MX2008001811A - Multilumen tracheal catheter to prevent cross contamination - Google Patents

Abstract

A multilumen tracheal tube (12) or catheter is disclosed. The tube (12) has a plurality of ingress (44) and egress (45) lumens, each having a suction (40) or discharge (41) port as appropriate. At least one rotatable collar (38) is provided. The collar (38) is capable of selecting various combinations of suction (40) and discharge (41) ports without increasing the likelihood of cross contaminating any others .

Description

TRAQUAL CATHETER OF MULTIPLE LUMENES TO AVOID CROSS CONTAMINATION Background The present invention relates to a tracheal tube used for the mechanical ventilation of a patient in the hospital, by inserting the tube into the trachea of the patient. In particular, the present invention relates to a tracheal tube having means for irrigating and / or evacuating contaminated fluids that accumulate above the fold of the tracheal tube and thereby reducing the risk that such contaminated fluids will penetrate the patient's lungs. .

Tracheal tubing involves the insertion of a tubular device, known as a tracheal tube, into the trachea of a patient. The tracheal tube passes through the trachea and terminates in a position above the carina, anterior to a position between the second and fourth thoracic vertebrae. The gases can then be introduced through the tracheal tube and into the lungs of the patient.

The primary purposes of tracheal tubing are to mechanically ventilate the patient's lungs, when a disease avoids breathing induced, normal ventilation of a patient, or to apply anesthetic gases during surgical intervention. In order to create sufficient air pressure to achieve such mechanical ventilation and to prevent the escape of gases past the tube, it is necessary to seal the path around the tracheal tube. A seal can be produced by the use of an integrally inflated fold formed with and surrounding the tracheal tube. When the tracheal tube has been inserted into the patient's windpipe, the fold that is normally inflated may be located about 3 to 5 centimeters above the carina and inside the tube similar to the trachea.

The fold that is inflated is then inflated in order to attach itself to the wall of the trachea and therefore seal the trachea and prevent gases that are introduced through the tracheal tube from simply retracting around the tube. While treatment of this type has proved successful for patients who have acute or chronic respiratory diseases, there is a constant risk of several complications.

In particular, many patients who receive tracheal tubing develop pneumonia, which results from an infection of the lungs, possibly induced by flooded, contaminated fluids that penetrate the trachea and lungs after diverting the epiglottis during tubing. The fluids can then be in the form of saliva, blood, secretions, stomach contents and food, even medications. The epiglottis normally operates as a valve which selectively closes the entrance to the trachea and lungs, to avoid the introduction of secretions and matter into a particle. However, when a tracheal tube is in place, the epiglottis is kept in an open position, and the secretions which normally can be directed away from the trachea and into the digestive system, instead follow the path of the tracheal tube and they float above the fold that inflates from the tracheal tube.

The great risk of such infectious fluids reaching the lungs is the aspiration of these fluids past the fold of the tracheal tube during the episode of mechanical ventilation. An additional risk in particular is when the need for endotracheal intubation ends, the fold that is inflated from the endotracheal tube is deflated so that the endotracheal tube can be removed, the infectious fluids which have accumulated above the fold that is inflated are released and flow freely in the lower airway where bronchitis and pneumonia can develop rapidly. - ' To overcome these risks, it is known in the prior art to combine a simple lumen suction tube with a tracheal tube. The suction tube is attached to the tracheal tube in an appropriate manner, and the end of the suction tube terminates in a position above the fold that is inflated. The suction tube provides the means for suction or evacuation of any waterlogged secretions which accumulate in the trachea above the fold that is inflated. Nevertheless, such devices of the prior art have the disadvantage that using a simple lumen for the suction tube often causes direct suction to be exerted on the tracheal mucosa which then can result in damage to the mucosa.

The patent of the United States of America No. 4,840,173 issued to Porter III, describes an endotracheal tube having a simple lumen suction tube operated thereon. In particular, this patent describes a device in which the suction tube is laminated to the outside of the ventilation tube, so that the suction tube terminates in a position just above the fold that is inflated. The suction tube includes multiple openings which can be used to evacuate secretions which are flooded above the fold that is inflated. Additionally, the fold that is inflated includes a section immediately adjacent to the end of the suction tube that is less flexible than the rest of the fold being inflated, to ensure that the flexible material of the inflating fold is not sucked against the openings of the suction tube. The endotracheal tube described in the Porter III patent has the disadvantages noted above, that the simple lumen suction tube can exert suction on the tracheal mucosa and therefore cause damage to the mucosa. In addition, the Porter III device is of a relatively complex design, which requires difficult processing, resulting in expensive production.

