US 3605751 A
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Description (OCR text may contain errors)
P 1971 R. GULLING 3,605,751
TRACHEOTOMY TUBE, ASSEMBLY Filed 001;. 10, 1969 L j? l United States Patent 3,605,751 TRACHEOTOMY TUBE ASSEMBLY Roger Culling, Saint-Fons, France, assignor to Rhone-Poulenc S.A., Paris, France Filed Oct. 10, 1969, Ser. No. 865,447 Claims priority, application France, Oct. 10, 1968,
169,502 rm. 01. A611) 17/24;A61m /00; F161 41/00 U.S. c1. 12s-ss1 6 CIalmS ABSTRACT OF THE DISCLOSURE A tracheal device, for use in tracheotomy in which a main tube is inserted in the trachea. A lateral orifice therein accommodates the reduced end portion of an external lateral tube which is fitted after the tracheotomy. A clip having hooks thereon passes through the external tube and an internal tube is pushed in to force the hooks to engage on the interior of the main tube, thus holding the two tubes and the clip in place.
The present invention relates to a tracheal device which permits the respiration of the patient without closing the natural passages.
A tracheal device is used in those cases where the nor mal respiratory functions of the nose or throat are injured. This use is normal when the surgical operation of tracheotomy has to be undertaken. The tubes forming the tracheal device are introduced, partly directly into the interior of the trachea and partly through the laterally formed opening, and then they are assembled.
Such an assembly of tracheal tubes permits the trachea to be brought into communication either with the nose and the throat, or directly with the ambient air, while short-circuiting the injured surfaces of the nose and throat.
Different types of tracheal tubes permitting respiration through the natural passages are known. The assembly of tubes which is most usually employed comprises a polytetrafiuorethylene tube having thin walls and pierced laterally by an orifice, of which one end has rounded edges to facilitate the introduction thereof into the interior of the trachea. After incision of the trachea, a curved silver cannula is introduced through the opening thus formed and through the lateral orifice of the polytetrafiuorethylene tube.
This tube assembly is difiicult to assemble correctly. In actual fact, if the orifice formed in the polytetrafiuorethylene tube is too small, the introduction of the silver tube is difiicult. If this orifice is too large, the two tubes are not rigid and the polytetrafiuorethylene tube can be displaced in the trachea. Moreover, the length of the polytetrafluorethylene tube has to be adjusted to the desired dimensions before it is introduced into the trachea. For this purpose, one end of the tube is cut off and thus it has traumatising sharp edges.
An attempt has been made to obtain a correct assembly of two polytetrafiuorethylene tracheal tubes by screwing a straight tube into the lateral orifice of the main tube placed in the trachea. However, as the tracheal tubes have thin walls, the engaged threaded and tapped surfaces are insufficient to form a sufiiciently resistant asice sembly which does not become loose. This assembly remains inadequate, even if the lateral tube is caused t penetrate into the interior of the main tube. Since a considerable part of the section of the main tube is shut off in this way, the respiration of the patient through the natural passages is considerably impaired and it is only with difiiculty that the mucus is evacuated.
According to the present invention there is provided a tracheal device comprising a main tube having a laterally extending orifice in the side wall, an external lateral tube including a portion of reduced exterior size adjacent one end thereof, shaped to fit snugly within said orifice, an internal lateral tube axially slidable within said external lateral tube, abutment means on the internal lateral tube, abutting the external lateral tube to prevent the internal lateral tube projecting substantially inwardly, with respect to the main tube, beyond the inner end of the external tube, a clip of inert material fitted within the external lateral tube and exteriorly of the internal lateral tube and at least one hook on said clip such that when the internal lateral tube is slid fully into said external lateral tube, said at least one hook locates interiorly of said main tube to retain the external and internal lateral tubes in position on the main tube.
In order that the invention will be better understood the following description is given, merely by way of example, reference being made to the accompanying drawings, in which:
FIG. 1 is an exploded sectional elevation of one embodiment of tracheal device according to the invention; and
FIG. 2 is a sectional elevation of a modified form of the main tube of FIG. 1.
