SA515360509B1 - Endotracheal tube having outer and inner cannulae - Google Patents

Abstract

The tube apparatus tracheal includes a cannula that includes a first and a second tip. An inflatable cuff is formed on the cannula between the first and second limbs. A conduit extends from the cuff to introduce the inflating fluid into the cuff when the cuff is desired to be inflated, and to remove the inflating fluid from the cuff when the cuff is desired to be removed. A gauge gauge is coupled to indicate the inflation pressure of the cuff in the canal. Figure 1

Description

1 Endotracheal tube includes external and internal canals

Endotracheal tube having outer and inner cannulae FULL DESCRIPTION BACKGROUND This application is based on US application sequence number precedence; 11/191097 deposited in ? Oped 07 which is a partial continuation of US Requisition Sequence Number 44 1"/8858:7 filed at Yo September + .7001 and US VY ANCES Requisition Sequence Number is the same as US Requisition Sequence Number 0 180749/11 FILE DECEMBER YY” 001*now US Patent No. 799751. Inclusions of Discoveries USP No. 4 191097/03 US Patent No. 7099/0851; and USP No. 11 /088574 here for reference This invention relates to improvements in endotracheal tubes eg orotracheal tubes and nasotracheal tubes Ye this invention is directed at the problem of saliva collecting Other secretions around the inflated cuff of the “tracheal” tube, for example; endotracheal tubes, and the possibility of leakage of these secretions past the cuff and into the lungs are the following of interest: US Patents GCM Applec YAY ET 431171 (Ec209¢AAE 64:47 7) 1 Mother Lak Aghaf: 1 p. How many milliliters were rubbed for vinegar 7447 m per ton? Design a mukla lahm halal lah lah lah akht how m mukhif AYA yaaak d richer allam mkk sant oY TM ¢0cTAAY for both active mkv LY voovY 211. Td Yo) YY (RE Love Lav What you eat Lev ay m1 VV eVeE EY YA ¢TVIVYTIY TAY YOU CTVYYAYTY eV sah

Ad — No (Veg 56779 TAY EC US Patent Publications: jee AEA.

JA AY 84 Foreign/International Patent Publications: German 05177 5*?; German 3684)?; Deutsche 970 AY Deutsche 5 .81797/?; German No. 998177871; German 010;international eq [VEYA International 59/17544; International 0/7717 and other such consultations: Quick Reference Guide to Shiley's "Quality-Of Life" Line of Tracheostomy Products, 1991; Granuloma Associated with Fenestrated Tracheostomy Tubes, Padmanabhan Siddharth, MD, PhD, FACS and Lawrence Mazzarella, MD, FACS, Case Reports, vol. 150, August. 1985, p. 279-280; Technical Support Information Connections with the Passy-Muir Tracheostomy and Ventilator Speaking Valves, one sheet; 568 and 572; Tracheostomy Tube Adult | 0 ‎Home Care Guide, Shiley Tracheostomy Products, Mallinckrodt Medical pp. 1-40; D. Hessler, MD, K.

Rehder, MD and S.W.A.

Karveth, MD, "Tracheostomy Cannula for Speaking During Artificial Respiration", Anesthesiology, vol 25, No. 5, pp. 719-721 (1964) and no representation by this list is intended to imply that all material is thoroughly researched for the foregoing field. No better field is available than this note. None of this simulation should be inferred. 0 Findings of all of the above are included here in full by reference. Endotracheal tube apparatus on an outer cannula comprising first and second limbs Fenestration windows are provided with an extension of 0 length of the outer cannula between the first and second limbs An inflatable cuff is formed on the small dl between the windows The second end The first channel extends from the cuff to insert an inflating fluid into the cuff when it is desirable to inflate the cuff and to remove the inflation fluid from the cuff when it is desirable to remove inflation from the cuff.The size of the inner cannula is determined. selectively to be inserted into and removed from the external canal. The internal cannula includes a second channel to evacuate Yo from the user's trachea next to the cuff. The second cannula includes an orifice which is located adjacent to the point nearest the fenestra to the cuff when the inner cannula is inserted selectively in the direction of use in the outer cannula. illustratively; The Lad includes a coupled gauge in the first channel to indicate the inflation pressure of the cuff. 0 7 [+]

