Classifications

• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
  • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. ventilators; Tracheal tubes
  • A61M16/04—Tracheal tubes
  • A61M16/0488—Mouthpieces; Means for guiding, securing or introducing the tubes
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
  • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. ventilators; Tracheal tubes
  • A61M16/01—Devices for influencing the respiratory system of patients by gas treatment, e.g. ventilators; Tracheal tubes specially adapted for anaesthetising
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
  • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. ventilators; Tracheal tubes
  • A61M16/04—Tracheal tubes
  • A61M16/0402—Special features for tracheal tubes not otherwise provided for
  • A61M16/0411—Special features for tracheal tubes not otherwise provided for with means for differentiating between oesophageal and tracheal intubation
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
  • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. ventilators; Tracheal tubes
  • A61M16/04—Tracheal tubes
  • A61M16/0434—Cuffs
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
  • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. ventilators; Tracheal tubes
  • A61M16/04—Tracheal tubes
  • A61M16/0461—Nasoendotracheal tubes
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
  • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. ventilators; Tracheal tubes
  • A61M16/04—Tracheal tubes
  • A61M16/0486—Multi-lumen tracheal tubes
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
  • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. ventilators; Tracheal tubes
  • A61M16/04—Tracheal tubes
  • A61M16/0475—Tracheal tubes having openings in the tube
  • A61M16/0477—Tracheal tubes having openings in the tube with incorporated means for delivering or removing fluids
  • A61M16/0484—Tracheal tubes having openings in the tube with incorporated means for delivering or removing fluids at the distal end
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
  • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. ventilators; Tracheal tubes
  • A61M16/04—Tracheal tubes
  • A61M16/0402—Special features for tracheal tubes not otherwise provided for
  • A61M16/0411—Special features for tracheal tubes not otherwise provided for with means for differentiating between oesophageal and tracheal intubation
  • A61M2016/0413—Special features for tracheal tubes not otherwise provided for with means for differentiating between oesophageal and tracheal intubation with detectors of CO2 in exhaled gases
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
  • A61M2207/00—Methods of manufacture, assembly or production
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
  • A61M2209/00—Ancillary equipment
  • A61M2209/06—Packaging for specific medical equipment
• • A—HUMAN NECESSITIES
  • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
  • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
  • A61M2230/00—Measuring parameters of the user
  • A61M2230/40—Respiratory characteristics
  • A61M2230/43—Composition of exhalation
  • A61M2230/432—Composition of exhalation partial CO2 pressure (P-CO2)

