is inserted into the other of the pair of frame through holes, and the connector is inserted into the connector through hole. A margin may be provided in the circumferential length of each of the pair of frame through holes so that the tracheostomy tube can be rotated. Depending on the patient, the trachea may be tilted diagonally with respect to the midline, and intubation of a tracheostomy tube in such a patient may tilt the pair of frames at an angle.

According to this aspect, a margin is provided in the circumferential length for each of the pair of frame through holes. Therefore, even in a patient whose pair of frames tilts when the tracheostomy tube is intubated as described above, the tilt is absorbed by the margin in the circumferential direction of the through hole for the frame, so that the patient tilts to the fixed plate. There is no. Therefore, the fixation of the tracheostomy tube intubated in such a patient does not become unstable. In addition, the pair of frames of the tracheostomy tube are not limited to those extending straight to the left and right, but also various types such as those extending at an angle diagonally upward with respect to the left and right and those having different angles. exist. There are also various types of tracheostomy tubes for the vertical width of the pair of frames. According to this aspect, even in such various types of tracheostomy tubes, the pair of frames can be held by the through holes for the frame provided with a margin in the circumferential direction, so that the versatility is high.

In one aspect of the fixing plate of the present invention, the connector insertion portions (51, 61) in which the through holes for the connector are formed and the through holes for the fixing member are formed and are parallel to the connector insertion portion and are high and low. The pair of frame through holes including a fixing member mounting portion (52, 62) having a difference (ΔH) and a connecting portion (53, 63) connecting the connector insertion portion and the fixing member mounting portion. May be formed in the connection portion. When the connector of the tracheostomy tube is inserted into the connector insertion hole and the pair of frames are inserted into the frame through hole in a curved state, the elastic force that causes the curved frame to return to its original shape causes the curved frame to return to its original shape. A force may be exerted in the direction of pulling out the tracheostomy tube intubated by the patient. According to this aspect, the connector insertion portion and the fixing member mounting portion having a height difference from each other are connected by a connecting portion, and a pair of frame through holes are formed in the connecting portion. Therefore, if the height difference is at least the thickness of the frame, the pair of frames can be inserted into the through holes for the frame without bending each of the pair of frames with the connector of the tracheostomy tube inserted in the through holes for the connector.

In the above description, reference numerals of the accompanying drawings are added in parentheses to facilitate understanding of the present invention, but the present invention is not limited to the illustrated form.

As described above, according to the fixation plate of the present invention, the tracheostomy tube is fixed to the patient by the fixation plate supported by at least four support points, so that the tracheostomy tube is fixed to the patient's neck with only a pair of frames. Compared with the fixation method, the tracheostomy tube can be sufficiently fixed regardless of the patient's body shape and posture.

The figure which showed the appearance of an example of a tracheostomy tube. The figure which showed the state which looked at the tracheostomy tube from the direction of arrow II of FIG. The figure which showed the fixing plate which concerns on 1st Embodiment of this invention. The figure which showed the state which the fixed plate of the 1st form was combined with the tracheostomy tube. The figure which showed an example of the fixing method of a fixing plate. The figure which showed another example of the fixing method of a fixing plate. The figure which showed the fixing plate which concerns on 2nd Embodiment of this invention. The figure which showed the state which the fixed plate of the 2nd form was combined with the tracheostomy tube. Explanatory drawing which showed the feature of a fixed plate. The figure which showed the state which the tracheostomy tube rotated counterclockwise. The figure which showed the state which the tracheostomy tube rotated clockwise. The figure which showed the fixing plate of the 3rd form. The figure which showed the fixing plate of the 4th form. The figure which showed the fixing plate of the 5th form. FIG. 14A is a cross-sectional view taken along the line XIVb-XIVb of FIG. 14A. The figure which showed the fixing plate of the 6th form. FIG. 15A is a cross-sectional view taken along the line XVb-XVb. The figure which showed the state which the fixed plate of the 5th form was combined with the tracheostomy tube.