Yeh

illustratively; The device also includes a one-way valve at the end of the first channel away from the cuff to prevent inflation fluid from escaping from the cuff.

illustratively; Cuff includes sleeve with oJ end 2nd end; And a third area between the first and second parties. The sleeve is placed around the external cannula with at least one end of the sleeve between

© External cannula and the third area of the sleeve.

illustratively; Both the first and second ends of the sleeve are between the external cannula and the third region of the sleeve.

illustratively; Both the first and second ends of the sleeve are between the external cannula and the third region of the sleeve.

0 illustratively; The apparatus comprises a first coupler fitted on the outer end of the external cannula and a second coupler fitted on the outer end of the external cannula. Both the first and second couplers are provided with at least one overlapping surface to orient the inner cannula in a predetermined direction relative to the outer cannula when the inner cannula is inserted into the outer cannula. illustratively; The Lad has at least one lug provided on an external terminal

15 _ for the external cannula and the internal cannula. At least one lug has an interlocking surface. At least one coupler is provided on the outer end of another one of the outer cannula and the inner canal for engagement by at least one lug. At least one coupler includes a ga to overlap with the interlocking surface to orient the inner cannula in a predetermined direction relative to the outer cannula. illustratively; At least one lug is formed or attached to the said one of the cannula

0 external and internal cannula. Depending on the OAT aspect, the endotracheal tube apparatus includes a cannula with first and second ends. An inflatable cuff is formed over the cannula between the first and second limbs. The channel extends from the cuff to introduce the inflation fluid into the cuff when it is desired to inflate the cuff and to remove the inflation fluid from the cuff when it is desirable to inflate the cuff. A gauge is coupled to the duct to indicate the inflation pressure of the cuff.

YO figuratively; The device also includes a one-way valve at the distal end of the first channel. The one-way valve prevents inflation fluid from escaping from the cuff.

Q

Com

illustratively; The cuff includes a sleeve that includes the first side » the second side; And a third area between

First and second parties. The sleeve is placed around the external cannula with at least one end of the sleeve between

The external cannula and the third region of the sleeve.

illustratively; Both the first and second ends of the sleeve are between the cannula and the third region of the sleeve.

© Brief explanation of the graphics.

The invention may be understood by reference J) The following detailed description and accompanying figures showing

invention. in figures:

1 JSS showing a partial perspective section of the system according to the invention in a deconstructed design;

Figure 1a shows a longitudinal transverse lateral elevation section of the upper airway anatomy of a user with the Ve device shown in Figure 1 in position;

shape? Ble shows a perspective section of the part of the system shown in Figure OV

Figure © showing a perspective section of the part of the system shown in Figure OV

JSS; An enlarged longitudinal sectional lateral elevation section shows a detail of Figs 1 and oF taken in Fig

general along sector lines 4 -; for the shape?; VO fig. © showing an enlarged longitudinal sectional lateral elevation section detailing Figs 1 and oY taken Fig.

General along sector lines 0-0 of shape oY

Figure fo A sectional side elevation section shows an extended length of an alternative cut to the cut shown in

Figure F

Figure 7a-c showing expanded anterior elevation, lateral elevation and posterior elevation sections; respectively, 0 a for details of figures 1, 7 and f

Figures A-E show schematic circuit diagrams of the detail shown in Figures 1A-C

Referring now specifically to figures 1 and 1a; the endotracheal tube system 01 herein includes the system

Endotracheal tube orotracheal tube system on external cannula 11 for insertion through mouth of user vo 10; down throat of user YE pharynx “VE through glottis YY glottis

User 01 and in the trachea of user YA trachea below glottis YY user 01.

