SU1500263A1 - Method of tracheography - Google Patents

Abstract

This invention relates to X-ray diagnostics. The purpose of the invention is to reduce complications. An intubation tube with an inflatable cuff at the distal end and a catheter through a hole made in the wall of the endotracheal tube are inserted into the tracheostomy opening. The endotracheal tube is installed in the trachea so that the end of the catheter is located in the trachea and the proximal end through which the contrast agent is inserted is the outer surface. Prior to the introduction of a contrast agent with a rubber cuff, the lower airways are blocked, the contrast agent is introduced into the trachea independently of the patient's artificial ventilation. The method avoids such complications as hypoxia and allows long-term contrasting of the upper trachea at the level of the lesion.

Description

The invention relates to medicine, namely to X-ray diagnostics, and can be used to diagnose a tracheal sthenetic lesion.

The purpose of the invention is to reduce complications by forming obstacles to the penetration of the contrast agent into the underlying ventilated tracheal and lung sections.

The method is carried out as follows.

Before tracheography, the patient removes the tracheostomy cannula from the trachea and inserts an endotracheal tube into it, selected individually according to the size of the aperture, so that the stoma fits tightly around the tube. The intubadion tube should be fitted with a rubber cuff, or a rubber cuff should be put on before any soft tube. In the intubation tube, on a curved side of it, two inches from each other

holes with a diameter equal to the diameter of the catheter. A catheter is led into the lumen of the tube through the opening (proximal), and the catheter is again pulled out of the distal opening. Thus, the catheter is passed through a tube. The tube is inserted into the stoma in such a way that the proximal opening on it with the inserted catheter remains over the neck, and the distal opening of the tube with the extended end of the catheter is in the lumen of the trachea. At the same time, the catheter is fixed by a tube, in the area of the tracheostomy channel is in the lumen of the tube, therefore, when the catheter advances the wall of the channel, one hundred we are not injured, no gaps are formed in the channel - a stoma, for contrast outflow. At the same time, the catheter can be easily controlled, manipulated, and extended to different levels of the upper tracheal segment, since the catheter, as a punctured needle easily slides through the holes in the tube, is bent freely at an angle as a result of phycoe

tations to the wall of the endotracheal tube. The rubber cuff is inflated in the usual way, air is blown into it with a pear or syringe — methods of inflating and controlling the expansion of the cuff have long been known and widely used in anesthesiology and resuscitation in cases of artificial lung ventilation to ensure tightness of the respiratory tract. The inflatable cuff, lying snugly against the walls of the trachea, delimits the tracheal sections (upper and lower) between each other, preventing the transition of both air and any substances introduced into one or the other departments of the trachea. It is this principle that we use in tracheography, when the mayor becomes a kind of gate, preventing the movement of contasta in the lower respiratory tract and at the same time preserving the lower paths for

ensure adequate ventilation.

Only after all the listed techniques in a certain sequence, namely: the catheter is threaded (like a needle stitch) through the endotrache tube; - on the basement tube (its distal end) wear a rubber cuff if there is no standard tube with a cuff; - the tracheotomy cannula is removed from the patient's stoma and the prepared tube is firmly inserted into the stoma; - the rubber cuff is inflated, the tightness of the lower respiratory tract is checked (the safety of the rubber cuff is checked by the ballooning of the outer part of the cuff). Then, the tracheography itself is started through a catheter, the end of which is placed under the control of X-rays at the required distance, and any contrast agent is injected. The movement of the contrast is monitored under x-ray control at various turns of the head, conical, and the patient's torso is monitored by filling the upper trachea and larynx with contrast. In this case, the speed of advancement of the contrast is controlled both by the speed of the pressure on the syringe syringe, and by giving the body a position down the head end, then the head up. In the process of filling with contrast or with a full tight filling of a segment of the airways by contrast, radiographs are produced in any given projection. At the same time, the patient calmly dies or vents the lungs with a ventilator. Contrast does not flow out through the stoma to the outside, nor does it enter the trachea below the cuff.

Example. Patient E. 10 l. On admission, they were disturbed by a cough with a small amount of mucous sputum and inability to breathe through the mouth. The child is a chronic cannula from the age of one. He was repeatedly treated in hospitals, twice operated on the trachea.

Q 5

0

5 5 0

e

five

0

The general condition of the child is average, not very active, but in physical development it is lagging behind its peers in physical development. It makes good contact. The skin and mucous membranes are pale, respiratory organs: cough wet, small amount of sputum. The chest is of the usual form, both halves equally involved in breathing. Nasal breathing is difficult, breathing through the stoma. voice breathing is the same on both sides. The boundaries of the lungs in the normal range. Auscultation - breathing hard, large bubble moist rales on the right. Heart without features. Preliminary diagnosis: cicatricial stenosis of the trachea. Implemented right under the ringoscopy. The mucous larynx is overexposed, the vocal cords are drawn together, thickened, there is no gap between them. When palpating with a hard suction behind the vocal cords, the tissue is dense. Conclusion: Stenosis of the larynx III degree. Extending it to the trachea is necessary for you to fit with tracheography. A retrograde tracheography was made with a 60% solution of triom-brast with starch. On the tracheogram, in the upper third of the trachea a cone-shaped constriction is determined, ending blindly in the larynx. Contrast material did not penetrate beyond the inflated cuff and was not detected in the bronchial tree. Despite the tight filling, it did not forgive even through the glottis. Radiological conclusion: Stenosis of the trachea of the III degree trachea. Tracheotomy, dissection of trachea and larynx scars, T-tube prosthetics.

This example shows that the application of the proposed diagnostic method allowed us to obtain a complete and accurate picture of the nature of the pathological process, namely, the location, extent and degree of stenosis of the trachea, as well as avoid complications associated with the use of a radiopaque substance, which in tracheography in other ways, as a rule, enters the bronchial tree. The ventilation during the test does not stop.

Thus, the proposed method avoids such complications as hypoxia and provides the possibility of long-term contrasting of the upper trachea at the level of the lesion, regardless of the ventilation of the lower parts of the trachea and lungs.

Claims (1)

Invention Formula The method of tracheography by retrograde introduction of a contrast agent through a tracheostomy, characterized in that, in order to reduce complications, an intubation tube with an inflatable cuff is inserted into the trachea through a tracheostomy opening. 5 1500263 distal end and catheter, held substance, - on the outer surface, with through the holes made in the wall before the introduction of a contrast agent an endotracheal tube, establish an pos-rubber cuff block lower the last one in the trachea so that the end of the catheterious paths and the contrasting substance was located in the trachea, and the proximal end, 5, was inserted independently of the artificial ventilator which introduced the contrast value of the patient.