US 2541402 A
Description (OCR text may contain errors)
Feb. 13, 1951 c. w. CAINE ENDOBRONCHIAL INTUBATING STYLET Filed Jan. 15, 1948 Crtis W. Caine IN VEN TOR.
Patented Feb. 13, 1951 UNITED STATES PATENT OFFICE The present invention relates to a stylet particularly adapted to facilitate insertion of an endobronchial tube or catheter into the desired bronchus.
An object of the present invention is to provide a" stylet including a flexible outer portion, and a removable inner stiffening portion which renders the outer portion rigid and inflexible and gently curves its distal portion anteriorly to facilitate passage between the vocal cords. A further object is to provide a stylet including an outer portion which is rigid longitudinally and flexible laterally so as to provide for positive longitudinal thrust and conformation tothe deflections of the upper respiratory passages from the axis of the human body.
Intubation of the right bronchus is relatively simple, but some difficulty is often encountered in getting a tube or catheter into the left bronchus because of the fact that it leaves the treachea at a more pronounced angle than the right bronchus.
A still further object of the present invention, therefore. is to provide an endobronchial intubating stvlet incl ding a flexible shaft having a hinged pilot or guiding ti on its distal end. a d means operab e from the proximal end of the stylet for an ulating the pilot or tip to direct it into the desired bronchus.
A further object of the invention is to provide a simple means to limit insertion of the stylet into the endobronchial tube or catheter in ac 'cordance with the length of the latter.
Still another object of the invention is to provide a stylet of the above kind which is comparatively simp e in construction efficient, easy to use. and economical to manufacture.
The exact nature of the present invention will become ap arent from the following description when considered in con ection with the accompanying drawing, in which:
Figure l is an elevational view of an endobronchial intubating stylet constructed in accordance with the present invention, with the inner stiffening rod thereof removed.
Figure 2 is a side elevational view of the inner stiffening rod of the present stylet;
Figure 3 is a view showing the complete stylet inserted within an endobronchial tube or catheter, the tube or catheter being partly in elevation and partly broken away and in section, and the catheter being partly in elevation and partly in central longitudinal section;
Figure 4 is an enlarged central longitudinal sectional view of the distal portion of the stylet;
3 Claims. (01. 128-351) Figure 5 is an enlarged transverse section taken on line 5-5 of Figure 3;
Figure 6 is an end elevation looking toward the proximal end of the complete stylet;
Figure 7 is a diagrammatic view illustrating the left bronchus intubated by the present stylet with the stiffening rod of the latter removed.
Referring in detail to the drawing, the illustrated embodiment of the invention consists of a stylet which includes a laterally flexible and resilient tubular shaft 5 consisting of a helical spring whose coils are closely wound to render the shaft rigid or non-compressible longitudinally, a hollow pilot or guiding tip 6 carried by the distal end of the shaft 5, and a circular peripherally knurled knob 1 threaded onto the proximal end of the shaft 5. The pilot or guiding tip 6 includes a rigid tubular proximal section 8 having a flared entrance and threaded into the distal end of shaft 5, and a hollow rigid distal section 9 hinged at one side to the corresponding side of the proximal section 8 as at [0 for adjustment to diiferent angular positions relative to the shaft 5 and section 8.
A flexible operating wire ll extends through the shaft 5 and its knob l and is pivotally attached at its distal end to the proximal end of the distal pilot section 9 as at I2, for use in ad justing the latter. A ring shaped finger piece I3 is provided on the proximal end of the operating wire II, and is disposed proximal of the knob I and faces in the same direction as the pilot section 9 may be angulated, by pulling said operating wire. A stop collar I! 4 is slidably disposed and ad iustable longitudinally on the shaft 5, and this stop, collar is adapted to form an abutment for engagement with the proximal end of an endobronchial tube I5, or the end fitting l6 of the latter, to limit insertion of the stylet into said tube in accordance with the length of the latter. It will of course be understood that an endobronchial tube or catheter is sometimes provided with the coupling member it for use in connecting the tube" or catheter to the control valve of an apparatus commonly used to supply oxygen or other gas to the lungs. In practice, the collar I4 is preferably made of rubber or similar material, and it has a snug frictional fit on the shaft 5 so that it may be manually adjusted and will effectively remain in adjusted position under ordinary conditions of use.