The device illustrated in FIG. 1, includes a main tube 1, adapted to be introduced into the interior of the trachea, the tube being formed with a lateral orifice 2, the axis of which is inclined at an angle a above a plane perpendicular to the axis of the tube. The angle a is between 0 and 45 and preferably between 10 and 30. At least one end 3 of the main tube has rounded edges so as not to cause traumatism when it is introduced into the trachea.
A lateral tube, intended to be fixed on the orifice 2 of the main tube, includes an external lateral tube 10 and an internal lateral tube 12. The external tube is cylindrical and its external diameter is larger than the diameter of the orifice 2. One end 11 is of reduced diameter so as to fit snugly within the orifice 2 over a length sufficient to permit its complete engagement in the orifice.
The internal tube 12 is also cylindrical and has the external diameter such as to permit it to slide with light friction inside the tube 10, one end being formed with a collar 13.
Between the sleeves 10 and 12 and fitted into grooves formed for this purpose is a clip 14 of resilient and inert material, formed by at least two arms, the ends of which are bent to form opposite and outwardly facing hooks 15 and 16. The arms of the clip are joined at the other end by a connection ring 17 which is adapted to bear against the end 18 of the tube 10. The length of each arm of the clip is accurately determined, so that the ring 17 comes into contact with the end 18 of the tube 10, when the hooks 15 and 16 reach the opposite end 11 of the tube. They can be opened outwardly, either under the effect of the elasticity of the arms of the clip or under the pressure of the tube 12 as it is fitted.
In order to fit the device according to the invention, after having performed a tracheotomy on the patient, the tube 1 is introduced into the trachea and it is suitably adjusted. The external lateral tube is inserted laterally through the formed opening and the end 11 of the sleeve is fitted into the orifice 2. The clip 14 is introduced into the interior of the tube 10 after having manually pressed the hooks 15 and 16 together, and they are pressed in until the connecting ring 17 abuts against the end 18 of the tube 10. Then the tube 12 is introduced into the interior of the tube 10 until the collar 13 is stopped. It is then certain that the arms of the clip are bearing satisfactorily against the internal wall of the tube 1 and that consequently the hooks ensure the locking of the lateral tube on the main tube 1. The extraction of this device is easily elfected by operating in the reverse manner. If the elasticity of the clip is insufiicient to ensure the unlocking, it is sufiicient to make a quarter turn of the clip 14, by gripping it by means of the ring 17, so that the hooks re-enter the interior of the bore of the tube 10.
In the modification of the main tube which is illustrated in FIG. 2, the tube 1 is divided into three elements of the same external diameter. These include a central section 4 which is threaded and/ or tapped at each end and is formed with a lateral orifice 2, and two similar end sections 5 and 6, of which the ends 7 and 3 have rounded edges and of which the ends 8 and 9 are tapped and/ or threaded over a length which is between a quarter and three quarters of the total length of each end section.
The length of a tapped portion is preferably greater than the corresponding threaded length. It is thus possible to cut oil each tapped portion to the desired length, perpendicularly of its axis, and to adjust the length of the main tube for each patient, while keeping its two rounded and non-traumatising ends.
The main tube has a thin wall, preferably between 0.8 and '3 mm. thick, the thickness being such that the tube has a sufiicient rigidity as a function of the material being employed and has the smallest possible ratio between external section and internal section. The external diameter of the main tube is selected according to the internal dimensions of the patients trachea, and the diameter of the lateral orifice 2 is preferably between a third and two thirds of the external diameter of the main tube.
The elements forming the lateral tube preferably have a length which is between 3 and 10 cm., the arms of the clip 14 being formed by wires or preferably by fine lamellae. It is generally suificient to have two arms disposed in the plane of symmetry of the device. These arms are generally bent over at their end to form hooks, one at 90+0r and the other at 90oc. At the opposite end, they may be soldered on the connecting ring 17, the diameter of which is between the internal and external diameters of the tube 10. The two arms of the clip may be fitted between the tubes 10 and 12 by means of two flats (not shown) provided on the tube 12.