Definitions

• the present invention relates to equipment for use in and methods of performing anterograde or retrograde wire guided endotracheal intubation.
• An endotracheal tube is normally passed into the trachea of a patient to maintain a patent airway and allow the delivery of oxygen/air/anaesthetic gases and vapours to the patient. It may also be used to separate the lungs from the aero-digestive tract and protect from soiling due to aspiration of bodily fluids or to clear respiratory tract of secretions or blood. This is achieved by suction through the ETT. Such procedures may be necessary during resuscitation or general anaesthesia, in a patient being treated in an intensive care unit (ICU) or in an accident and emergency treatment area.
• ICU intensive care unit
• Tracheal intubation over a guide wire previously placed inside the larynx or trachea is an alternative method for anticipated or unanticipated difficult intubation [1- 4].
• the difficulties may arise mainly from anatomical variations, changes caused by disease, trauma, and/or surgical or radio therapeutic treatment in a patient.
• the guide wire may be placed in an anterograde (also known as antegrade) way through the mouth or nose and across the laryngeal inlet into the trachea or through a puncture at the space at the front of the neck between cricothyroid or criocotracheal junctions or upper tracheal rings and advanced upwards in a retrograde fashion [5 - 6].
• anterograde also known as antegrade
• Wire guided intubation is also used for exchange of endotracheal tubes and for trial of extubation in patients who are at a risk of developing an airway obstruction in postoperative period leading to an endotracheal re-intubation [7 - 9].
• tracheal tubes used in daily practice have a consistency and a fixed curvature that may not negotiate the midline of mouth and pharynx or the acute pharyngo-laryngeal angle well and are known to drag relatively more flexible and redundant loop of guide (bougie, introducer, fibreoptic scope, airway exchange catheter] into the oesophagus) [14]. Pressures from the tip of an advancing tube can be high on points of contact with tissues causing trauma to the airway structures [15-16].
• Silicone reinforced tubes follow guides more closely and easily conform to the anatomy of the upper airway. When the tip of the tube meets with an obstruction the silicone reinforced ones can bend laterally because of its flexibility and thus dissipate the pressure transmitted to the tip. Obtuse bevel in these tubes also help avoiding impingement on tissues causing trauma to airway structures [17].
• the present inventor aims to provide a simple easy to follow system using single piece of equipment and a single step for wire guided endotracheal intubation (i.e. once the guide wire is placed only a single piece of equipment is used).
• the simple system provides the opportunity to deliver oxygen throughout the procedure and to monitor ETC0 2 to indicate the progress and correct placement of the tube. This offers unprecedented safety for management of difficult airway using wire guided tracheal intubation technique.
• the present invention provides an endotracheal tube for use in a wire guided intubation procedure, said tube comprising: a) a proximal end portion suitable for attachment to a breathing circuit which end portion in use protrudes from the mouth or nose of a patient; b) a distal end portion suitable for insertion into the nose and/or mouth of a patient, said distal end portion having a tip suitable for traversing the laryngeal inlet of a patient; and c) a guide housing means running between the portions having a proximal opening adjacent said proximal end portion and a distal opening adjacent to said tip, said guide housing means suitable for slidingly receiving an anterograde or a retrograde guide during an intubation procedure to allow the tube to follow the guide into the patient.
• endotracheal tube refers to a medical catheter that is inserted into the trachea through the nose or mouth in order to maintain a patent airway to deliver oxygen/ artificial ventilation/anaesthetic gases and vapours to a patient or to keep the tracheo bronchial tree clean by removing secretions or blood.
• the term "wire guided intubation procedure” includes anterograde intubation and retrograde intubation involving a guide wire or similar piece of equipment.
• Anterograde intubation simply involves passing the tube over the wire through the nose or the mouth and advancing it downwards into the larynx and into the trachea; the wire having been previously placed anterograde.
• Retrograde intubation refers to a procedure in which one end of a guide, most commonly a guide wire, is introduced from the front of the upper neck of the patient and is threaded up through the larynx and either out through the mouth or nose. The end of the guide wire is then retrieved and used as a guide to 'railroad' an endotracheal tube into the larynx.
• breathing circuit refers to a circuit or system that helps to connect the patient to the anaesthetic gas delivery machine.
• the term "having a tip suitable for traversing the laryngeal inlet of a patient” refers to an end or extremity of the distal end portion of the tube which has a suitable shape, and is made of suitably flexible material to pass smoothly through the laryngeal inlet.
• a guide housing means refers to a means for enclosing, or capturing the guide such that when the endotracheal tube is pushed over the guide, the tube will be able to closely follow the path of the guide.
• the housing means is of a suitable shape, configuration and size that will substantially follow the long axis of the guide with little lateral movement or play.
• the term "for slidably receiving a guide” refers to the guide housing means being of a size and suitable configuration to allow the endotracheal tube to slide along the guide when the guide is within the housing means.
• follow the guide refers to the tube following the path or the route that the guide has taken through the anatomical spaces or structures; for example through the centre of the mouth negotiating various degrees of angular bends between the pharynx, the larynx and into the trachea, ideally without straying off course or snagging on airway structures.
• guide used herein includes a guide wire and also contemplates other types of guides not made of wire. Many other materials had been used as guides including, epidural catheters or long CVP lines.
