US2873742A - Surgical instruments - Google Patents

Description

c. H. SHELDEN 2,873,742

Feb. 17, 1959 SURGICAL INSTRUMENTS 3 Sheets-Sheet 1 Filed July 14, 1954 INVENTOR CHARLES HUNTER SHELDEN BY 7M7 AM ATTORNEY Feb.'17, 1959 c. H, SHELDEN 2,873,742

\ SURGICAL INSTRUMENTS Filed July 14. 1954 v '3 Sheets-Sheet 2 INVENTOR 27 49 a9 32 37 CHARLES HUNTER SHELDEN 9 ATTORNEY Feb. 17, 1959 Filed July 14, 1954 C; H. SHELDEN SURGICAL INSTRUMENTS 3 Sheets-Sheet 3 I INVENTOR CHARLES HUNTER SHELDEN ATTORNEY SURGICAL INSTRUMENTS Charles Hunter Shelden, Pasadena, -Calif.,- assignor to Research Corporation, New York, N. Y., a corporation of New York Application July 14, 1954, Serial No. 443,275

Claims. (Cl. 128-305) The present invention relates to surgical instruments and more particularly and specifically to new and improved instruments and techniques for their use in tracheotomy.

The instruments used and the general technique of tracheotomy have been substantially standardized for a half century or more without benefit of improvement. This continued medical acceptance of the prior standardized instruments and techniques of tracheotomy has undoubtedly been occasioned by the fact that such practice has proved amply satisfactory heretofore for elective operative tracheotomy for relief of chronic tracheobronchial obstructions. 1

However, these standardized procedures have several serious and important disadvantages which are evidenced by the fact that the accepted tracheotomy procedure generally requires for its performance complete hospital facilities and a complete set of surgical instruments in addition to a considerable amount of operation time.

It has been discovered that emergency treatmentby way of atrahceotomy would furnish an important and often life-saving function in, the case of numerous forms ofhead and facial injuries.

For example, the internal bleeding caused by jaw and facialbone fractures, tissue lacerations in the face, mouth and pharynx, and spinal fluid escaping from skull fractures, often gravitate into the tracheobron-chial tree to cause obstructions to respiration. These obstructions alone can often be fatal in caseswhere injured persons have become sufficiently comatose to havelost their natural protective gag reflexes whereupon they are choked or drowned in their own secretions. 1

By the sametoken, obstruction or partial obstruction of the bronchial tree may result, often fatally,in secondary cerebral anoxia and in cerebral edema caused by accumulated carbon dioxide.

,In such emergency conditions as above noted it becomes immediately necessary to aspirate the air passages of the injured person of all foreign'matter, to provide a continuous supply of oxygen to the air passages and to prevent cerebral anoxia and accumulation of carbon dioxide.

While occasionally nasal aspiration can be successfully accomplished, tracheotomy is a sure and completely beneficial treatment for such conditions, and the complexities and extreme requirements of the present tracheotomy procedures have heretofore prevented the use of tracheotomy under emergency conditions.

It is therefore a general object of the present invention to provide instruments for tracheotomy and techniques for their use which overcome and eliminate all those disadvantages inherent in prior tracheotomy procedures, and which greatly simplify and improve these prior procedures. It is another object of the present invention to provide instruments and techniques which permit the safe and rapidperformance of tracheotomy under emergency con; ditions by semi-skilled practitioners. a

2,873,742 Patented Feb. 17, 1959 It is a further object of the instant invention to provide instruments for tracheotomy which provide all necessary equipment to the successful and safe performance of tracheotomy under emergency conditions by semi-skilled practitioner which instruments may be carried together with general emergency equipment to be readily available and usable at those times and places where emergencies are likely to occur.

Still another object of the instant invention is the provision of an improved needle and retractable barb pin which are quickly and easily employed for the purpose of transfixing the trachea to elevate and prevent lateral movement of the trachea during the subsequent placement of the tracheotomy tube.

Yet another object of the instant invention lies in the provision of an improved needle employed for the purpose of making an initial opening through the skin and into the trachea and to serve as a means of introducing a new and improved trocar into the trachea in advance of a new and improved tracheotomy tube associated therewith.

It is still another object of this invention to provide a new and improved cutting trocar for providing a proper opening into the trachea for the insertion conjunctively therewith of the new and improved tracheotomy tube.

