WO2018009118A1

WO2018009118A1 - Tracheostoma device holder

Info

Publication number: WO2018009118A1
Application number: PCT/SE2017/050661
Authority: WO
Inventors: Richard Falkenberg
Original assignee: Atos Medical Ab
Priority date: 2016-07-06
Filing date: 2017-06-19
Publication date: 2018-01-11

Abstract

A tracheostoma device holder (100) for holding a tracheostoma device superimposed of a tracheostoma of a person is provided. The tracheostoma device holder (100) comprises a rigid plate (101) for attachment over a trachestoma via a proximal side thereof, said plate (101) being provided with a through hole (102), and a tubular trachestoma device fitting (103), arranged circumferentially of the through hole (102), said tubular trachestoma device fitting (103) extending distally from a distal side of the plate (101). The plate (101) comprises a main portion (101b) and at least one removable portion (101a). A method for adaptation of such tracheostoma holding device (100) is also provided.

Description

TRACHEOSTOMA DEVICE HOLDER

Field of the Invention

This invention pertains in general to a trachestoma device holder. More particularly, the present invention pertains to a trachestoma device holder, comprising a plate for attachment over a trachestom a via the proxim al side of the plate, said plate being provided with a through hole having a tubular trachestoma device fitting extending distally from the plate circumferentially of said through hole. Additionally, the present invention pertains to a method for adapting such a trachestoma device holder to its intended user.

Background of the Invention

A tracheostomy is a surgical procedure in which an opening is formed through the anterior surface of the neck into the trachea. The opening is referred to as a tracheostoma. A tracheostomy tube can be provided to extend between the tracheostoma and the trachea. A tracheostomy is peiformed for example when there is a malfunction, such as a result from injury or disorder, in respect of the nervous system or the respiratory passages, which malfunction results in an incapacity to obtain enough air. An inferior lung capacity or need of respirator)' treatment may also result in a tracheostomy.

A laryngectomy is a surgical procedure, used for example to treat a carcinoma, which involves removal of the larynx or voice box and the creation of a tracheostoma. A consequence of the procedure is that the trachea is no longer connected to the pharynx but is diverted to the tracheostoma. After this procedure, normal nasal function is not possible. In a subject whose breathing functions normally, the nose and the mucous membrane lining of the nasal cavity perform important functions in conditioning inhaled air. The convoluted passages and rich blood supply serve to increase both the temperature and humidity of the inhaled air to minimise the differential in these parameters with those of the surface of the lungs. Normally some heat and moisture is also captured from exhaled air prior to its release to the atmosphere. The mucous lining of the nasal passages also serves to remove particulate matter, such as fine dust particles, pollutants and microorganisms, from the inhaled air, and the action of cilia transports mucous and any particles away from the lungs.

When a person has received a laryngectomy, in effect all inhaled air enters the lungs via the tracheostoma, and the nose is effectively not involved in the inhalation process. Exhaled air may pass through the tracheostoma or, if a voice prosthesis has been fitted, the stoma can be occluded so that the exhaled air is diverted through the voice prosthesis into the pharynx and the mouth, enabling the person to speak. It is desirable that the flow of the exhaled air be controlled by means of a tracheostoma valve. In these situations, the valve can be arranged to remain open during breathing but can be closed to divert the airflow, through a small additional increase in exhaled air flow.

In this respect tracheostoma devices, such as filter devices, HME, breathing protectors, and speech valves, have been developed to enable moisturizing of inhaled air, removal of small particles and bacteriological substances in said inhaled air, and providing the person with the ability to speech by closing the air passage through the trachestoma by manual operation.

These tracheostoma devices are held in place by a tracheostoma device holder, arranged above the tracheostoma of the person. The tracheostoma device holder is normally attached to the skin of the person by a plaster, having an adhesive surface on the side of the piaster intended to be directed towards the person in use. Either, the tracheostoma device holder is welded to the plaster, or the tracheostoma device holder is arranged on an adhesive surface on the side of the plaster intended to be directed outwards from the person in use. On the skin adhesive surface a covering sheet may be applied, which is removed just before application of the tracheostoma devi ce holder. The covering sheet facilitates transportation, and maintains skin adhesive ability of the skin adhesive surface. A plaster of this kind is disclosed in EP 0 078 685 Al .