• the endotracheal tube is a flexible tube of suitable material which is reinforced along most of its length except for small sections at each end.
• the endotracheal tube may be made of silicon or other suitable softer non-allergenic materials.
• the tip of the distal end portion of the tube is in the form of a bevel with an appropriate angle. More preferably the bevel is made of soft and deformable material. Even more preferably the bevel wall is devoid of reinforcing. Preferably there are two apertures on the bevel wall (one on each side) to function as secondary routes to ventilation or suction on occasions of obstruction to the main opening at the distal end of the tube. These are akin to the function of a Murphy eye.
• the guide housing means is in the form of a channel or passage adjacent the main lumen of the endotracheal tube. Even more preferably the guide housing means is integrated into the sidewall of the endotracheal tube. Still more preferably the guide housing means comprises a smooth continuous lumen.
• the invention provides a kit for endotracheal intubation comprising: i) an endotracheal tube comprising: a) a proximal end portion suitable for attachment to a breathing circuit which end portion in use protrudes from the mouth or nose of a patient; b) a distal end portion for insertion into the nose and/or mouth of a patient, said distal end portion having a tip suitable for traversing the laryngeal inlet of a patient; and c) a guide housing means running between the portions having a proximal opening adjacent said proximal end portion and a distal opening adjacent to said tip, said guide housing means suitable for slidingly receiving a guide during an intubation procedure to allow the tube to follow the guide; and ii) a suitable guide.
• the suitable guide is a guide wire.
• the invention provides an improved method of endotracheal intubation comprising: i) introducing an anterograde guide into the nose or mouth of a patient in a standard manner or introducing a retrograde guide by passing an end of a guide through into the larynx of a patient and retrieving the end from the nose or mouth of a patient in a standard manner; ii) advancing into the trachea of the patient an endotracheal tube of suitable length wherein said tube comprises: a) a proximal end portion suitable for attachment to a breathing circuit; b) a distal end portion having a tip suitable for traversing the laryngeal inlet of a patient and; c) a guide housing means running between the portions having a proximal opening adjacent said proximal portion and a distal opening adjacent to said tip, said guide housing means suitable for slidingly receiving the guide to allow the tube to follow the guide; iii) wherein the tube is advanced anterograde by sliding the tube
• the improvement resides in the fact that once the guide is in place, the design of the ETT allows it to be positioned in a single step. This saves time compared to the existing practice especially where in current retrograde procedure the retrograde guide is withdrawn whilst either pressure is exerted on the ETT to keep it in place or the guide catheter is removed from the retrograde guide and re-introduced into the lumen of the tracheal tube - all to prevent unintended displacement of the tube from the larynx.
• the method of the present invention involves fewer pieces of equipment than existing methods resulting in less potential confusion and lower costs. As the method involves fewer steps this saves crucial time in achieving intubation. In addition the method of the invention avoids certain undesirable effects of maneuvers required by current methods.
• the invention also provides a system for an endotracheal tube insertion.
• the invention provides a method of making an endotracheal tube for use in a wire guided intubation procedure, said method comprising forming an endotracheal tube of suitable materials, said tube having a) a proximal end portion suitable for attachment to a breathing circuit; b) a distal end portion suitable for insertion into the nose and/or mouth of a patient, said distal end portion having a tip suitable for traversing a laryngeal inlet of a patient; and c) a guide housing means running between the portions having a proximal opening adjacent said proximal end portion and a distal opening adjacent to said tip, said guide housing means suitable for slidingly receiving a guide during an intubation procedure to allow the tube to follow the guide into a patient.
• the current techniques of wire guided tracheal intubation consist of: a hollow semi-rigid introducer/ catheter- over the guide wire already placed inside the airway; sometimes using another larger introducer catheter (Aintree catheterTM) over the first introducer (FOS, AECs); or tracheal tube railroaded over the guide wire/introducer complex.
• Aintree catheterTM another larger introducer catheter
• FOS, AECs first introducer
• tracheal tube railroaded over the guide wire/introducer complex.
• the problems with these protocols include: restriction of size of a tracheal tube that can be used as it is determined by outer diameter of the guide (e.g. FOS); a gap between the guide and the tracheal tube which causes difficulties with placement; pressure (from tip of the tube) related injuries and oesophageal intubation; trauma from the semi-rigid guides inside airway; failure to railroad a tracheal tube over guides every time; continuous delivery of oxygen to the patient is difficult and delivery of oxygen through the hollow guide from a high pressure source (jet) had caused barotrauma; the procedure does not have definite marker for completion of a step before proceeding to the next step.
• FOS outer diameter of the guide
• a gap between the guide and the tracheal tube which causes difficulties with placement
• pressure from tip of the tube
• trauma from the semi-rigid guides inside airway
• continuous delivery of oxygen to the patient is difficult and delivery of oxygen through the hollow guide from a high pressure
• a marker for completion of a step before proceeding to the next step provides a very important opportunity to correct a failed step immediately thereby saving time which is crucial in preventing hypoxia or the need for an emergency surgical airway. It will be appreciated that markers of completion of steps are important in a multi-step blind procedure. For example incorrect placement of tube is only diagnosed after guiding implements are withdrawn (except when FOS is used as guide). [45] Another problem is the mass of guide/larger guide/ tracheal tube complex when presented at the larynx can cause sizable obstruction to the airway and it may be difficult for a patient to breathe. This problem can be even worse in a patient with a narrower larynx
