US 3137299 A
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June 16, 1964 c. J. TABOR TRACHEOTOMY TUBE Filed July 28, 1961 INVENTOR. CARL J. TABOR W ATTORNEY United States Patent 3,137,299 TRACHEOTOMY TUBE Carl J. Tabor, 9845 Reavis Road, Alfton 23, Mo. Filed July 28, 1961, Ser. No. 127,639
.4 Claims. (Cl. 128-351) This invention relates in general to certain new and useful improvements in surgical appliances and, more particularly, to a tracheotomy tube.
Under certain pathological conditions, such as cancer of the larynx, for instance, surgical removal of an extensive amount of tissue in the upper portions of the trachea becomes necessary. As a result of such surgical procedures, the passage between the trachea and the otolaryngeal cavity are seriously impaired or completely blocked and the patient cannot breath unless a new auxiliary air-passage through the trachea is artificially created. To provide such auxiliary air-passage, it has become routine surgical practice to cut an opening through the throat of the patients neck above the bronchi and install a metal breathing tube, which is commonly referred to as a tracheotomy tube. However, tracheotomy tubes which have heretofore been available have been found to be rather unsatisfactory in many instances, since it has come to be recognized that the maintenance of a clear air-way employing conventional tracheotomy tubes is often impossible. This is forcefully illustrated at the autopsy of patients who die after a tracheotomy and are found to have complete air-way obstruction due to mucopurulent exudate in the bronchi.
In the normal trachea, such secretions are raised from the periphery of the lungs by coughing and by ciliary action. Unless one or both of these mechanisms are operative, endotracheal aspiration may be insuflicient to maintain a free air-way. With the conventional tracheotomy tube, effective cough is nullified by the presence of a tracheal fistula. It has also been observed that theciliary mechanism becomes impaired in the early hours after the performance of a tracheotomy. An acute rangement, and combination of 3,137,299 Patented June 16, 1964 With the above and other objects in view, my invention resides in the novel features of form, construction, ar-
parts presently described and pointed .out' in the claims. a
In the accompanying drawings:
FIG. 1 is a side elevational view of a tracheotomy tube constructed in accordance with and embodying the present invention;
FIG. 2 is a longitudinal sectional view' taken along line 2-2 of FIG. 1; FIG. 3 is an end elevational view of the tracheotomy tube;
FIG. 4 is a transverse sectional view taken along line 44ofFIG.1;and f FIG. 5 is a diagrammatic sketch showingthetracheotomyin place in a patient.
Referring now in more detail and by reference charactersto the drawings, which illustrate a preferred embodiment of the present invention, A designates a tracheotomy tube comprising an elongated tubular duct 1 formed of inert polyvinylacetate plasticized to a degree of resiliency such that the duct l may be readily inserted into and withdrawnfrom the trachea. The duct, 1 is of substantially circular cross-sectional shape and is integrally provided, upon its outer surface, with a plurality of uniformly spaced annular beads 2 and, adjacent its interior end, that is to say the end which is inserted into the trachea, the duct 1 is diametrally reduced in the provision of a very short concentric constriction 3, which is, in turn, integrally joined to a relatively large diameter, flexible, annular flange 4.
At its other or'exterior end, the tubular duct 1 is inte grally provided with a diametrally enlarged concentric tracheobronchitis develops promptly and frequently extends to the most peripheral bronchial branches. The cilia are destroyed and the mucosa maybe completely denuded in the area of inflammation. One of the very substantial factors in creating this condition is the presence of an inlying metallic foreign body which extends through the tracheal wall and is bent so as to curve downwardly therein. 7
It is, therefore, the primary object of the present invention to provide a non metallic tracheotomy tube which cylindrical cup 5 which is joined to the tubular duct 1 by means of a flat annular wall 6, the latter being diametrally larger than the outside diametral size of the cup, thereby. providing an external annular flange 7. Formed integrally upon the outer periphery of the flange 7, in diametrally opposed relationship, are two flexible ears 8, 9,
which are disposed in outwardly spaced parallel relation to, and are substantially shorter than, the cup size, said ears 8, 9 being centrally provided with radially extending apertures 10, 11, respectively.
Provided for snug-fitting removable disposition over the cup 5 is acylindrical cap 12 having a flat front Wall 13 provided with four radial Web members 18, 19, 20, 21,
will not produce irritation or inflammation of the tracheal wall and is suflic iently resilient so that it is entirely comfortable for the patient when in operative position.
It is another object of the present invention to provide a tracheotomy tube which is provided with a unique valve structure enabling the patient to cough and thereby expel bronchial secretions in a substantially normal manner.
It is a further object of the present invention to provide a tracheotomy tube which is providedwith a simple, but nevertheless, highly eflicient and convenient external holding means which can be easily and quickly adjusted in accordance with the conformation and size of the patients neck.
It is an additional object of the present invention to provide a tracheotomy tube which does not destroy cilia or materially interfere in any other way with ciliary action.
It is also an object of the present invention to provide a tracheotomy tube of the type stated having an external valve-containing cap which can be readily removed for cleaning and can be very inexpensively replaced whenever necessary.