The patent of the United States of America No. ,143,062 issued to Peckham, describes an endotracheal tube comprising a double lumen through which air can be circulated, creating an indirect gentle suction through a suction eye that communicates with the lumen crystals ends, and located in the position next to the fold to inflate. This design, however, does not provide the adequate suction necessary to aspirate secretions and is easily occluded.

The aforementioned patent references fail to adequately deal with the suction of secretions which have puddled above the fold that is inflated in a manner that is sufficient to accomplish the task but is not so strong as to cause damage to the mucosa. Moreover, these references and other conventional tracheal and endotracheal tubes lack the ability to suck both of these secretions, even when a patient is flipped according to nationally instituted decubitus prevention protocols. That is, they fail to provide alternate suction capabilities in the event that the patient is turned over or in the event that the desired suction lumen is occluded by the secretions.

As the above devices fail to describe a tracheal tube and suction catheter system having these structural characteristics, the need for such a device is evident. The instant invention faces this by providing a multiple lumen tracheal tube and a suction catheter system comprising a device that allows the surgical team to directly suck any number of lumens into the tracheal tube.

Synthesis of the Invention The present invention improves on a tracheal tube. In one embodiment, a tracheal tube is provided having a cannula which in turn has a distal end and a proximal end. The cannula has at least one lumen of entry into the cannula that has a suction port, the suction port is located distal to the proximal end. Also, the cannula has at least one exit lumen within the cannula in not in communication with which at least one entry lumen, which at least one exit lumen has a discharge port, the discharge port as well it is located distal to the proximal end. An entry for introducing an externally applied therapeutic agent or method is provided in at least one entry lumen and an exit for fluid discharge is provided from at least one exit lumen. In some embodiments, the cannula is made of at least one first wall and a second wall which is concentric with the first wall. The first wall surrounds and defines a ventilation lumen which is adjacent to a first surface. The first wall is joined to the second surface to a first surface of the second wall by means of at least two divisions. The at least one entry lumen is defined by the second surface of the first wall, the first surface of the second wall, and the first surfaces of the at least two divisions. The at least one exit lumen is defined by the second surface of the first wall, the first surface of the second wall, and the second surfaces of the at least two divisions.In these embodiments, a collar is provided that surrounds the cannula and overlaps each entry and exit. The collar is positioned to selectively enable and disable fluid communication through each lumen between its port and its entrance or exit. In some embodiments, two collars are supplied. A first collar that surrounds the cannula and that overlaps the inlet, and a second collar that surrounds the cannula and superimposes the outlet is provided. Each collar is positioned to selectively enable or disable fluid communication through each lumen between its port and its entrance or exit. An inflating fold that surrounds the cannula at the distal end is also provided. The fold that is inflated is adapted to seal the trachea of a patient, the entrance and exit are close to the fold that is inflated.

In another embodiment, a tracheal tube is provided. The tracheal tube has a cannula having a distal end and a proximal end. A plurality of ingress lumens are provided within the cannula, each having a suction port located distal to the proximal end and a localized entrance proximal to the proximal end. A plurality of discharge lumens are also provided within the cannula, each having a distal port located distal to the proximal end and a localized outlet proximal to the proximal end. Each entry lumen is maintained in non-fluid communication with each exit lumen in order to minimize cross-contamination of any entry lumen with any exit lumen. A selector that manipulates the user is provided to selectively enable and disable fluid flow through at least one entry lumen, at least one exit lumen, or both. The selector that manipulates the user can be a rotating collar that rotates fixed to the cannula that overlaps all of the inputs and outputs. The collar itself may contain a first and a second port through it. The rotation of the collar aligns the first port with the entry of an entry lumen selected by the user while automatically aligning the second port with the output of a corresponding egress lumen. In many embodiments, a guide is coupled to the cannula. The guide overlaps all of the entrances and exits and has openings aligned with each entrance and exit. The collar is rotationally attached to the guide. In each embodiment that has a guide, a tight seal of fluid is supplied between the collar and the guide.