(First form)
The tracheostomy tube 100 shown in FIGS. 1 and 2 is intubated into a tracheostomized patient, and various devices such as a respirator (not shown) are connected. The tracheostomy tube 100 has a pipe portion 101 intubated by the patient, a connector 102 connected to the end of the pipe portion 101 and exposed to the outside of the patient, for example, a connector 102 to which a ventilator pipe (not shown) is connected, and the patient. It is provided with a pair of frames 103 used for fixing the neck to the neck. The pipe portion 101 is provided with a cuff 104 that closes between the outer circumference of the pipe portion 101 and the inner surface of the trachea of the patient to prevent air leakage on the outer peripheral side of the pipe portion 101. As shown in FIG. 2, the pair of frames 103 extend in the left-right direction, and an opening 103a is formed at each end. When fixing to the patient's neck using a pair of frames 103, a fixture (not shown) such as a medical cotton tape or a cannula holder is attached to the opening 103a, and such a fixture is attached to the patient's neck. Wrapped around.

The fixation plate 1A shown in FIG. 3 is used, for example, to fix the tracheostomy tube 100 shown in FIGS. 1 and 2 to the patient. The fixed plate 1A is basically used instead of using the pair of frames 103, but it does not prevent the pair of frames 103 from being used while using the fixed plate 1A. The fixing plate 1A is made of, for example, a plate-shaped resin material having a certain degree of flexibility. Further, in order to ensure visibility when the tracheostomy tube 100 is fixed, a translucent material may be selected as the material of the fixing plate 1A.

The fixing plate 1A includes a connector through hole 2 having a size capable of inserting the connector 102 of the tracheostomy tube 100, and a pair of frame through holes 3 having a size capable of inserting each of the pair of frames 103. , A pair of upper through holes 4 and a pair of lower through holes 5 for attaching various fixing members are formed around the connector through holes 2 and the frame through holes 3.

The pair of frame through holes 3 are arranged on both sides of the connector through holes 2 in the left-right direction so that the pair of frames 103 can be inserted at the same time. Each of the pair of frame through holes 3 is formed in an elongated shape curved in an arc shape toward the connector through hole 2. Then, as will be described in detail later, one of the pair of frames 103 is inserted into one of the pair of frame through holes 3, and the other of the pair of frames 103 is inserted into the other of the pair of frame through holes 3, and the other is for a connector. A margin is provided in the circumferential length of each of the pair of frame through holes 3 so that the tracheostomy tube 100 can be rotated with the connector 102 inserted in the through hole 2.

The pair of upper through holes 4 and the pair of lower through holes 5 correspond to an example of the four through holes for fixing members of the present invention. The pair of upper through holes 4 are arranged on the left and right in the upper part of the fixing plate 1A, and the pair of lower through holes 5 are arranged on the left and right in the lower part located below these.

When fixing the tracheostomy tube 100 intubated to the patient using the fixing plate 1A, as shown in FIG. 4, the connector 102 of the tracheostomy tube 100 is inserted into the connector through hole 2 of the fixing plate 1A. , One of the pair of frames 103 is inserted into one of the pair of frame through holes 3, and the other of the pair of frames 103 is inserted into the other of the pair of frame through holes 3. As a result, the tracheostomy tube 100 is combined with the fixing plate 1A. In that state, the fixation plate 1A is fixed to the patient P as shown in FIGS. 5 and 6.

FIG. 5 shows a method in which two medical cotton tapes are prepared and the fixing plate 1A is fixed to the patient P so as to intersect at the back surface of the patient P. In this fixing method, first, the first cotton tape T1 is passed through one of the pair of upper through holes 4 (for example, the left side in FIG. 5), and the excess cotton tape T1 is passed through the neck Pn of the patient P and the back surface is slanted. Guide downwards. Then, the first cotton tape T1 guided diagonally downward is guided diagonally upward on the front side of the patient via the armpit Pa of the patient P. On the front side of the patient P, the first cotton tape T1 guided diagonally upward is passed through one of the pair of lower through holes 5 (for example, the right side of FIG. 5), and the surplus first cotton tape T1 patient's armpit. Tie with Pa to form a knot Tk. On the other hand, the second cotton tape T2 is knotted in the same way as the first cotton tape T1, with the other side of the upper through hole 4 on the diagonal line (right side in the figure) and the other side of the lower through hole 5 (left side in the figure). A second cotton tape T2 is passed through and tied at the armpit Pa of the patient P to form a knot Tk. As a result, the fixing plate 1A is fixed to the patient P so that the two cotton tapes T1 and T2 intersect at the back surface of the patient P.