• Figure 1 a is a sectional longitudinal view of one embodiment the ETT.
• Figure 1 b is a cross-section through the line A-A Figure 1a.
• Figure 1 c is a schematic of another embodiment of the ETT.
• Figure 2 is a representation of a sectional view through part of a patient's head and neck showing alternative guide wire insertions (A being anterograde and B being retrograde) with the ETT railroaded over the guide prior to insertion of the ETT into the patient's mouth.
• the inflation cuff is omitted from the inserted tube for clarity.
• ETT 10 comprises a generally cylindrical sidewall 12 with a central lumen 15 which runs the entire length of the tube from proximal end portion 20 to distal end portion 30. Distal end portion 30 comprises beveled end 35.
• Inflation tube 60 which runs partway along the length of the ETT 10 is used to inflate inflatable annular cuff 67 once tube 10 is located within the trachea to create a fluid seal.
• Guide housing means 50 in the form of guiding channel 55 is located opposite inflation tube 60 in cylindrical sidewall 12 of ETT 10.
• Guiding channel 55 has a smooth, continuous (un- perforated) lumen and has a proximal opening 55a at one end and distal opening 55b at the other end adjacent tip 35a. Proximal opening 55a may be sealed by stopper 56.
• the diameter of guiding channel 55 is suitable to allow sliding movement of guide wire 70 within.
• the diameter of guiding channel 55 is wide enough to snugly accommodate a guide wire for example to accommodate a 0.038 inch (0.9652 mm) guide wire.
• ETT 10 is provided in a suitable length for either oral or nasal placement.
• Generally guiding channel 55 will run within sidewall 12 from tip 35a of beveled or slanted end 35 to where it exits the sidewall of the tube and terminates in proximal opening 55a.
• Inflation tube 60 exits sidewall 12 at a similar point on the opposite side.
• Beveled end 35 comprises a beveled or slanted section at extreme end of distal portion 30. Tip 35a of beveled end 35 is suitable for traversing the nasal passages and the laryngeal inlet. Guiding channel 55 runs along the long axis of tube 10 from extremity of tip 35a to proximal end portion 20. Once tube 10 is threaded onto guide wire 70 via channel 55, channel 55 provides a 'backbone' around which beveled end 35 may deform.
• the beveled portion is composed of un-reinforced material (described in more detail below) which allows both sides of the tube adjacent the extremity of tip 35a to be deformed by bending inwards into the lumen of the tube making the tube particularly adapted to negotiate the laryngeal inlet.
• the size and shape of end 35 recover quickly to the original as soon as it gets past the narrow section of the larynx 96 and enters the subglottic area.
• ETT 10 comprises a reinforced section for most of its length from part of distal end portion 30 into proximal end portion 20.
• the reinforced section comprises a spiral metal member embedded in sidewall 12.
• the extreme end part of distal end portion 30 and the extreme end part of proximal end portion 20 comprise relatively short non-reinforced sections as shown by the different cross hatching in Figure 1 a and can be more clearly seen in Figure 1 c.
• the end 25 of proximal end portion 20 fits an intraluminal segment of a 15 mm tracheal tube connector suitable for connection to a breathing circuit or system as seen in Figure 1 c.
• the unreinforced end of distal portion 30 adjacent bevel end 35 is pliant and easily deformable and comprises two standard apertures 37 similar to Murphy eyes (only one shown for illustration purposes).
• ETT 10 may be made of any suitable material such as silicon that is non- reactive to tissues.
• ETT 10 is of a suitable diameter to fit a patient's anatomy (adult or child).
• ETT 10 has an internal diameter of 7.5 mm with a wall thickness of 3.2 mm.
• the reinforced portion of ETT 10 has a number of benefits over normal PVC ETTs. These include flexibility which allows it to follow a retrograde guide easily across the tortuous upper airway. Where axial pressure is applied ETT 10 does not impinge adversely on tissues causing trauma. Further, it is kink resistant. In addition, having no pre determined curve ETT 10 can be easily rotated about its long axis. [60]
• the ETT of the present invention is employed in intubation as follows:Thorough lubrication of the tip 35 and cuff area 67 of the ETT 10 and the guide wire 70 with suitable lubricant is performed. This is a very important step of preparation for the guiding at all times.
• Guide wire 70 in the form of a 0.038" diameter suitably coated wire is placed in the trachea 97 of a patient using one of the following techniques:
• Macintosh laryngoscope [e.g. in a grade 3 Lehane and Cormack] view of the larynx 96;
• ETT 10 connected to breathing circuit with an attachment for Capnography is simply loaded over the guide wire 70 through the guiding channel 55 and advanced until the wire is out from proximal end 25.
• the guide wire 70 is now grabbed securely taking care not to push or pull it in any manner.
• ETT 10 is railroaded by grabbing it 8-10 cm from the tip at first and then similar distance from the top for the rest of the tube. If there is any resistance at the vocal cord level, pulling back the tube by few millimeters and then advancing it with a rotating motion may be necessary to negotiate the larynx 96. It is a surprisingly quick, single instrument and single step procedure.
• the fiberscope may be inserted inside the main lumen of the tube for monitoring the progress and position of the tube inside the airway;
• the trajectory of the tip of the advancing tube is solely determined by the guide wire inside the airway.
• Stiles C M A flexible fibreoptic bronchoscope for endotracheal intubation of infants. Anesth Analg 1974; 53 (6): 1017-1019.
• Warrillow S Difficult intubation managed using standard laryngeal mask airway, flexible fibreoptic bronchoscope and wire guided enteral feeding tube. Anaesth Intensive Care 2005; 33: 659-661.
• composition affects the response to external compression and kinking (Abstract).