It is another object of the instant invention to provide a new and improved tracheotomy tube construction for associated use with a new and improved cutting trocar to be inserted and positioned with its distal end within the trachea and with its'proximal end located externally of the skin thereby providing an artificial air passage into the trachea.

It is still a further object of the present invention to pro vide operative instruments of the type heretofore set forth which are of relatively simple, inexpensive design and manufacture and which are capable of safe and effective use by semi-skilled practitioners for the ready performance of emergency tracheotomy.

Still further objects of the present invention will become readily evident to those skilled in the art in the light of'the following general statement and in view of the description and appended drawings.

. The nature of the present invention may. be stated in general terms as including instruments'for tracheotomy including a needle for making an opening into the lumen of the trachea, an elongated pin movable within the needle, a retractable barb on said pin engageable with the lumen of the trachea through an aperture in the needle for purposes of transfixing the trachea, a second longitudinally slotted needle for introductioninto the lumen of the trachea at a spaced distance from said first needle, a cutting trocar having a leading end engageable and movable within said needle slot for introduction into the treachea and for producing 'a prescribed incision thereinto, and a tracheotomy tube telescopically engaged over said trocar for movement thereon through said incision into the trachea.

Referring now to the accompanying drawings in which like numerals indicate similar parts throughout the several views:

,Fig. 1 is a side elevation of the transfixing needle;

" Fig. 2 is a side elevation of the barbed pin;

Fig. 3 is a partial vertical section of the needlewith the barbed pin illustrated in a retracted position;

Fig. 4 is a side elevation in partial section of the needle with the barbed pin in extended transfixing position;

7, Fig. 5 is a front elevation of the trocar introducing needle;

Fig. 6 is a side elevation in partial section of the tracheotomy tube with the trocar in extended position therein;'

Fig. 7 is a top plan view of the construction illustrated Fig. 8' is a sectional view of the cutting trocar and tracheotomy tube taken on'line 88* of Fig. 7;

Fig. 9 is a partial view showing the transfixing needle and pin in holding position with the trocar introduction needle in place and the'trocar engaged therewith prior to insertion;

Fig. 10 is a pictorial sectional elevation of the trachea with the transfixing needle and pin' in lumen elevating position and with the trocar introduced into the trachea and with the tracheotomy tube at an intermediate position of insertion into the trachea in association with the trocar; and

Fig. 11 is a pictorial elevation in partial section of the trachea with the tracheotomy tube shown in final fixed position.

Apparatus With reference to Figs. 1, 3 and 4 there is illustrated therein a trachea transfixing needle 1%) which includes an elongated tubular shaft 11 being atfixed at one end thereof in a collar member 12 which in turn is provided with an extended shank 13 for insertion within the boss 14 of a knurled handle member 15 wherein it is removably secured by means of a set screw or the like 16, which also serves as guide pin for groove 27 to be described later. The extended or distal end of the needle shaft 11 terminates in an off-center point construction 17 to provide a sharp extremity for ready insertion through the skin and into the lumen of a trachea A.

At a spaced distance upwardly of the needle shaft 11 from the pointed end 17 there is provided a slotted opening 18 in the tubular wall of the shaft for cooperative function with a holding pin to be hereinafter described. At the same time, there is provided upwardly from the uppermost end of the needle shaft 11 through the collar 12, the shank' 13, the boss of the handle 15 and the handle proper a circular passage 19 providing aligned communication from a point above the handle with the distal end of the needle shaft.

Referring now to Figs. 2, 3 and 4 there is shown therein a holding or transfixing pin 20 which includes an elongated pin bar 21 terminating at its extreme distal end in an off center tapered point 22 at the angle of needle taper 17 and serves to fill needle opening during insertion into trachea, and being fixed at its upper proximal end in a boss 23 of a knurled handle member 24 wherein it is removably secured by means of a set screw 25 or the like. Along the upper part of pin 20 is a groove 27 parallel to the pin shaft which coacts with screw 16 in Fig. 1, and aligns barb 26 with slot 18 of the needle during insertion as shown in Figs. 3 and 4.