It is however a problem associated with the application of the tracheostoma device holder after the removal of the covering sheet, since the throat of the person receiving the tracheostoma device holder by no means is planar. It is difficult to adhere the tracheostoma device holder in the pit in between the sternocleidomastoid muscles, at persons with sunken stomas, i.e. stomas that somewhat has sunken into the throat of the person, since the adhesive surface of the tracheostoma device holder inevitably will adhere to the walls of the pit before reaching the bottom of the pit with the central portion of the system. Sunken stomas are very frequent in the group of persons not having the two vertical sternocleidomastoid muscles on the neck cut during laryngectomy. As a result, it is very common that the tracheostome device holder flip over, since the bad connection between adhesives and skin and the axial displacement of the speech pressure resulting in loosening of the tracheostoma device holder and need of unduly high speech pressure.

Furthermore, in many hospitals the surgical steps during laryngectomy are adapted for creating stomas of substantially planar natures, to comply with the tracheostoma device holder system presently on the market. This adaptation includes the cutting of the two vertical sternocleidomastoid muscles on the neck.

WO2014090549 discloses a trachestoma device holder, comprising a plate for attachment over a trachestoma via the proximal side of the plate, said plate being provided with a through hole having a tubular trachestoma device fitting extending distaily from the plate circumferentially of said through hole, wherein the plate is manufactured in a thermoplastic material, with a melting/softening temperature allowing for molding according to the local anatomic shape of the person through direct contact between the plate and the skin of the person. However, when applying a trachestoma device holder there may be a need to adapt the shape of the plate so as to compensate for patient specific anatomy and/or local and momentary skin wounds or irritations, which is commonplace on patients using a trachestoma device holder.

Hence, an improved tracheostoma device holder would be advantageous, and in particular a tracheostoma device holder allowing for convenient application of the tracheostoma device holder with improved positioning ability, while simultaneously decreasing the risk of loosening of skin adhesion close to the tracheostoma, also in persons with sunken tracheostomas, thus keeping speech pressure at a convenient level, as well as making up for irregularities in skin shape adjacent the stoma, while simultaneously compensating for patient specific anatomy and/or local and momentary skin wounds or irritations.

Summary of the Invention

Accordingly, the present invention preferably seeks to mitigate, alleviate or eliminate one or more of the above-identified deficiencies in the art and disadvantages singly or in any combination and solves at least the above mentioned problems by providing a trachestoma device holder for holding a tracheostoma device superimposed of a tracheostoma of a person, said tracheostoma device holder compri sing: a rigid plate for attachment over a trachestoma via a proximal side thereof, said plate being provided with a through hole; a tubular trachestoma device fitting, arranged eircumferentiaily of the through hole, said tubular trachestoma device fitting extending distaily from a distal side of the plate; and wherein the plate comprises at least one main portion and a removable portion,

A method for adaptation of such tracheostoma holding device is also provided for the same reasons.

Advantageous features of the invention are defined in the dependent claim s.

Brief Description of the Drawings

These and other aspects, features and advantages of which the invention is capable of will be apparent and elucidated from the following description of

embodiments of the present invention, reference being made to the accompanying drawings, in which

Fig, 1 is a perspective view of a tracheostoma device holder according to an embodiment of the present invention, in a pre-adapted form;

Fig. 2 is a perspective view of a tracheostoma device holder according to an embodiment of the present invention, in a post-adapted form;

Figs. 3a to 3e are views of a tracheostoma device holder according to an embodiment of the present invention;

Fig. 4 is a side view and a cross sectional view of a tracheostoma device holder according to an embodiment of the present invention;

Fig. 5 is a perspective view of a tracheostoma device holder according to an embodiment of the present invention, in a post-adapted form placed on the neck of a person; and

Figs. 6a to 6c are views of a tracheostoma device holder according to an embodiment of the present invention, with an alternative configuration of base plate.

Description of embodiments

The following description focuses on an embodiment of the present invention applicable to a tracheostoma device holder, for holding a trachestoma device 100, such as a tracheostoma valve, over the stoma of a person. A tracheostoma device may in this context be a HME, speech valve, etc.