Shameless

The external cannula 11 also includes a first port 77 which is located outside the mouth of user 01 during use and a second port YA which is located inside the trachea VA of user 01 below the cuff 11 during use. The cuff 16 is inflatable through channel 0 once the external cannula VY is in position in the trachea VA to limit the passage of secretions TY from the upper respiratory tract © downward In the hepatitis of user .01, these secretions 7 collect above cuff 16 (ie; on the side of the VT cuff opposite the lungs) when cuff 17 is inflated into position. The construction of the cuff 11 in the form of a sleeve $Y Fig. 0 with the upper and lower ends o£ ff respectively (dial) under and not extending behind the cost Jef 116 and below the outer lateral wall of the external cannula VY is aided by the use of Thin-wall material for the VT cuff and in an alternative embodiment; It is indicated in the form fo only 0 that the upper limb ?;' It flexes under rather than extends behind the cuff 16 above the external lateral wall of the external VY cannula. The constructions shown in figures © and fo provide certain advantages which are discussed below. The external cannula VY includes fenestrations 07. Although these two windows 27 are shown; It should be understood that any number of windows 57 can be provided in the outer canal VY for this VO purpose. The construction of the cuff 16 with its double upper and lower extremities in an upper upper and lower extremities ct £7 respectively” (Fig. more towards the user's lungs (Ve on the external NY cannula) and the adjoining of the cuff 16 to window(s) 57 also provides some additional protection for the VA tracheal tissue against irritation and damage caused by contact with window edges (windows) 57 Yo By virtue of the spacing provided by the AT inflated cuff now referring specifically to Figures 1 and © the internal cannula 610 is inserted into the abdominal cavity lumen TY for the external cannula NY and for evacuation Collected secretions 9 oF The ve channel extends down the lateral wall of the internal cannula 60. The ve channel ends at the open end VY in the lower range of the windows 57 to expose the VY secretions to suction at the open end VY of tube 71 Supplied by the VY suction source YO at the outer end of the internal cannula 10. Due to the construction of the cuff 13 with the double end off, this location corresponds to General shape with top cuff 16 in the range MA

For the lower window (dary Lo) of this (co Lay) secretion extraction 7 is more predictable than Lean.

sas), additionally; It is envisioned that replacement of the internal cannula 70 could occur more frequently, with less difficulty, and without as much damage as would accompany replacement of the external OY cannula, which is typically placed in the trachea for a longer duration. stereotypically; Both the outer 0" and inner 10" cannulas are constructed of suitable filled and/or unfilled resin(s) and/or polymer(s). The 7610's inner cannula can be replaced in a relatively straight modular fashion by detaching from the device Ventilator VE ventilator (shown schematically) to which the outer VT end of the inner cannula Te is attached when in use and the inner cannula Te withdrawn from the outer cannula OY because of the relative ease with which the cannula can be removed Inner Te cannulas should be appropriately disposed of and replaced with a new 010 cannula incorporating a new Ve tube Providing the 71 tube on the inner To cannula instead of the outer 11 cannula gives somewhat more reliable effectiveness to the Ve tube than if tube 110 is provided in the cannula 11 which, as indicated, is not typically easily removed for cleaning or replacement. The inner cannula 0 which can be formed with the 001 by one or more clamping lugs (two in the pattern shown) and the VE is formed with the aerator To, to which the Te cannula is attached to the VT cannula, and of the same material; For coupling with surfaces 001 and the lugs Te are provided fixed or fixed with the coupling 776 of the inner cannula 001 the lugs include NY at the proximal end 54 of the outer cannula 018 provide the coupler oT (Sigs) interlocking 0 Coupler 018 on the tooth 114 notch not to receive part of each lug 01 which extends behind the interlocking surfaces 016 and parts 111 to retain the surfaces . 610 with window(s) (57 in Figure 1) of the outer cannula VY When the inner cannula 10 is inserted into the outer cannula AY referring to Figures 1 and oY a digital pressure gauge 016 is inserted Yo in conduit 300 between fitting FY and cuff 16 by means of a WoT fitting fitted on the Tot gauge and fitting 307 designed complementary to fitting on source 07 for compressed air; Jie is a syringe