Immediately rearward from the distal point 22 of the pin 20 the pin is provided, preferably by means. of a portion being partially severed therefrom longitudinally of the shaft 21, with a retractable resilient barb 26 which offers obstruction to the pin movement in the direction away from the distal point thereof and which is tracted by compression thereof within the hollow of the needle shaft 11 of the needle 10 to permit the pin to be moved through the needle shaft until the resilient barb thereon comes into coincidence with the cut-out slot in the shaft whereupon the barb will spring outwardly through the opening, as best seen in Fig. 4, to protrude beyond the wall of the needle shaft 11 and offer resistance to the retraction of the needle and the pin from a fixed position within the trachea A, as shown in Fig. 10.

Referring now to Fig. 5 there is shown a second needle construction 27' which includes an elongated tubular needle shaft 28 terminating in a tapered off-set point 29 at the distal end thereof, the upper proximal end of the needle shaft being removably secured within the boss 30 of a handle member 31.

A straight slotted opening 32 of constant width is. provided from the extreme distal end of. the needle shaft 28 longitudinally of the shaft to terminate in an enlarged 7 oval opening 33 in the wall of the shaft at a point closely adjacent the'boss 30' of the needle handle.

With particular reference to Figs. 6 through 8 there is seen a cutting trocar and a silver tracheotomy tube associated therewith. The trocar generally designated at 34 consists of an elongated arcuate shaft 35 which carries a spool-like handle. 36 at one extremity thereof and the second and distal extremity of the trocar shaft 35 is provided with an enlarged head portion 37 which serves to support in a forward longitudinal direction an elongated arcuate double-edged cutting blade 38 which tapers in width from its greatest lateral measurement where it projects outwardly from both sides of the enlargement 37 to a point on its extended distal end 39 which point is provided with a small. ball tip 40 secured thereto. A second cutting blade 41 is carried by the enlarged head portion 37 in a perpendicular upward relationship relative to the cutting blade 38 to extend for a spaced distance along the length of the blade 38, the blade 41 having a rounded or arcuate upper cutting edge 42 defining a convex configuration between the enlarged head portion 37 and the extreme distal end of the blade.

The trachoetorny tube generally designated at 43, and best illustrated in Figs. 6 through 8 in association with the cutting trocar 35, includes an elongated, arcuate can.- nular tube section 44 being provided at its upper proximalend with a cup-like head member 45 having a central flange 46 about the tubular opening therein for abutment with the handle portion 36 of the cutting trocar 35', and said cup-like head member 45 being provided with means 47 for coupling hose or like tubular sections thereto for introduction of oxygen and the like into the mouth of the tube;

The extended distal end of the tracheotomy tube 44- terminates' in a divided tapered wall arrangement providing a short slot 48 extending longitudinally of the tube in the center of the normal top wall thereof for the telescopic reception therein of the upper cutting blade 41 of the trocar, and a pair of slotted passages. 49 in diametrically opposed positions in the sides of the tubular wall for the telescopic reception therein of the side portions of the base or proximal end of the elongated cutting'blade38 of the trocar. The distal end of the tracheotomy tube is open and is tapered slightly from the normal upper wall portion thereof forwardly and downwardly to the normal lower wall portion thereof.

With reference to Fig. 6 it can be seen that the arcuate configuration of the cannular tracheotomy tube 44 is substantially similar to the arcuate configuration of the trocar whereupon the tracheotomy tube is telescopically engageable over the trocar entering upon the same from the distal end of the trocar to bring the central flange 46 within the cup-shaped head 45 of the tube into abutment with the distal side of the trocar handle 36. At the same time the enlarged head portion 37 on the trocar is of such a size as to permit it to move freely within the tracheotomy tube and to assume a partially inset position within the open tapered distal end of the tube with the knife members 38 and 41 thereon properly aligned and engaged in the slotted passages 48 and 49 in the wall of the tracheotomy tube at the distal end thereof.

In this manner, the trocar and the tracheotomy tube are substantially rigidly assembled as a single unit prior to the initial movement of the tube over the trocar for insertion into the trachea.

Techniques of use In performance of a tracheotomy utilizing the instruments heretofore described the patient is placed in a supine position with the head hyperextended: as generally illustrated pictorially in Fig. 9. When the trachea A has been located the needle 11 with. barbed. pin in the retractedv position. as shown inFig- 3 is inserted; After insertion of needle and barbed pinthrough the-skin and into the lu'rn'en of the trachea, the barbed pin is forced outward through the needle until the end of the bark protrudes through the needle notch 18 whereupon traction is applied to the needle to bring the barb 26 into contact with the inside of the trachea, as illustrated generally at 50 in Fig. 10, whereupon the trachea is elevated and transfixed against lateral movement.