As materials for forming the tubes, it is possible to employ various rigid or semi-rigid plastic materials which are substantially neutral to the secretions of the organism. Thus, as non-limiting examples, it is possible to use polytetrafiuorethylene, thermoplastic polyesters, polyamides, polyvinyl chloride, polyolefines. The end sections are preferably made of a material which is easy to cut with a surgeons knife. The clip should be formed or plated with a stainless metal or alloy. It can for example consist of stainless steel with 18% of chromium, 8% of nickel and 2% of molybdenum, or any other stainless alloy, but it can also consist of noble metals, such as gold, silver, platinum, or of metal or alloy provided with a coating protecting it against oxidation.
It is obvious that variants of this device can be pro vided; for example, one or more hook elements can be provided, which may or may not be made integral, and
4 various forms of hooks can be used. The main tube can also be divided into only two sections.
Preferably, the tracheal end of the external lateral tube terminates in a cylindrical surface, so that after insertion into the orifice of the main tube, the said end is fiush with the internal wall of the main tube.
Advantageously, the portion of the lateral tube of largest diameter ends on the tracheal side in a cylindrical surface with a radius substantially equal to the external radius of the main tube, the two cylindrical surfaces being substantially coaxial.
The device according to the invention has outstanding advantages. It is formed of simple elements, which can be easily placed in position, assembled and extracted. The assembly thereof offers absoluute safety. This device has the outstanding feature of being formed by two tubes, each of a practically constant effective section throughout the length. The respiration of the patient is thus made particularly easy, either through the natural passages or by short-circuiting the natural passages. The evacuation of mucus and the cleaning of the tubes are considerably facilitated. The lengths of the end sections of the main tube can be adjusted exactly for each patient before being fitted, without having ends with sharp edges and thus without causing any traumatism. Finally, the extraction of the device on completion of treatment is easy and rapid, this resulting in a saving of time for the surgeon and less pain for the patient.
1. A tracheal device comprising, in combination:
(a) a main tube having a side wall;
(b) a laterally extending orifice in said side wall;
(0) an external lateral tube;
(d) first and second ends to said external lateral tube;
(e) a portion of reduced exterior size adjacent the first end of said external lateral tube, shaped effective to fit snugly within said orifice in the side wall of said main tube;
(f) an internal lateral tube axially slidable within said external lateral tube;
(g) abutment means on said internal lateral tube abutting said external lateral tube, efiective to prevent said internal lateral tube projecting substantially inwardly, with respect to said main tube, of said first end of said external lateral tube;
(h) a clip of inert material fitted within said external lateral tube and exteriorly of said internal lateral tube having at least one arm extending to said first end of said external lateral tube in a direction parallel to the axes of said lateral tubes; and
(i) at least one hook on said clip extending generally radially outwardly, whereby when said internal lateral tube is slid fully into said external lateral tube, said at least one hook locates interiorly of said main tube, effective to retain said external and internal lateral tubes in position on said main tube.
2. A tracheal device as defined in claim 1, wherein said abutment means comprises a collar on said internal lateral tube, said collar abutting said second end of said external lateral tube.
3. A tracheal device according to claim 1, wherein said internal and external lateral tubes are cylindrical and wherein said portion of reduced exterior size is of cylindrical external configuration, and said orifice in said side wall is circular.
4. A tracheal device as claimed in claim 1, wherein said laterally extending orifice has an axis which is at an angle to the perpendicular to the axis of said main tube, said angle being between 0 and 45.
5. A tracheal device as defined in claim 1, wherein said clip comprises a pair of parallel arms, ends to said arms, a ring connecting to one end of each of said arms located to abut said second end of said external lateral tube, and
6 wherein two hooks are arranged, one at the other end of References Cited each arm, to extend outwardly from one another.
6. A tracheal device as defined in claim 1, wherein said UNITED STATES PATENTS main tube comprises three tubular elements of the same 3,297,027 1/1967 Rlfsch external diameter, including a central section in which 5 3,322,126 5/ 1967 Rusch said laterally extending orifice is formed, threaded ends 3,461,877 8/1969 Morch 128351 to said central section, and two similar end sections, each having a first and a second end, the first ends of said sec- CHANNING PACE Pnmary Exammer tions being threaded to co-operate with the threaded ends U 5 C1 X R of said central section, and the second ends having rounded 1O edges. 285-191