In other embodiments, the selector manipulated by the user is configured as a first and a second rotating collar. Each one is rotating fixed to the cannula, the first collar overlaps all of the entries, and the second collar overlaps all of the outputs. Each collar has at least one port therethrough, wherein the rotation of the first collar is aligned to at least one port with the entry of an entry lumen selected by the user and the rotation of the second collar is aligned to at least one port with the exit of an exit lumen selected by the user. For this incorporation, a guide can be attached to the cannula that overlaps all of the entrances and exits. The guide may have openings aligned with each inlet and outlet, the first and second collar may be rotationally attached to the guide. In alternate embodiments, a first and second guides may be attached to the cannula. The first guide can for example overlap all of the inputs, and the second guide can overlap all of the outputs. Each guide can be supplied with aligned openings with each entry and exit respectively. The first collar may be rotationally attached to the first guide and the second collar may be rotationally attached to the second guide.

At each incorporation the entry lumen can enable the introduction of an externally applied therapeutic agent or method to be introduced into a patient within which the tracheal tube is placed. The exit lumen can enable the suction of fluids from a patient within which the tracheal tube is placed. Additionally, a ventilation lumen can be supplied. In many embodiments, the inlet and outlet lumens may be radially disposed about an outlet diameter of the ventilation lumen. An inflating bend that surrounds the cannula at the distal end adapted to seal the trachea of a patient may also be supplied in many embodiments. The inlets and outlets of the cannulas may be proximal to the fold that is inflated. Moreover, an inflammation lumen can be supplied to selectively inflate and deflate the fold that is inflated.

Other objects, advantages and applications of the present invention may be made clearer by the following detailed description of a preferred embodiment of the invention and the accompanying drawings in which reference numbers refer to similar or equivalent structures.

Brief Description of the Drawings Figure 1 is a diagrammatic illustration of an incorporation of a multi-lumen catheter positioned within a patient according to the present invention; Figure 2 is an isometric view of the multi-lumen catheter Figure 1 in an untapped configuration; Figure 3 is a sectional view of the multi-lumen catheter of Figure 1 seen through an axial centerline of the multi-lumen catheter in order to describe the trajectories therethrough; Figure 4 is a diagrammatic illustration of an alternate embodiment of Figure 1 of the multi-lumen catheter to describe trajectories therethrough; Figure 5 is a sectional view of yet another alternate embodiment of the multi-lumen catheter of Figure 1 seen through the axial center line of the multi-lumen catheter to thereby describe trajectories therethrough; Figure 6 is a partial section through yet another embodiment of the multi-lumen catheter of Figure 1 which describes a possible configuration of the port; Figure 7 is an isometric view of an alternate embodiment of the multi-lumen catheter of Figure 1 in a straightened configuration; Y Figure 8 is a side section of the multi-lumen catheter of Figure 1 seen through the radial midline of the multi-lumen catheter, perpendicular to the description of Figure 3, so as to describe the guide and the collar.

Detailed description Reference may now be made to the drawings in which the various elements of the present invention may be given numerical designations and in which the invention may be described so as to enable one skilled in the art to make and use the invention. It should be understood that the following description is only an example of the principles of the present invention, and should not be observed as narrowing the pending claims. Those skilled in the art will appreciate that aspects of the various embodiments described can be exchanged and modified without departing from the scope and spirit of the invention.

Referring to Figure 1, a tracheal tube 12 is described as extending through the mouth 14 and trachea 16 of the upper respiratory system of a patient 10. The tracheal tube 12 terminates at a distal end 18 well above the point 20 at the first bifurcation of trachea 16 in the right lung 22 through the bronchus of the right main channel 24 and in the left lung 26 through the bronchus of the left main channel 28. The typical sub-branches of the main channel bronchus are shown in Figure 1 for illustrative purposes in relation to the sub-branched bronchus of the left main channel 24 in the left lung 26.

The distal end 18 of the tracheal tube 22 is supplied with a balloon 30 which, when inflated, is attached to the walls of the trachea 16 to facilitate mechanical ventilation of the patient 10 through a connector 32 coupled to a tube adapter standard tracheal 34 at the proximal end 36 of the tracheal tube 12. As will be understood by those of skill in the art, air from the ventilating apparatus for the patient 10 penetrates the tracheal tube 12 through a leg of the connector 32, and correspondingly, the air is returned to the patient ventilation apparatus 10 through a second leg of the connector.