While traction is exertedto maintain the trachea in an elevated position as described, the needle 27 is introduced into the trachea lumen through the skin at a point about two centimeters distance from the needle 10. When the needle 27' is positioned to extend into the trachea, the ball tip 40 on the extended end of the trocar 35, which trocar is positioned at this time within the silver tracheotomy tube 44 in the position illustrated in Fig. 6, is introduced into the oval opening 33 in the slot 32 in the wall of the needle 27' in the manner generally shown in Fig.9. Pressure is then exerted upon the trocar to move the tapered cutting blade 38 downwardly along the needle 27' whereupon it is guided into proper contact with the skin to form upon continued insertion an incision into the trachea, the cutting blade 41 subsequently making an additional right angular incision to that made by the blade 38 when the blade 41 comes into contact with the skin. When the ball tip 40 has reached a point within the trachea the needle 27' is withdrawn to permit the continued insertion of the cutting trocar and the continued insertion of the tracheotomy tube which will easily enter into and pass through the tracheotomy type incision made by the cutting blades 38 and 41 of the trocar.

When the tracheotomy tube has been inserted well into the trachea, the cutting trocar is removed and the tracheotomy tube is then completely inserted until head portion 45 thereof is in contact with the skin as illustrated in Fig. 11, leaving the tracheotomy tube properly positioned to provide an artificial air passage into the trachea.

Once the tracheotomy tube has been positioned it is possible to strap the same'in place around the back of the neck of the patient by means of a belt strap secured in the opposed slots 51 formed in the head 45 of the tracheotomy tube.

It is extremely important to note the arcuate configuration of the cutting trocar and the tracheotomy tube which properly position the tracheotomy tube within the trachea without irritating contact with the posterior wall thereof. It should be additionally noted that the ball tip 40 on the extended end of the arcuate trocar prevents any irritation or damage to the posterior wall of the trachea while the trocar is being inserted for the purpose of making an incision for the subsequent insertion of the tracheotomy tube.

From the foregoing description it now becomes readily evident that new and improved instruments and techniques for their use in the performance of tracheotomy have been provided which satisfy all those objects and advantages heretofore set forth. It is to be understood and recognized that certain terms have been used in the foregoing description for the purpose of brevity and clearness of understanding and no unnecessary limitations are to be implied therefrom as they are to be broadly construed.

Having now described the invention, the construction and operation of the preferred embodiments thereof illustrated herein by way of example only, the advantageous new and useful results obtained thereby, the invention is hereinafter set forth in the appended claims.

I claim:

1. Surgical instruments for tracheotomy including in combination a tubular guide needle provided with a longitudinal guide slot in the wall thereof from a point adjacent the proximal end thereof throughout its distal end, said needle adapted for insertion into the trachea, a cutting trocar including an arcuate shaft provided with a plurality of angularly disposed cutting knives and a ball tip on the extended distal end thereof, said ball tip being releasably engaged in the guide slot of said needle for-movement therein to permit said knives to make an incision into the trachea, and an arcuate cannular tracheotomy tube telescopically releasably engaged over the distal end of said trocar to be positioned adjacent the proximal end thereof, and said tube being movable on said trocar to bring the distal end of said tube into an inserted position through said trocar incis ion within the trachea.

2.-'Surgical instruments for tracheotomy including in combination a tubular needle provided with a guide slot in the wall thereof extending from the distal end to terminate in an enlarged opening adjacent the proximal end of the needle, a cutting trocar including a handle portion supporting an elongated arcuate shaft terminating -'at its distal end in an enlarged head portion, a plurality of angularly disposed cutting knives carried by the enlarged distal head portion of said trocar, one of said cutting knives extending arcuately forward and being provided with a ball tip on the extended end thereof, said ball tip being releasably engaged in the guide slot of said tubular needle for movement therein to permit said knives to make an incision in the trachea, and a cannular tracheotomy tube of an arcuate configuration substantially like that of said trocar, said tube being telescopically releasably engaged over the distal end of said trocar to abut the handle portion of said trocar and locate the distal end of said tube on the proximal side of said enlarged head portion of said trocar.