A

or a suitable combination of Luer conjugation and such combination may be for example; syringe lock assembly Compressed air source in assembly 07? for this purpose. This Assembly 307 may also include an Exhaust Ball Valve (JB) on a one-way valve of a suitable type; eg separating from Fitting 907 once the YoY has been completed allowing the compressed air source oT to inflate The cuff to proper pressure. 11 Inflate the cuff © The schematic and detailed circuit diagram descriptions that follow identify specific integrated circuits and other components and in many cases specific sources for these. Relates to this for purposes of completeness. It must be understood that these terminal and pin identifiers are provided for these specific components. It must be understood that this does not constitute a representation, nor should any such representation be derived so that the components are the component values or the specific resources are the components Only 0's available from the same or other sources are capable of performing the necessary functions.It should also be understood that other suitable components available from the same or different sources cannot use the same terminal/screw IDs as those supplied in this description. In Figures 1a-c the layout of the Feo removed from its housing 700 4 is shown. The scale dV 1b and oY-1a lakshala Figs. 7a-e. As shown in AYE Electron for scale 0 Two digits (seven pieces each) (LCD) liquid crystal display The scale has a liquid crystal display

Glory Sound (Asia) Ltd., AE359 type DS - 10? which is illustratively a display of Figure 01 of the VOY display and with reference to Figures 1b and b; The actuator is 1412684-7. Freescale is paired with an illustration of the semiconductor microcontroller 110950801340117 “+Vbat, +Vbat ' 0 4 ? In Gauge 11 to actuator Vdd, Vreth, Vrefl and Vss 4-1 pins Yo through Vbat + Coil to Vreth Common and Uncommon terminals respectively. The + and - terminals are paired and shared; at +Vbat MHz. And be, 0,8 inductor inductive, coin cell, lithium “dissolve?” volts; 2 PC metal cell in series; For example; nail holder

Renata SA type 614-CR2025FH-MFR - for example metal cell Jie mAH 0 See fig. 1a-c. 17 Ye.

With reference to Figure AB; A parallel combination of a capacitor 3.7 microfary and RAS 001 nanofary is paired via pins 1 and ; for 7011 micro©. The parallel combination YY ESA Farai and capacitor 001 nanoFarae are paired via pins 7 and ©. Pins E - YE are paired terminals PB7/EXTL, PB6/XTL, 85, PB4, PCI, PCO, PB3/AD7, terminals PB2/AD6, PBI/TXD/AD5, 0

PBO/RXD/AD4, PA7, PA6, PA3/AD3, PA2/AD2, PA1/AD1, PAO/ADO, PC7, PC6, Segment LCD, COHM VI Y respectively for PAS/RST , and PA4/BKGD Liquid Crystal Display segment (IF, Sila) LCD segment 16, LCD segment COM, LCD segment 2A, LCD segment, 23; Liquid Crystal Display segment (IE, Liquid Crystal Display widget (1B, Sila Liquid Crystal Display widget,©1; LCD widget ID, Vo Unconnected widget 28; OF, LCD widget 2G, LCD widget ( 1A, for scale NET PRESSure for scale;09; terminal TEMPerature terminal 01 through capacitor 2C 2D segment, ??, liquid crystal display segment; liquid crystal display segment

AVbat and through a resistor 8.4 kOhm to Fe Eula] NanoFray for the common terminal