Now looking at Figure 2, a more detailed view of the tracheal tube 12 can be obtained. This view describes the tube 12 in a straightened configuration. A collar 38 is placed in the tube 12. The collar 38 partially rotates through the tube or cannula and provides the user or medical personnel with the ability to select functionalities as will be explained in more detail below.

A plurality of suction ports 40 are provided in disposable locations along the tube 12. In some embodiments, a portion of the suction ports 40 are located above the balloon 30, for example, between the balloon 30 and the proximal end. 36, while another part is located below the balloon 30, for example, between the balloon 30 and the distal end 18. Some embodiments may have suction ports 40 on only one side of the balloon 30. In the same manner, a plurality of discharge ports 41 are also provided in desirable locations along the tube 12. In some embodiments, a portion of these discharge ports 41 are also located above the balloon 30, while another part is located below the balloon 30. Similarly, in some embodiments the discharge ports 41 may be located only on one side of the balloon 30.

As shown in Figure 3, the tube 12 is configured as a cannula with a plurality of internal lumens that extend at least partially along the length of the tube 12. In Figure 3 for example, a ventilation lumen 42 is supplied in the center of the tube 12. Surrounding the ventilation lumen 42 is a plurality of lumens, including the input lumens 44 and the output lumens 45. Many embodiments, such as the embodiment of FIG. 3, contain a plurality of of such lumens 44 and 45 arranged radially around the ventilation lumen 42. A first wall 46 separates the ventilation lumen 42 from the lumen 44 and / or 45. In this embodiment, a second wall 48 forms the outer wall of the tube 12. A plurality of divisions 50 is provided to separate each lumen 44 and 45 from each other. Each of these walls and partitions can be created by extruding the material comprising the tube through an appropriate matrix during the formation of the tube 12 and as such it can effectively be considered as a simple component having a plurality of lumens located in it. In any case, the placement of the lumens in a tracheal tube is a process that can be understood by those of skill in the art.

As seen in Figure 3, additional lumens, for example an inflation lumen 52. The inflation lumen 52 connects the balloon 30 to some means capable of inflating the balloon, thereby keeping the tracheal tube 12 suitably sealed and placed desirably within the trachea 16. As can be seen in this figure, the lumens of income 44 are arranged in a group. In the same way, the 45 egress lumens are arranged in a group as well. This is so that the collar 38 can align an ingress volume 44 with a previously designated and corresponding egress lumen 45. As such, the collar 38 is capable of rotating about 180 ° about the tube 12. A guide 54 can also be provided within each collar 38 and allowed to rotate.

Looking in more detail in Figure 3, it can be seen that there are four lumens of income, designated 44a-d and four corresponding discharge lumens, designated 45a-d respectively. Each of these lumens is diametrically opposite to a corresponding counterpart, that is, lumen 44a is diametrically opposite to lumen 45a, and so on. It should be understood that this labeling only means to illustrate that in this embodiment, for each input lumen 44 there is a corresponding exit lume diametrically opposite one from the other.

Turning now to an alternate incorporation as shown in the cross-sectional view labeled Figure 4, it can be seen that there is a total of six positions on each hemisphere of the tube 12. Each position is designated Pl to P6 respectively. Of course there may be more or less than six positions, the illustrated incorporation simply means to illustrate the concept in principle. Thus, observing each in turn it can be seen that the first position, or Pl, contains the inflation lumen 52 and no corresponding lumen of ingress or lumen discharge 44 or 45 respectively. P2 contains the 45d egress lumen but no corresponding entry lumen. The positions P3, P4, and P5 each contain a corresponding input lumen 44a and 45a, 44b and 45b, and 44c and 45c respectively. P6, similar to Pl, contains an entry lumen 44d, but no corresponding exit lumen.