FIG. 6 shows a method of preparing two medical cotton tapes and a neckband, and fixing the fixing plate 1A to the patient P at the neck and chest of the patient. In this fixing method, first, the neckband N is passed through both of the pair of upper through holes 4, and the patient P is fixed on the back side of the neck Pn of the patient P with a hook-and-loop fastener (not shown) provided on the neckband N. On the other hand, two maintenance tapes T1 and T2 are passed through the pair of lower through holes 5, respectively, and the surplus cotton tapes T1 and T2 are circulated from the chest Pb of the patient P toward the back side, and these cotton tapes T1 and T2 T23 are tied together on the anterior side of patient P to form a knot Tk. This fixes the fixation plate 1A to the patient P in the patient's neck and chest.

Various fixing methods other than those in FIGS. 5 and 6 can be adopted, but in consideration of various factors such as the body shape of the patient P and the state of the tracheostomy opening, a fixing method that makes it difficult for the tracheostomy tube 100 to come off should be appropriately selected. Just do it. The fixing plate 1A is formed so that each of the pair of upper through holes 4 has an elongated hole shape extending linearly and the long side side faces diagonally upward, and each of the pair of lower through holes 5 has an elongated shape. It has a long hole shape that extends linearly, and is formed so that the long side side faces diagonally downward. Therefore, the cotton tapes T1 and T2 and the neck holder N, which are examples of the band-shaped fixing members, can be easily guided in the oblique direction, so that the tracheostomy tube 100 can be easily fixed to the patient P.

According to the first aspect, since the tracheostomy tube 100 is fixed to the patient by the fixing plate 1A supported by four support points, it is compared with the fixing method in which the tracheostomy tube 100 is fixed to the patient's neck with only a pair of frames 103. Therefore, the tracheostomy tube can be sufficiently fixed regardless of the patient's body shape and posture. Moreover, while the fixing member is attached to each of the pair of upper through holes 4, by attaching the fixing member to each of the pair of lower through holes, the tracheostomy tube 100 is attached to the patient on the upper side and the lower side, respectively. Can be fixed. Therefore, the tracheostomy tube can be fixed more reliably than fixing it only to the patient's neck.

(Second form)
Next, the second embodiment of the present invention will be described with reference to FIGS. 7 to 11. As shown in FIGS. 7 and 8, the fixing plate 1B of the second form is basically configured in the same manner as the fixing plate 1A. That is, the fixing plate 1B has a connector through hole 12 having a size capable of inserting the connector 202 of the tracheostomy tube 200 and a pair of frame through holes 13 having a size capable of inserting each of the pair of frames 203. And a pair of upper through holes 14 and a pair of lower through holes 15 for attaching various fixing members are formed around the connector through hole 12 and the frame through hole 13. The tracheostomy tube 200 shown in the figure is an example for children, and includes a pipe portion 201 and a cuff 204 as configurations other than the above.

The fixed plate 1B is designed for children, has a smaller overall size than the fixed plate 1A of the first form shown in FIG. 3, and is designed according to the body shape of the child. Children with tracheostomy are characterized by a smaller space around the tracheostomy under the neck than adults. Children also have weaker skin than adults. Therefore, an obstructive part should not be used around the neck as much as possible, and the size of the part should be kept to the minimum necessary. Therefore, the fixed plate 1B is designed so that its overall size is smaller than that of the fixed plate 1A for adults.

In addition, tracheostomy tubes for children have different shapes depending on the manufacturer, and there is no unified standard. Based on this situation, it is a requirement for the product that the fixed plate for children, which should be the minimum required size, can be applied to various tracheostomy tubes for children. However, the connector part is connected to the pipe of the respirator, and its outer diameter is the same and there is no difference from the one for adults. Therefore, the fixed plate 1B for children has the following features because it should be designed according to the body shape of the child and the greatest common divisor of the tracheostomy tube for children.

(1) The shape of the through hole 12 for the connector is a D shape in which a part of the circle is formed by a straight line while the through hole 2 for the connector of the fixed plate 1A is circular.
(2) The arch at the top of the plate is shallower than the fixed plate 1A.
(3) The relative positional relationship between the pair of through holes 13 for the frame and the through holes 12 for the connector is closer to the upper side than that of the fixed plate 1A.
(4) A point that is relatively wider than that of the fixed plate 1A when the left-right distance between the pair of upper through holes 14 and the left-right distance between the pair of lower through holes 15 are compared.