AVbat and 711 of the YY driver between screw Al and a 7, ? kOhm Vo which is the FT pressure. The pressure at port 2 V is monitored with reference to Figures 7b; 1c and silicone pressure sensor other than 701 pressure sensor; ; through resistor 004 in series in the 6) differential of the non-inverting oF differential amplifier; Pin (+) input terminal 0 kOhm to 01 of terminal 784 + of scale 04 and through resistor “77 amplifier Input terminal (-) reflecting amplifier 377 pin 7. The amplifier is 377 in the form of Illustration A quarter of the octave differential amplifier 1110646414 is of the domestic semiconductor type. To the amplifier 77 of terminal 1 the feedback is provided from the output terminal KOhm screw. The pin ; of the amplifier 001 is coupled through a resistor FYY For inputs - of the amplifier Yo to the common. The parallel combination YYY of the amplifier 11 is paired and the +V bat pin is paired to 77 1nV via +1700 and the common. Pin 001 is paired to the capacitor 7.7 Microvariety and condenser MA

-1.- and terminal FYE is paired with terminal +; © pin of the differential amplifier FYY of the amplifier of the amplifier ;77- Input terminal; FYE of the amplifier 17- Output terminal; YY terminal screw as insulating material for unit gain. The TYE screw oT forged amplifier the screw pictorially forms a quarter of the TYE amplifier of the 1010 scale. The amplifier is NET. Terminal PRESSure octal differential 11406464818 of the domestic semiconductor type. © As thermistor 96 1 kOhm; +961 kOhm +Vbat is paired in series between 01 and resistor “Vishay type 71- 110112061100277 kOhm to terminal 01 and subscriber. And the common terminal of the thermostat is paired 0?? The resistor and the differential amplifier TTY terminal 11 are paired to the pin ob terminal of the inputs

AY to amplifier 77 at amplifier input terminal 377; screw 14 A to output; Pin 0 YY terminal of the VE amplifier as unit gain buffer. The pictorially shaped amplifier YYY pin constitutes a quarter of the amplifier YYY of the scale ;10. The terminal TEMPerature amplifier is N1 octal differential 114064648114 of the local semiconductor type. With reference to the figures

appropriate Jie 4 7; switch for the circuits indicated by switch +Vbat b; f-Snaptron dome switch is supplied with a dome switch 0 for the gauge; 70 Topography can be better understood with reference to figures

YY C; As the relative positions of the assembly can be easily ascertained 707 Lcd =I Gauge configured to be TYE and switch TY 1 Pressure sensor PYF Battery (YY actuator) Reliable and therefore inexpensive in line with Philosophy that the inner cannula 60 is made disposable. 317 0 and fitting vo stall junction T On the other hand, the gauge 304 can be fitted with a connection point with appropriate complementary fittings, so that connection point 1 can be easily separated. remove and reconnect ot and fitting 307 if appropriate to keep gauge 106 between cuff Ye in conduit (use gauge 04 as long as it is sale) and discard inner cannula 20. In these models; It may still be playable. Yo ma

Relay list:

Jl Crystal display i

COM "b" COM1 n_n

CC 02 ny temp re

NET _PRESS and "Vbat" g

Vdd nn ch

Vssnin

Vreth "5"

Vrefl to "

PA7 "for".

PA6"on 2

PAS/*RST "at the same time

J

PA4/BKGD "1 SS

PA3/AD3 en 2 uy a PA1/AD1 nom PAO/ADO "G3"

N.C. "yr

[+]

-17-

PB2/AD6 PB1/TXD/ADS ny fo

PBO/RXD/AD4 "NO

CD 2A Ne!