Figure 5 illustrates a partially cut-away view of the embodiment of Figure 4. In this figure, the collar 38 is also described, and together with the following description should be apparent to one skilled in the art of as in the manner in which which the device works. As shown, the entry and exit lumens 44 and 45 are arranged radially around the ventilation lumen 42. Each entry lumen 44 contains an entry 56, while each exit lumen 45 contains an exit 58. The collar 38 has a dedicated conduit 60 for the intake lumens 44 as well as a second dedicated conduit 60 for the discharge lumens 45. Each conduit 60 is used to pass fluids in patient 10 via lumens of admission 44, or to extract fluids from the patient. Patient 10 via the discharge lumens 45. Each conduit has a path 62 that extends from a point adjacent the second wall 48 to a distal point of the second wall. Rotating the collar 38 around the tube 12 selectively aligns the path 62 within each conduit 60 with a specific lumen 44 and its corresponding exit lumen 45 thereby enabling the flow in or out of the specific lumen as appropriate so that it can achieve its function in intention.

Observing in each position, Pl to P6, provides one with better understanding of this particular embodiment of the invention. It can be seen that rotating the collar 38 so that the paths 62 in the conduits 60 are placed in Pl effectively occludes both trajectories 62, and as such, no flow in or out of the cannula can be carried out. Turning the collar 38 so that the paths 62 in the conduits 60 are placed in P2 aligns one of the paths 62 with an egress lumen 45, in this case the egress lumen 45d. The second path 62 is however occluded and not aligned with an input lumen. This position enables the operator or medical personnel to suction fluids from patient 10 without losing suction by having an open path through an entry lumen 44. Turning collar 38 to any of positions P3, P4, or P5 aligns trajectories 62 in conduits 60 with; the input lumen 44a and an egress lumen 45a, the input lumen 44b and the egress lumen 45b, and the input lumen 44c and the egress lumen 45c respectively. Any of these orientations enables the operator to introduce fluids into the patient's respiratory system and to suck them out during the same operation. For example, the operator may wish to introduce an antimicrobial solution to reduce the potential for infection. In such instances it may be desirable to introduce the fluid and to suck it out in a relatively short period of time. P6 aligns one of the trajectories 62 with an entry lumen 44, in this case the egress lumen 44d. The second path 62, however, is occluded and not aligned with an egress lumen. This position enables the operator or medical personnel to introduce fluids, such as the medicament, into the patient 10 without immediately sucking the medicine out of patient 10. It can be seen in the illustration of figure 4 that the movement of the collar 38 over the Pl to P6 positions achieves a partial revolution around the tube 12 of approximately 180 °.

The above description provides for a completely occluded position, Pl, a suction only in the position, P2, and an introduction only in the position, P6, respectively. It should, however, be understood that the devices themselves that effect the suction and / or the introduction of fluids are not part of the invention and therefore are not described. However, each of these devices will possibly be provided with means to enable or disable them. Additionally, it is not necessary that such devices be connected to either or both of the conduits 60. As such, the fluid flow through any of the lumens can be independently controlled by the devices that are connected to either of the two conduits, without taking into account the function in intention of the specific lumen. Through this, the embodiment described in Figure 3 is capable of a non-fluid position, a suction only in position, and / or a discharge only in position.

Still another alternate embodiment as shown in Figure 6 will enable a 360 ° rotation of collar 38 around tube 12. In this embodiment, collar 38 contains a single conduit 60 having paths 62a and 62b spaced therethrough. These trajectories 62a and 62b are illustrated as being side by side and adjacent to each other, separated by a divider 64. However, other arrangements such as coaxial are also contemplated. In any case, trajectories 62a and 62b are aligned with lumens 44 and 45 respectively. Unlike the incorporations of figures 3 and 4 which diametrically oppose the input lumens 44 with the discharge lumens 45 / this incorporation of the placed even arrays which are repeated around the circumference of the tube 12. An advantage of this Incorporation is that the irrigation or introduction of fluids can be done in close proximity to the suction if this is desirable or necessary and if the ports 40 and 41 are close to one another.

Figure 7 describes yet another embodiment. In this embodiment, the input lumens 44 and the exit lumens 45 can be arranged in any appropriate configuration, including those shown in Figures 3, 4, and 6. In this embodiment, however, a second collar is provided 39 A collar, for example, the collar 38 is adapted to align only with the inputs 56 of the input lumens 44 while the collar 39 is adapted to align only with the output 58 of the input lumens 45. Otherwise, the collars 38 and 39 as well as the lumens 44 and 45 operate in exactly the same manner as those previously described.