According to a first embodiment, disclosed in a perspective view in Figs. 1 to 4, the tracheostoma device holder 100 comprises a rigid plate 101 for attachment over a trachestoma via the proximal side of the plate 101. The plate 101 is provided with a through hole 102. Circumferentially of the through hole 102 a tubular trachestoma device fitting 103, such as a cylindrical sleeve, is provided. The trachestoma device fitting 103 extends distally from the plate 101 circumferentially of said through hole 102. In one embodiment, the trachestoma device fitting 103 is made of a flexible and resilient material, such as a soft polyethylene, a polyethylene copolymer, a aibber, silicone, or mixtures thereof. In one embodiment the tracheostoma device fitting 103 and the plate 101 can be made as on monolithic unit, i.e. of the same material, such as disclosed in Fig. 4. In the embodiment disclosed in Fig. 4, the tracheostoma device fitting 103 is provided with an annular lip 107 at its inside lumen. This lip 107 allows for retaining cooperation with a corresponding and matching annular rib on a tracheostoma device intended and adapted for cooperation with the tracheostoma device fitting 103. In such configuration, the plate 101 will extend laterally as a flange from the tubular trachestoma device fitting 103, in relation to a central axis of the through hole 102. Similarly, the tubular tracheostoma device fitting 103 extends axially and distally from the plate 101, in accordance with above.

The trachestoma device fitting 103 comprises an annular recess 104 at its inside/lumen wall. This recess 104 allows for retaining cooperation with a

corresponding and matching annular rib on a tracheostma device intended and adapted for cooperation with the tracheostoma device fitting 103.

Alternatively, the inside/lumen wall of the tracheostoma device fitting 103 may be provided with a rib, to correspond in a retaining manner with an annular recess on the tracheostoma device holder, in the same way.

The plate 101 is manufactured in a thermoplastic material, with a

melting/softening temperature allowing for molding according to the local anatomic shape of the person through direct contact between the plate 101 and the skin of the person. Such thermoplastic may suitably be a polyester based thermoplastic, such as a polycaprolactone (PCL) based thermoplastic. Polycaprolactone is a biodegradable polyester with a low melting point of about 60°C. Once softened, it can be molded by hand in the proper shape. If the temperature of an outer layer decreases, it becomes non- sticky, but still pliable and moldable. Hence, it is preferable to heat the plate 101 to above 50°C, such as above 55 to 65 °C, such as above 58 to 62 °C, and then cooling the plate 101 after being molded to below 50 °C, such as below 55 to 65 °C, such as below 58 to 62 °C.

The plate 101 may be coated with acrylate, urethane, or a combination thereof, on its distal side. This allows for easier handling during molding, since it decreases the stickiness to skin.

The plate 101 has at least one removable portion 101a. In this way, the plate 101 comprises a main portion 101b and at least one removable portion 101a. In Figs. 1 and 3a to 3e an embodiment with two removable portions 101 a is disclosed. The at least one removable portion 101a is positioned adjacent the main portion 101b, such as flush to the main portionlOlb. The main portion 101b circumvents the tubular tracheostoma device fitting 103, such that no leakage will be present between the through hole 102 underneath the tubular tracheostoma device fitting 103, since skin adhesive agent then can be applied onto the main portion 101b in a sealing manner. In the embodiment disclosed in Fig. 1, there are two removable portions 101a. These removable portions 101a are arranged on separate sides of the device fitting 03 and being sickle shaped, whilst the main portion 101 b is star shaped, withy rounded edges, in such a way that four tongues extend substantially at 90 degrees interval away from the device fitting 103. hi this way, the plate 101 may be sized and dimensioned after most stomas through removing none, one or both of the removable portions 101 a, in accordance with Figs. 3 a to 3d.

This may be accomplished by first manufacturing the plate 101 in one piece, and cut through the plate 101 - partly or fully - such that the removable portion 101a becomes removable through picking or tearing from the main portion 101b. Preferably, the removable portion 101a and the main portion 10 lb are kept together through a foil/liner 105 proximally, in accordance with Fig. 3e.

A suitable material for the foil/liner 105 is paper, polypropylene, polyester or polyethylene. These materials are well adapted to be provided with tear lines, such that they can hold the main portion 101b in close proximity to the removable portions 101a during transportation and fusion, in accordance with below, such as the coating of acrylate, urethane, or a combination thereof, of the plate 101.