3. Surgical instruments for use in tracheotomy for the purpose of making an incision in the trachea for receiving a tracheotomy tube including in combination a tubular needle provided with a guide slot opening through the wall thereof and extending from the distal end to terminate in an enlarged opening adjacent the proximal end of the needle, and a cutting trocar including a handle portion supporting an elongated arcuate shaft terminating in an enlarged head portion at the distal end thereof, a plurality of right angularly disposed cutting knives carried longitudinally of the enlarged distal head portion of said trocar, one of said knives extending arcuately forward from said head portion and being provided with a ball tip on the extended end thereof,

' said ball tip of said trocar being releasably engaged for movement within said guide slot of said tubular needle, whereby said trocar is movable along said needle to enter the initial opening made by said needle and bring the cutting knives thereof into incision-making contact for providing an incision into the trachea.

4. Surgical instruments for use in tracheotomy for the purpose of making an incision in the trachea and aflixing an artificial airway therein including in combination a tubular needle provided with a guide slot opening through the wall thereof and extending from the distal end to terminate in an enlarged opening adjacent the proximal end of the needle, and a cutting trocar including a handle portion supporting an elongated arcuate shaft terminating in an enlarged head portion at the distal end thereof, a plurality of right angularly disposed cutting knives carried longitudinally of the enlarged distal head portion of said trocar, one of said knives extending arcuately forward from said head portion and being provided with a ball tip on the extended end thereof, said ball on said cutting knife being releasably engaged with and slidable within the guide slot in said tubular needle, and a cannular tracheotomy tube of an arcuate configuration substantially like that of said trocar, said tube being provided with a cup-like head member surrounding its proximal end and a tapered configuration at its distal end, said tube being telescopically releasably engaged over the distal end of said trocar to bring the head portion thereof into abutment with the handle portion of said trocar and locate the distal end of said tube on the proximal. side; of .said;enlargedsheadipor? tion of the'trocar, whereby the. tubular needle-:may'bezinserted into the. trachea and whereupon the. balli. tip on the distal end of said trocar may beengaged inthe. guide slot of said needle whereupon the trocar ismovable along said needle to enter the initial openingmade by. said needle and bring the cutting knives thereofihto incisionmaking contact for providing an incision into thetrachea, whereupon the cannular tracheotomy tube: is moved telescopically over the trocar with the distalend. thereof entering through the incision into the trachea to position the tube within the trachea as an artificial airway.

5. Surgical instruments for use in tracheotomy. for the purpose of making an incision in the. trachea and atfixing an artificial airway therein including incombination an arcuate trocar comprising an arcuate. shaft pro.- videdwith a handle portion at its proximal end andan enlarged head portionat its distal end, a pluralityv ofright angularly disposed knife members. being carriedlongitudinally of the enlarged distal. end head portion. one of said knife members extending arcuatclyv forward. and tapering laterally thereof and provided on its extended end. with a ball tip,- and: a-cannulartracheotomy tube;o f anarcuate, configuration.substantially like that, of"; said trocar, said tube, being.provided;with a cup-like member at its. proximal end and. a tapered point configuration at its distal end, said-tube being telescopically releasably engaged overthedistal end of said trocarto bring the head portion thereof into abutment with the handle portion of said trocar and locate the distal end of said tube on the proximal side of said enlarged head portion of the trocar, whereby the cuttingtrocar is inserted into the trachea making anincision therein, andwhereupon said cannular tube is movable over said trocar with the tapered end thereof entering the trocar-made incision to. assume a position within the trachea thus providing upon with drawal of said trocar an artificial airway into the trachea.

References'Cited-in the file of this-patent UNITED STATES PATENTS 300,285. Russell ..June 10, 18.8.4 674-,738- Mills May*2l, 19.01 l,063;750 Townsend June 3, 1913 2,224,575 Montalvo-Guenard' Dec; 10, 1940 UNITED STATES PATENT OFFICE CERTIFICATE OF CORRECTION Patent Non 2,873,742 February 17, 1959 Charles Iiiunter Shelde'n It is hereby certified that error appears in the printed specification of the above numbered patent requiring correction and that the said Letters Patent should read as corrected below.

Column 8, line 3 after 'Itube" strike out the comma; same line, for

"cup like member" read me cup like head member 1,

Signed and sealed this 4th day of August 1959.,

I SEAL) Attest:

KARL H.,- AXLINE Attesting Ofiicer ROBERT c. WATSON Commissioner of Patents

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