It should be noted that any of the embodiments described above, by rotating the collar 38 and / or 39 in a desired position, the user or medical personnel is provided with a selection means to which to add or suction fluids from the patient 10. In some embodiments, the trajectory or trajectories 62 within the collar 38 can be configured to access more than one lumen 44 or 45 simultaneously.

Finally, observing Figure 8, a partially cut away view normal of Figure 3 describes the internal configuration of an embodiment of the collar 38 for additional clarity. This view describes the tube 12, the ventilation lumen 42, an intake lumen 44a separated from the ventilation lumen by the first wall 46 and joined on the opposite side by the second wall 48. In the same way the corresponding exit lumen 45a is likewise described. This is also separated from the ventilation lumen by the first wall 46 and joined on the opposite side by the second wall 48. As is evident, the inlet 56 can be clearly seen as forming a path through the second wall 48 in the input lumen 44a while output 58 can be clearly seen as forming a path through the second wall 48 in the egress lumen 45a. The details can be observed with respect to the guide 54 as well as the collar 38. As can be seen, in some embodiments, the guide 54 is secured to the tube 12 such that the rotational movement of the guide with respect to the tube is prevented. Appropriate measures must be taken to ensure that the collar 38 is able to rotate with respect to the guide 54. For example, an interface with flange 66 may be used between the two components. Such an interface must be tight to the fluid so as not to enable the drip of air in the system when it is sucked or to have fluid dripping from the system into the environment. As such, those skilled in the art should understand and be able to provide a tight seal to the proper fluid in those areas.

During use, collar 38 and 39, if supplied, may be turned to the desired position. An indicator 68, for example, may be provided as one described in Figure 3. An indicator may enable a user to appropriately align path 62 within conduit 60 with the desired lumen. As such, with indicator it can be supplied which corresponds to each lumen. Instead of or in addition, the collar 38 can be made to incrementally click, close, or tighten in each position. This can be achieved by any number of means known to those skilled in the art. As can be seen from the figures and the detailed description each lumen is designed to operate in only one direction. This is to avoid cross-contamination of the inlet lumens with the discharge lumens as well as to minimize the need to prevent any of the lumens from flowing, thus preventing the reintroduction of contaminants that line any particular discharge lumen. Additionally, in some embodiments, a one-way valve (not shown) may be included, in the entry path, the egress path, or both in order to avoid such cross-contamination.

As used herein and in the claims, the term "comprising" is inclusive or open-ended and does not exclude additional non-recited elements, compositional components, or steps of the method.

While several patents have been incorporated herein by reference, to the extent that there is any inconsistency between the embodied material and that of the written specification, the written specification shall prevail. Additionally, while the invention has been described in detail with respect to the specific embodiments thereof, it may be apparent to those skilled in the art that various alterations, modifications and other changes can be made to the invention without departing from the spirit and of the scope of the present invention. It is therefore intended that such claims cover such modifications, alterations and other changes encompassed by the appended claims.

Claims (18)

R E I V I N D I C A C I O N S

1. A tracheal tube comprising: a cannula having a distal end and a proximal end; at least one lumen of entry with the cannula having a suction port, the suction port located distant from the proximal end; at least one exit lumen with the cannula in a non-communication with at least one entry lumen, the at least one exit lumen having a discharge port, the localized discharge port distant from the proximal end; an entry for introducing an externally applied therapeutic agent or method into at least one entry lumen; Y an exit for the discharge of fluids from at least one exit lumen.

2. The tracheal tube as claimed in clause 1, characterized in that the cannula comprises a first wall and a second wall concentric to the first wall, the first wall surrounds and defines a ventilation lumen adjacent to a first surface, the first wall being joined on a second surface to a first surface of the second wall by at least two divisions, the at least one entry lumen being defined by the second surface of the first wall, the first surface of the second wall and the first surface of at least two divisions, and the at least one exit lumen being defined by the surface of the first wall, the first surface of the second wall, and the second surface is of at least two divisions.

3. The tracheal tube as claimed in clause 1, characterized in that it comprises any of a plurality of output lumens, input lumens or both.

4. The tracheal tube as claimed in clause 1, characterized in that a ring surrounds the cannula and overlaps each inlet and outlet, the ring being positioned as to selectively enable and disable fluid communication through each lumen between its port and your entry or exit.