CD 2B ny yr 01020 1 "U 0121 1"

PCO " "G PC1 Me

PC6 ny Lr

PC7 "1 to VCC ny al for the degree of stagnation is not activated

Claims (1)

ype The elements of the endotracheal tube apparatus include an outer cannula endotracheal tube apparatus 1. The outer fenestration along the length of the external cannula includes the first and second limbs; cannula windows on the inflatable cuff between the first and second limbs; The first cannula conduit and the second end are formed by the inflatable cuff; A fenestration extends between the windows of the outer cannula when it is desired to inflate the cuff inflating fluid to selectively introduce the cuff of the cuff to be inserted into and removed from the nner cannula Determining the size of the inner cannula, the cuff, the first lumen on the inner cannula, and the inner cannula, the couter cannula, includes the outer cannula, the second couff, to evacuate the tracheal region of the user next to the cuff, the second lumen; The cuff is designed for fenestration and the second channel includes an opening which is adjacent to the nearest point in the windows selectively in the direction of use in the inner cannula when the inner cannula is inserted 0 . 1 Include the device according to the first channel. gauge. The cuff Vo gauge is coupled to a one-way valve that also includes a one-way valve. 1 The device according to the protection element LY exits a one-way valve and the one-way valve prevents the end of the first channel away from the cuff The blowing fluid from the cuff in a one-way valve also includes a valve Unidirectional? _— ¢ \ _ Lo the device of claim 1 wherein the cuff includes a sleeve comprising a first limb; a second party” and a third area between the first and second parties; The sleeve is placed around the outer cannula with at least one end of the sleeve between the outer cannula and the third region of the sleeve. 0 +. The device according to the protection element © where both the first end of the sleeve and the second end of the sleeve are between the outer cannula and the third region of the sleeve. LV The device according to the element of protection ¥ where the cuff includes a sleeve that includes a first limb; a second party” and a third area between the first and second parties; The sleeve is placed around the outer cannula Yo with the first tip on | To lower the sleeve between the outer cannula and the third region of the sleeve. LA is the device according to Clause 1, where both the first end of the sleeve and the second end of the sleeve are between the outer cannula and the third region of the sleeve. Vo +. the device according to the element of protection; where the cuff includes a sleeve that includes a first limb; a second party” and a third area between the first and second parties; The sleeve is placed around the outer cannula with at least one end of the sleeve between the outer cannula and the third region of the sleeve. 8 . The device according to Clause 9, where the first end of the sleeve and the second end of the sleeve are 0 between the outer cannula and the third region of the sleeve. 11. The device according to claim 1 comprises a first coupler fitted on the outer end of the outer cannula and a second coupler fitted on the outer end of the couter cannula Both couplers are provided with a coupler The first and the second b one at least then I am angled 0 Yo to direct the inner cannula in the direction of use relative to the outer Laie cannula The inner cannula is inserted into the outer cannula couter cannula 0 7 [+] -M1- and the others for the first and second couplings are provided with an overlapping surface for cooperating with at least one surface to direct the inner cannula in the direction of use relative to the outer cannula -outer cannula NY 0 the device according to the protection element Y Includes a first coupler fitted on the outer end of the outer cannula and a second coupler fitted on the outer end of the couter cannula Both the first and second couplers are provided with at least one surface for guiding the inner cannula inner cannula in the direction of use relative to the outer cannula when the inner cannula is inserted into the couter cannula and the other 0 of the first and second couplings are provided with an overlapping surface for overlapping with at least one surface for guiding the inner cannula inner cannula in the direction of use relative to the outer cannula -outer cannula NY device according to claim; Also includes a first coupler fitted on the outer end of the couter cannula and a second coupler fitted on the outer end of the couter cannula One of the first and second couplers is provided with at least one surface for guiding the cannula The inner cannula is in the direction of use relative to the outer cannula when the inner cannula is inserted into the couter cannula and the other is provided for the first and second couplers with an interfering surface to overlap with one surface on The lower one is to direct the inner cannula in the direction of use relative to the outer cannula. 