When adapting the tracheostoma device holder 100 in correspondence with the anatomy of the neck portion in the vicinity of the tracheostoma of the person intended to use the tracheostoma device holder 100, at least the plate 101 is heated to somewhat over the melting temperature of its thermoplastic material, i.e. approximately 65 °C in case of a PCL based thermoplastic. Normally, this is accomplished after approximately 5 minutes of heating the plate 101 in for example warm water. Before heating the plate 101, the shape of the plate is adjusted by removing one or more removable portions 101a, to comply with the specific needs of the patent, such as tracheostoma anatomy and momentary skin wounds and/or irritations. The removing of the removable portions 101a may be accomplished through tearing the plate 101 along division lines 106. The division lines 106 may be perforation lines going through the plate 101 as well as the foil/liner 105. Alternatively, the removable portions 101a are already fully separated from the main portion 101 b, and the removable portions l Oland the main portion 101 b are kept together via the foil/liner 105, the latter being provided with perforation lines corresponding to the interface between the removable portions 101a and the main portion 101b. Once, the plate 101 is heated, in accordance with above, the main portion 101b will fuse, through the melting action, with the remaining removable portions 101a, In this way, the heating not only makes the plate compilable and shapabie after the anatomy of the stoma but also fuses the parts of the plate 101 into one integral plate 101.

After the plate 101 has reached its melting temperature, the plate 101 becomes compilable, and thus hand moldable, as well as integral. Also, when the thermoplastic material used is a PCL based thermoplastic, the plate changes in transparency from opaque to transparent. In this state, the plate is molded/shaped in accordance with the neck anatomy of the person, in accordance with Fig. 2, such that the through hole 103 is superimposed over the tracheostoma, such as for example disclosed in Fig. 5. The available molding time is normally about 2 minutes, where after the plate 101 turns unmoldable but still flexible. After approximately 10 minutes, the plate 101 again turns rigid, and is then ready for use. In this way, the plate may be molded in correspondence with the anatomy of the neck of the user, such that it conforms with for example the two vertical sternocleidomastoid muscles, as disclosed in Fig. 5, and still getting close also to sunken stomas. During speech, the pressure exerted from exhalation will be taken up by the entire plate 101, and the reluctance of the plate 101 to yield severely decreases the risk of flipping the tracheostoma device holder. Still further, due to the plate 101 being rigid in cured state, the entire plate 101 will have to move distaliy upon exerted pressure, which will decrease the risk of detachment at peripheral borders of the plate 101 against the skin of the person, which in turn improves the retaining properties of the plate 101. Additionally, due to the change in transparency at the melting temperature of PCL based materials, not only will it be easy to know when to start the molding process, but also it will be easy to adapt the plate 101 after the anatomy of the neck, since it will be possible to see through the plate 101 and detect and make up for contour changes at the neck. Also, the plate 101 may be simply remolded by reheating the plate 101 and reshaping it, if anatomy changes would occur or if it should be shaped in accordance with another user.

After cooling, i.e. after the plate 101 has returned into a rigid shape, the proximal side of the plate 101 may be provided with a tape or foam tape being adhesive on both sides, and at least skin adhesive on one of these. Such a tape may be

dimensioned in accordance with the proximal side of the plate 101 , such that the interaction surface between the plate 101 and the skin may be high. Alternatively, the plate 101 may be provided with a skin adhesive formulation on its proximal side through spraying or painting. The skin adhesive can be acrylate based or a hydrogel.

Thereafter, the plate 101 is attached to the neck of the user after the liner/foil 105 has been removed, such as disclosed in Fig. 5, such that the through hole 102 is superimposed over the tracheostoma, and a tracheostoma device, such as a speech valve, is connected to the trachestoma device fitting 103 in a known manner.

When the plate 101 and the tracheostoma device fitting 103 are made of different materials, these parts may not be injection molded into a monolithic body. Instead, the plate 102 may be overmoided to the tracheostoma device fitting 103, or vice versa. The tracheostoma device fitting 103 may al so be connected to the plate 102 through welding or gluing.

In Figs. 6a to 6c an alternative configuration of the base plate 101 is disclosed, with another design of the main portion 101b and removable portions 101a. In Fig. 6b it al so disclosed how the foil/liner 105 is arranged on the proximal side of the plate 101. In Fig. 6c, the plate 101 is disclosed with different number of removable portions 101a removed.

Although the present invention has been described above with reference to specific embodiments, it is not intended to be limited to the specific form set forth herein. Rather, the invention is limited only by the accompanying claims and, other embodiments than the specific above are equally possible within the scope of these appended claims.

In the claims, the term "^'comprises/comprising" does not exclude the presence of other elements or steps. Furthermore, although individually listed, a plurality of means, elements or method steps may be implemented by e.g. a single unit or processor. Additionally, although individual features may be included in different claims, these may possibly advantageously be combined, and the inclusion in different claims does not imply that a combination of features is not feasible and/or advantageous. In addition, singular references do not exclude a plurality. The terms "a", "an", "first", "second" etc do not preclude a plurality. Reference signs in the claims are provided merely as a clarifying example and shall not be construed as limiting the scope of the claims in any way.