. The tracheal tube as claimed in clause 1, characterized in that it comprises a first ring that surrounds the cannula and overlaps the entrance and a second ring that surrounds the cannula and overlaps the exit, each ring being placed as to selectively enable and disable Fluid communication through each lumen between its port and its entrance or exit.

6. The tracheal tube as claimed in clause 1, characterized in that it comprises an inflatable cuff surrounding the cannula at the distal end, the inflatable cuff adapted to seal the trachea of a patient, the entrance and exit being close to the inflatable cuff .

7. A tracheal tube comprising: a cannula having a distal end and a proximal end; a plurality of lumens of entry into the cannula, each having a localized suction port distant from the proximal end and a localized entrance proximate to the proximal end; a plurality of output lumens within the cannula, each having a localized discharge port distant from the proximal end and a localized outlet proximate to the proximal end; each input lumen is maintained in a non-fluid communication with each output lumen, to minimize cross-contamination of any input lumen with any output lumen; a selector that can be manipulated by the user to selectively enable and disable the flow of fluid through at least one of an entry lumen, one of an exit lumen, or both.

8. The tracheal tube as claimed in clause 7, characterized in that the selector that can be manipulated by the user comprises a rotating ring fixed rotatably to the cannula and overlapping all the entrances and exits, the ring comprises a first and a second port through it, wherein the rotation of the ring aligns the first port with the output of an entry lumen selected by the user while automatically aligning the second port with the exit of the corresponding exit lumen.

9. The tracheal tube as claimed in clause 7, characterized in that it comprises a guide coupled to the cannula overlapping all the inlets and outlets, the guide having openings aligned with each inlet and outlet, the ring is rotationally attached to the guide.

10. The tracheal tube as claimed in clause 9, characterized in that it comprises a fluid-tight seal between the ring and the guide.

11. The tracheal tube as claimed in clause 7, characterized in that the selector that can be manipulated by the user comprises a first and a second rotary rings each fixed rotatably to the cannula, the first ring overlaps all the entrances and the second The ring overlaps all the outlets, each ring having at least one port therethrough, wherein the rotation of the first ring aligns at least one port with the entry of an entry lumen selected by the user and the rotation of the second ring aligns at least one port with the exit of an exit lumen selected by the user.

12. The tracheal tube as claimed in clause 11, characterized in that it comprises a guide coupled to the cannula that overlaps all the inlets and outlets, the guide having openings aligned with each inlet and outlet, the first and second rings rotationally fastened to the guide and comprising a fluid-proof seal between each ring and the guide.

13. The tracheal tube as claimed in clause 11, characterized in that it comprises first and second guides coupled to the cannula, the first guide overlaps all the inlets and the second guide overlaps all the outlets, each guide having the openings aligned with each inlet and outlet respectively, the first ring rotationally attached to the first guide and comprising a fluid-tight seal between the ring and the guide, the second ring rotationally fastened to the second guide and comprising a fluid-tight seal between the ring and the guide.

14. The tracheal tube as claimed in clause 7, characterized in that the entry lumen allows the introduction of an externally applied therapeutic agent or of a method to be introduced into a patient within which the tracheal tube is placed.

15. The tracheal tube as claimed in clause 7, characterized in that the exit lumen allows the suction of the fluids from a patient within which the tracheal tube is placed.

16. The tracheal tube as claimed in clause 7, characterized in that it comprises a ventilation lumen, the inlet and discharge lumens being positioned radially around an outside diameter of the ventilation lumen.

17. The tracheal tube as claimed in clause 7, characterized in that it comprises an inflatable cuff surrounding the cannula at the distal end, the inflatable cuff is adapted to seal the trachea of a patient, the entrances and exits being close to the inflatable cuff , and each inflation lumen to selectively inflate and deflate the inflatable fist.

18. The tracheal tube as claimed in clause 17, characterized in that any of the inlet and outlet can be selectively occluded alone or in combination. SUMMARY A multiple lumen tracheal tube or catheter is described. The tube has a plurality of ingress and discharge lumens, each having a suction or discharge port as appropriate. At least one rotating ring is provided. The ring overlaps each port and is capable of selecting various combinations of suction and discharge ports without increasing the possibility of cross-contamination of any other.