A removable substantially rigid stiffening rod 11 for the shaft 5 and pilot 6 is extended through said shaft into the distal pilot section 9 and has its distal portion gently deflected anteriorly to similarly deflect the pilot 6 and the distal portion of shaft as shown in Figures 2 and 3. A circular peripherally knurled knob I8 is provided on the proximal end of the stiffening rod I! and it abuts the knob 1 of the shaft 5. Knob I8 has a longitudinal slot IS in the same side thereof as the distal portion of rod I1 is deflected, which slot is adapted to accommodate the finger piece I3 and the adjacent portion of the operating wire Ii.
In practice, the tube I5 is fitted with an infiatable cuif or collar near its tip, according to common practice and as disclosed in the U- S. patent to P. W. Gebauer, No. 2,175,726, October 10, 1939. The stylet is assembled and thoroughly lubricated, and then inserted through the tube or catheter until the latter or its coupling member I6 abuts the stop collar I4 which has been ad-- justed to the proper point longitudinally of shaft 5, so that the pilot section 9 protrudes slightly beyond the distal end of the tube or catheter. The tube or catheter is then lubricated and the patient is anesthetized. With the use of a laryngoscope, the larynx is visualized as usual, and the tube or catheter with the complete stylet therein is inserted and passed between. the vocal chords. The assembled stylet provides a body for and imparts rigidity to the tube I5 so as to provide for accurate handling. The gentlecurvature of the distal portion of rod I1 is such that the axis of the distal pilot section 9 and the adjacent portion of tube I5 are in line with the upper portion of the trachea. With the rounded distal section a of the pilot protruding, intubation is made easy and atraumatic. The pilot will readily pass through a spastic larynx, and the tube will easily follow. The procedure is followed until the pilot and the distal portion of tube I5 are" a short distance past the vocal chords. For endobronchial intubation, the laryngoscope and. the stilfening rod H are removed, and the tube and the remainder of the stylet are further in troduced until the pilot reaches the carina. The wire I I is'then pulled to defiect'the pilot into the desired bronchus, as indicated by the direction in which the ring I3 is pointed. The tube and stylet, minus the stiffening rod, are introduced until the desired intubation is effected as shown in Figure 7 with the tube or catheter extending through the trachea 2!] and into the bronchus ZI. The proximal end of the tube or catheter is then held firmly, and the shaft 5 and pilot 6 are withdrawn from the tube or catheter. The inflatable cuif or collar, not shown, is then inflated, whereupon the tube or catheter is connected to the anesthetic machine. Thus, isolation of the contralateral lung and use only of the ipsolateral lung in respiration, are easily realized.
. The rigidity afforded by the present stylet insures accuratecontrol of the pilot, allowing it to be passed through the mouth outside the laryngoscope and leaving an unobstructed view of the larynx through the procedure of intubating the latter. The fiexible shaft of the stylet allows blind intubation of a bronchus so as to avoid the necessity of using a straight bronchoscopic intubating outfit. In this way, swift atraumatic and efficient intubation may be done, the flexible shaft conforming to the bends of the mouth, throat, larynx, and trachea.
From the foregoing description, it is believed that the construction, manner of use and advantages of the present invention will be readily understood and appreciated by those skilled in the art. Modifications and changes in details of construction are contemplated, such as fairly fall within the spirit and scope of the invention as claimed.
Having described the invention, What is claimed as new is:
1. In an endobronchial intubating stylet, a longitudinally rigid and laterally flexible tubur lar shaft having open ends, a hollow pilot carried by the distal end of said shaft and including a proximal section attached to-the shaft and adistal section having an open proximal end hinged at one side to the corresponding side, of the proximal section for adjustment to dilferent angular positions relative to the latter, a knob on the proximal end of said shaft, a flexible operating wire extending through the shaft and its knob and attached at its distal end to the opposite side of said proximal end of the distal pilot section for use in swinging and thereby angularly adjusting the latter, and a removable stiffening rod extended through the shaft into the distal pilot section and having an anteriorly deflected distal portion to similarlydefiect the pilot section and the distal portion of the shaft.
2. The construction defined in-claim l, in com:- bination with a ring shaped finger piece on the proximal end of the operating wire, and a knob on the proximal end of said stiffening rod abutting the knob of the shaft and having alongitudinal slot at one sideaccommodating the finger piece.
3'. The construction defined in claim- 1, in combination with a stop collar disposed on and adjustable longitudinally of the shaft and adapted to forman abutment for engagement with: the proximal end of an endobronchialtube-to limit insertion of the stylet therein in accordancewith the length of said tube.
CURTIS W. CAINE.
REFERENCES CITED The following references are of record in the file of this patent:
UNITED STATES PATENTS