As shown in FIGS. 7 and 8, in the fixed plate 1B, similarly to the fixed plate 1A, each of the pair of frame through holes 13 is an elongated hole in which each of the pair of frame through holes 13 is curved in an arc shape toward the connector through hole 12. It is formed in a shape. Then, one of the pair of frames 203 of the tracheostomy tube 200 is fixed in one of the pair of through holes 13 for the frame, and the other of the pair of frames 203 is inserted in the other of the pair of through holes 13 for the frame. Plate 1B is combined with the tracheostomy tube 200. As the fixing method of the fixing plate 1B to the patient, the fixing method using the medical cotton tape or the neckband shown in FIGS. 5 and 6 can be adopted as in the case of the fixing plate 1A.

In the fixed plate 1B, since the pair of elongated frame through holes 13 have a margin in the circumferential direction, the angle of the pair of frames 203 is different from that of the tracheostomy tube 200 as shown in FIG. It is also applicable to other tracheostomy tubes 200'and tracheostomy tubes 200 ″. Therefore, even with various types of tracheostomy tubes, through holes for frames with a margin in the circumferential length. Since a pair of frames can be held by 13, the versatility is high.

Further, due to the circumferential margin provided in the frame through hole 13, one of the pair of frames 203 is placed on one of the pair of frame through holes 13, and one of the pair of frames 203 is placed on the other of the pair of frame through holes 13. The tracheostomy tube 200 can be rotated with the other inserted and the connector 202 inserted into the connector through hole 12. Depending on the patient, the trachea may be tilted diagonally with respect to the midline, and intubation of a tracheostomy tube in such a patient may tilt the pair of frames at an angle. As shown in FIGS. 10 and 11, even in a patient whose trachea is tilted with respect to the median plane CL, the tilt is absorbed by a margin in the circumferential direction of the through hole 13 for the frame, so that the fixed plate 1B Will not tilt. Therefore, the fixation of the tracheostomy tube intubated in such a patient does not become unstable.

According to the second form, the same effect as that of the first form can be obtained. Then, the tracheostomy tube can be fixed according to the body shape and condition of the child.

The present invention is not limited to each of the above forms, and can be carried out in various forms. The number of through holes for the connector and the through holes for the fixing member arranged around the pair of through holes for the frame is not limited to four, and may be four or more.

The fixed plate of each of the above forms has a constant plate thickness, but the constant plate thickness is only an example. For example, as shown in FIGS. 12 and 13, the fixing plates 1C and the third form in which the thickness of the hatching region AR existing around each through hole is relatively thicker than that of the other regions. It can also be changed to the fixed plate 1D in the form of 4. According to these forms, the plate thickness of other parts can be reduced while maintaining the strength of the through hole, so that the weight can be reduced as compared with the case where the plate thickness is constant. In the fixed plate of the fourth form, the thickness of the hatching region AR'is also relatively thick with respect to the peripheral edge portion.

Further, as shown in FIGS. 14A and 14B and FIGS. 15A and 15B, the fixed plate of the present invention can also carry out the present invention in a form configured in a three-dimensional shape. A fifth form is shown in FIGS. 14A and 14B, which corresponds to a modification of the third form. The fifth form is a fixed plate 1E for adults, designed for adult patients. The fixing plate 1E includes a connector insertion portion 51 in which a through hole 2 for a connector is formed, a fixing member mounting portion 52 in which an upper through hole 4 and a lower through hole 5 are formed, and a connector insertion portion 51 and a fixing member mounting portion. It is provided with a connecting portion 53 which is connected to 52 and has a through hole 3 for a frame formed therein. The connector insertion portion 51 and the fixing member mounting portion 52 are parallel to each other and have a height difference ΔH. The connecting portion 53 extends in a direction crossing each of the connector inserting portion 51 and the fixing member mounting portion 52. Therefore, the opening direction of the through hole 3 for the frame is a direction along each of the connector insertion portion 51 and the fixing member mounting portion 52. The height difference ΔH between the connector insertion portion 51 and the fixing member mounting portion 52 is set to be slightly larger than the thickness of the frame 103 (see FIG. 1) of the tracheostomy tube 100. According to the fixing plate 1E of the fifth form, as shown in FIG. 16, the frame without bending each of the pair of frames 103 with the connector 102 of the tracheostomy tube 100 inserted in the connector through hole 2. Can be inserted into the through hole. In the fifth form, as in the third form, the plate thickness around each of the upper through hole 4 and the lower through hole 5 is relatively thicker than the other regions.