-which meet in the center of the cap 12 and integrally sup- I port a small circular disk 22having an inwardly presented button 23 integrally connected thereto by a constricted neck-portion24. The cap 12 is, furthermore,-interiorly reinforced or stiflened structually by four short axial beads 25, 26,27, 28, which are respectively aligned with 'the Webs 18, 19,20, 21, all as best seen in FIG. 4
snapffitted upon the neck-like portion 24- and held retentively by the button 23 is a thin circular valve-diaphragm 29 having an external diametral size greater than the common diameter of the apertures 14,15, 16, 17, and
smaller than the diametral distance between the beads 25- "27, and 26-28; As-will be seen by reference to FIGS.
2 and. 4, the valve diaphragm 29 will normally fit around its periphery in seated position against the interior face of the cap-.wall 13, but will be peripherally free with respect to the beads 25, 26, 27,28, thereby forming a'oneway valve, sometimes referred to as an inhalation valve, which will allow air to be drawn through the tracheotomy tube A in the direction indicated by the arrows in FIG. 2. The cap 12 is finally provided, adjacent its peripheral margin, with two diametrally opposed radially projecting prongs 30, 31, which can be removably engaged within the apertures 10, 11, of the ears 8, 9, as shown in FIGS. 1, 2, and 3. By simply flexing the ears 8, 9, outwardly, it is possible to disengage them from the ears 30, 31, in a very simple, quick, and convenient manner, thereby permitting removal of the cap 12 whenever necessary.
The diaphragm valve 29 is formed from very thin flexible sheeting and, therefore, has very low inertia. Consequently, the valve-diaphragm 29 will open very readily upon inspiration and allow the patient to inhale through the tracheal stoma with complete ease. On the other hand, the valve-diaphragm valve 29 closes with the force fining a duct, said tube being formed of a synthetic resin and being integrally provided at one end with an annular resilient flange having a sufficient degree of fiexure so of exhalation and the exhaled air is thus made to pass out I through the larynx. By means of this one-way valve structure, a closed base is produced which makes it posintegrally provided with a pair of diametrally opposed radially projecting ears 33, 34, having apertures 35, 36, respectively, through which a suitable cord, tape, or elastic lace may be threaded after having been passed around the patients neck. The collar 32 fits snugly, but nevertheless, slidably upon the tubular duct 1 and will abut retentively against any one of the annular heads 2. However, since the tubular duct 1 is somewhat flexible, it is possible to slide the collar 32 inwardly until it rests snugly against the outer skin-surface of the patients neck, substantially in the manner shown in FIG. 5. If desired, a suitable neck-encircling tie-member of the type above-mentioned can be suitably attached to the collar 32 so that the entire device will be held firmly and securely in place. Since the tie-member is entirely conventional, it is not specifically shown or described herein. In fact, it is entirely possible to use the tracheotomy tube A Without any sort of tie-member, susbtantially in the manner shown in FIG. 5.
It will, of course, be understood that tracheotomy tubes constructed with the present invention may be made in various lengths to fit individuals of any size from infancy to adulthood.
Clinical tests and observations carried on over a substantial period of time have shown that the tracheotomy tube of the present invention does not destroy cilia, permits the patient to produce an eifective cough for expelling muscus, and also permits normal speech. It has also been observed that, through use of the tracheotomy tube of the present invention, the quantity of bronchial secretions during the period of convalescence following a tracheotomy, is significantly decreased and this seems to be attributable to the decreased need for aspiration and the elimination of the metallic foreign body. In vivo radiological studies have demonstrated an intact ciliary mechanism four weeks after the performance of a tracheotomy. 1
It should be understood that changes and modifications in the form, construction, arrangement, and combination of the several parts of the surgical appliances may be made and substituted for those herein shown and described without departing from the nature and principle of my invenas to be easily insertible through theartificial' passage surgically formed in the patients neck, said flange being con- 1 nected endwise to the duct by an annularly reduced resilient constriction which is thinner than the wall-thickness of the duct and is thereby readily and easily deformed to permit insertion and when so inserted, will spring back so that the flange will be in seated engagement against the internal surface of the patients tracheal Wall, said annular -wall being of sufficient length to extend through and pro ject beyond the exterior of-the patients neck, and valve means operatively mounted across said projecting .end.
2. Aitracheotomy tube according to claim 1 in which the tube is fabricated entirely of a polyvinyl acetate and the valve means is also fabricated entirely of polyvinyl acetate.
3. A tracheotomy tube according to claim 1 in which the external surface of the annular wall is provided with a plurality of spaced annular upstanding ribs and a collar is snugly fitted upon and around the external surface of the annular wall for optional disposition between any selected pair of successive ribs.
4. A tracheotomy tube adapted for insertion into a surgically formed opening in a patients neck comprising a tubular duct formed of a synthetic resin and being integrally provided at one endwith a flexible annular flange connected to the duct by an annularly reduced resilient Y constricted portion which is thinner than the wall-thickness of the duct and is thereby readily deformed to permit insertion and when so inserted will spring back into seated engagement against the internal surface of the patients tracheal wall, said tubular duct being of sufiicient length to extend through and project, beyond the exterior of the patients neck, said duct being integrally provided upon its external end with a diametrally enlarged outwardly opening cylindrical cup, a cylindrical cap having internal valve means removably mounted on said cup, a plurality of apertured flexible ears projecting outwardly from said cup, and radially projecting pin-like protuberances integrally formed on said cap for removably engaging the apertures in the earswhereby to hold the cap releasably in V .operative position on the cup.
References Cited in the file of this patent UNITED STATES PATENTS France May 18 1955 OTHER REFERENCES Moore: Plastic Trachestomy Button, J.A.M.A., Nov. 9, 1957, vol. #10, pages 1276-77. a