64. The apparatus of claim 1 also comprises at least one lug fitted on the outer end of the outer cannula and the inner cannula “and at least one lug has an interlocking surface; and at least one coupler is provided on the outer end of another one of the Yo outer cannula and the inner canal for engagement by at least one lug; It includes pus At least one coupler on a part to overlap with the interlocking surface to direct the inner cannula in the direction of use relative to the outer cannula -No device according to Clause 06 where at least one lug is shaped Fixed or © fixed to the one mentioned from the outer cannula and the inner cannula Jinner cannula 1. The device according to the protection element? It also includes at least one lug with an outer end of the cinner cannula and at least one lug having an interlocking surface; and at least one coupler is provided on the outer end of another one of the outer cannula and the inner canal for engagement by at least one lug; At least one coupler includes a part to overlap with the engagement surface to orient the inner cannula in the direction of use relative to the -outer cannula VY device Wy of the VT protection element where the lug is formed tab at least one fixedly or fixed to the said one of the outer cannula and the inner cannula NA endotracheal tube apparatus comprising an outer cannula comprising first and second ends; The first coupler is supplied at the second end of the outer cannula couter cannula Ye inner cannula includes the first and second ends and a second coupler provided at the second end of the inner cannula The size of the the inner cannula to be inserted into; And removing it from the outer canal, an inflatable cuff is formed on the outer cannula between the first and second limbs. The channel extends from the cuff to insert the inflation fluid into the cuff Laie cuff YO It is desirable to inflate the cuff and remove the inflation fluid from the cuff 0 7 [+] " —\y— to indicate the inflation pressure of the cuff gauge and couff gauge When it is desired to inflate the cuff “cuff “conduit into the gauge” the gauge is paired to indicate the inflation pressure of the cuff gauge Gauge and dinner cannula II of the inner cannula coupler At least one lug fitted on the coupler © One tab includes at least a cengaging surface The first coupler includes an engaging surface to receive at least one tab 00 to align the inner cannula Taped in the direction of use relative to the outer cannula -cannula 001 one-way valve It also includes a one-way valve, OA, the device according to the element of protection 4. A fluid exit one-way valve and the one-way valve prevents the couff at the end of the channel far from the cuff from ccuff dependent on the cuff fluid Blowing Ye Yo the device according to the element of protection OA, where the cuff includes a sleeve that includes a first limb; a second party” and a third area between the first and second parties; The sleeve is placed around the outer cannula with at least one end of the sleeve between the outer cannula and the third region of the sleeve. LY) the device according to the element of protection Yo where both the first end of the sleeve and the second end of the sleeve 01 between the cannula and the third region of the sleeve. YY The device according to Clause 16 where the cuff includes a sleeve that includes a first limb; a second party” and a third area between the first and second parties; The sleeve is placed around the outer cannula with at least one end of the sleeve between the outer cannula and the third region of the sleeve. Yo with M \ _ "?. The device according to the protection element YY, where the first end of the sleeve and the second end of the sleeve are between the cannula and the third region of the sleeve. 0 7 [+]" hay al-al ~~ rs 7 i] iN 3 J. Ny — > . ~ SHARE LT Nd Ld NET b 0 a k 8 el 1 no 0 1 b ON id ng x ) Ab Ny <n - Ps any 1 J To TE NG / h 0 { b 1 a l 3 ; “Se CRE } — 7 { = “* 0 a 2 rah l -r 1 2 1 - 1 - - 0! - NV a Fen ; su NW 1 | >” SEIN rg) iy - / 7 7 > the WN name I 7 yaba HT Makki em SN p ham Sl TEs Lk sk ls i for WLS NA N “3 L RIA AL THAI HA 01 TD M 7 LN Iai APA ay 0 Lo . / L J M A YD 27 for ME SE A Sl SEL ; I for J vod gr for Son J) ~- a mmh ss {i (7 TINE 4 < 0 aa * A A $e SX i ad SANG \ 7 it 3 m > 0 o> = 0 fig. 1 0 7 [+] " - Y[a ; / Ji Ie [TT lo pag B pod for ASN and A SU: TT 123 3 ya NY 3 BN 4 NA TT ISA count Say Dodge NSA A NTE m —— h) / i mt RE IT Se EY 3: ra SON 1 4 raz \ \ 1 to 0"! 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