Landscapes

• Health & Medical Sciences (AREA)
• Pulmonology (AREA)
• Anesthesiology (AREA)
• Hematology (AREA)
• Animal Behavior & Ethology (AREA)
• Emergency Medicine (AREA)
• Biomedical Technology (AREA)
• Heart & Thoracic Surgery (AREA)
• Veterinary Medicine (AREA)
• Life Sciences & Earth Sciences (AREA)
• Engineering & Computer Science (AREA)
• General Health & Medical Sciences (AREA)
• Public Health (AREA)
• Otolaryngology (AREA)
• Endoscopes (AREA)
• Media Introduction/Drainage Providing Device (AREA)
• Surgical Instruments (AREA)

Priority Applications (7)

Applications Claiming Priority (4)

Related Child Applications (2)

Publications (1)

Family

ID=52687989

Family Applications (1)

Country Status (7)

Cited By (2)

Families Citing this family (9)

Citations (15)

Family Cites Families (25)

• 2014
  • 2014-08-05 EP EP14845149.5A patent/EP3049138B1/en active Active
  • 2014-08-05 CN CN201480052122.3A patent/CN105579090A/zh active Pending
  • 2014-08-05 WO PCT/AU2014/000784 patent/WO2015039164A1/en not_active Ceased
  • 2014-08-05 JP JP2016543263A patent/JP2016531706A/ja active Pending
  • 2014-08-05 HK HK16111804.5A patent/HK1223575A1/zh unknown
  • 2014-08-05 AU AU2014324068A patent/AU2014324068B2/en active Active
  • 2014-08-05 US US14/917,540 patent/US20160220774A1/en not_active Abandoned
• 2020
  • 2020-02-19 US US16/795,412 patent/US11850362B2/en active Active

Patent Citations (15)

Non-Patent Citations (29)

Also Published As

Similar Documents

Legal Events