Claims

1. A tracheostoma device holder (100) for holding a tracheostoma device superimposed of a tracheostoma of a person, said tracheostoma device holder (100) comprising:

a rigid plate (101) for attachment over a trachestoma via a proximal side thereof, said plate (101) being provided with a through hole (102);

a tubular trachestoma device fitting (103), arranged circumferentialiy of the through hole (102), said tubular trachestoma device fitting (103) extending distally from a distal side of the plate (101 ); wherein the plate (101) comprises at least one main portion (101b) and a removable portion (101a).

2. The tracheostoma device holder (100) according to claim 1, wherein the main portion (101b) circumvents the tubular trachestoma device fitting (103).

3. The tracheostoma device holder (100) according to claim 1 or 2, comprising at least two removable portions (101a) and wherein the removable portions (101a) are arranged on separate sides of the device fitting (103),

4. The tracheostoma device holder (100) according to any of the preceding claims, wherein the at least one removable portion (101a) is sickle shaped.

5. The tracheostoma device holder (100) according to any of the preceding claims, wherein the main portion (101b) is star shaped, withy rounded edges, in such a way that four tongues extend substantially at 90 degrees interval away from the device fitting (103).

6. The tracheostoma device holder (100) according to any of the preceding claims, wherein the plate (101) is manufactured in a thermoplastic material, with a melting/softening temperature allowing for molding according to the local anatomic shape of the person through close contact between the plate (101) and the skin of the person.

7. The tracheostoma device holder (100) according to any of the preceding claims, wherein said thermoplastic material is a polyester based thermoplastic.

8. The tracheostorna device holder (100) according to any of the preceding claims, wherein said thermoplastic material is a polycaproiactone (PCL) based thermoplastic.

9. The tracheostorna device holder (100) according to any of the preceding claims, wherein at least the distal side of the plate (101) is coated with acrylate, urethane, or a combination thereof.

10. The tracheostorna device holder (100) according to any of the preceding claims, wherein the tubular trachestoma device fitting (103) is a cylindrical sleeve.

11. The tracheostorna device holder (100) according to any of the preceding claims, wherein the trachestoma device fitting (103) comprises an annular recess or rib (104) at its inside/lumen wall.

12. The tracheostorna device holder (100) according to any of the preceding claims, wherein the trachestoma device fitting (103) at least partly is made of a flexible and resilient material, such that a tracheostorna device may be brought into snap fit cooperation with the tracheostorna device holder (100).

13. The tracheostorna device holder (100) according to claim 12, wherein the flexible and resilient material is a soft polyethylene, a polyethylene copolymer, a rubber, silicone, or mixtures thereof.

14. The tracheostorna device holder (100) according to any of the preceding claims, wherein the plate (101) and the trachestoma device fitting (103) are brought into connection by overmolding.

15. The tracheostorna device holder (100) according to any of the preceding claims, wherein at least the proximal side of the plate (101) is provided with a skin adhesive.

16. The tracheostorna device holder (100) according to claim 15, wherein the adhesive is a tape or foam tape, a sprayed or painted skin adhesive formulation, said tape, foam tape, or skin adhesive fomiulation being adhesive on both sides, and at least skin adhesive on one of these, such that the proximal side of the plate (101) is skin adhesive.

17. A method for adapting a tracheostoma device holder (100) according to any of claims 1 to 14 in correspondence with neck anatomy of a person, said method comprising the steps:

removing at least one removable portion (101a);

heating the plate (101) over the melting temperature of its thermoplasti c material, such that the plate (101) becomes compilable and hand moldable;

applying the proximal side of the plate (101) onto the neck of the person, such that the through hole (102) is superimposed over the tracheostoma;

shaping the plate (101) in accordance with the neck anatomy of the person; and actively or passively cooling the plate (101 ) below the melting temperature of its thermoplastic material.

18. The method according to claim 17, wherein the heating is made to over 50°C, and the cooling is made to below 50 °C.

19. The method according to claim 16 or 17, further comprising applying a skin adhesive surface on the proximal side of the plate (101).

20. The method according to claim 19, wherein said skin adhesive surface is applied on the proximal side of the plate (101) through spraying a skin adhesive substance onto said proximal side, painting a skin adhesive substance onto said proximal side, or applying a skin adhesive tape or foam tape onto said proximal side.