A sixth form is shown in FIGS. 15A and 15B, which corresponds to a modification of the fourth form. The sixth form is a fixed plate 1F for children, which is designed for children's patients. The fixing plate 1F includes a connector insertion portion 61 in which a through hole 12 for a connector is formed, a fixing member mounting portion 62 in which an upper through hole 14 and a lower through hole 15 are formed, and a connector insertion portion 61 and a fixing member mounting portion. It is provided with a connecting portion 63 which is connected to 62 and has a through hole 13 for a frame formed therein. The connector insertion portion 61 and the fixing member mounting portion 62 are parallel to each other and have a height difference ΔH. The connection portion 63 extends in a direction crossing each of the connector insertion portion 61 and the fixing member mounting portion 62. Therefore, the opening direction of the through hole 13 for the frame is a direction along each of the connector insertion portion 61 and the fixing member mounting portion 62. The height difference ΔH between the connector insertion portion 61 and the fixing member mounting portion 62 is set to be slightly larger than the thickness of the frame 203 of the tracheostomy tube 200. According to the fixed plate 1F of the sixth form, the same effect as that of the fifth form can be obtained (see FIG. 16). That is, with the connector 202 of the tracheostomy tube 200 inserted into the connector through hole 12, each of the pair of frames 203 can be inserted into the frame through hole without being curved. In the sixth embodiment, as in the fourth embodiment, the plate thickness around each of the upper through hole 14 and the lower through hole 15 is relatively thicker than the other regions.

1A to 1F Fixing plate 2, 12 Through hole for connector 3, 13 Through hole for frame 4, 14 Upper through hole (through hole for fixing member)
5, 15 Lower through hole (through hole for fixing member)
100, 200 Tracheostomy tube 101, 201 Pipe part 102, 202 Connector 103, 203 Frame 51, 61 Connector insertion part 52, 62 Fixing member mounting part 53, 63 Connection part

Claims (5)

A pipe portion intubated by the patient, a connector connected to the end of the pipe portion and exposed to the outside of the patient, and a pair of frames extending in the left-right direction and used for fixing to the patient's neck. A fixing plate for fixing a tracheostomy tube provided with a device to the patient so as to cover the pair of frames in an intubated state.
A through hole for a connector having a size capable of inserting the connector is formed.
A pair of frames having a size that allows each of the pair of frames to be inserted, and arranged on both sides of the connector through hole in the left-right direction so that the pair of frames can be inserted from the back side to the front side at the same time. A through hole for the frame is formed, and
It is characterized in that at least four fixing member through holes are formed which are arranged around the connector through hole and the frame through hole and to which a fixing member for fixing to the patient can be attached. Fixed plate. The four fixing member through holes include a pair of upper through holes arranged on the left and right in the upper portion and a pair of lower through holes arranged on the left and right in the lower portion located below the pair of upper through holes. The fixing plate according to claim 1. Each of the pair of upper through holes has an elongated hole shape extending linearly, and is formed so that the long side side faces diagonally upward.
The fixing plate according to claim 2, wherein each of the pair of lower through holes has an elongated hole shape extending linearly and is formed so that the long side side faces diagonally downward. Each of the pair of through holes for the frame is formed in an elongated shape curved in an arc shape toward the side of the through holes for the connector.
One of the pair of frames is inserted into one of the pair of frame through holes, the other of the pair of frames is inserted into the other of the pair of frame through holes, and the connector is inserted into the connector through hole. The fixing plate according to claim 1, wherein a margin is provided in the circumferential length of each of the pair of frame through holes so that the tracheostomy tube can be rotated in this state. The connector insertion portion in which the through hole for the connector is formed, the fixing member attachment portion in which the through hole for the fixing member is formed and having a height difference with respect to the connector insertion portion, the connector insertion portion and the said. It is provided with a connecting part for connecting the fixing member mounting part.
The fixing plate according to any one of claims 1 to 4, wherein the pair of frame through holes are formed in the connection portion.

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