US 3916903 A
An emergency cricothyroid puncture apparatus for supplying ventilating gas directly into the trachea of a patient has a small, short trocar, which comprises a short, straight stylet with a long, tapered sharp point which protrudes from a close-fitting, thin, flexible, resilient wall cannula. The opposite end of the cannula is fitted with an integrally formed frustum conical receiver which uniformly slopes from a minimal radius near the cannula to a maximal radius remote from the cannula. The stylet has an abutment which engages the receiver for preventing further insertion of the stylet into the cannula beyond a point where the sharpened conical point just projects from an opening in the distal end of the cannula. A handle on the end of the stylet permits its easy withdrawal from the cannula. Radial openings in the cannula near the distal end permit gas flow when the distal end opening is blocked. The straight flexible but resilient walls of the cannula prevent damage to the rear wall of the trachea or to the larynx during insertion and use. The frustum conical receiver provides ready coupling with conventional endotracheal tube adapters.
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Description (OCR text may contain errors)
' United States Patent [191 Pozzi NOV. 4, 1975 CRICOTHYROID PUNCTURE APPARATUS  Inventor: Reta M. H. Pozzi, 2486-A E. Manoa Road, Honolulu, Hawaii 96822  Filed: July 20, 1973  Appl. No.: 381,261
 US. Cl. 128/3053; 128/347; 128/351  Int. Cl. ..A61B 17/32; A61B 17/34: A61M 16/00  Field of Search 128/347, 351, 305
 References Cited UNITED STATES PATENTS 300,285 6/1884 Russell 128/351 UX 1,845,727 2/1932 Slaughter 128/347 UX 3,039,469 6/1962 Fountain 128/351 3,088,466 5/1963 Nichols 128/351 3,182,663 5/1965 Abelson 128/351 X 3,461,877 8/1969 Morch 128/351 3,682,166 8/1972 Jacobs l28/l45.8 3,704,529 12/1972 Cioppa. 128/305 X 3,788,326 l/1974 Jacobs 128/305 OTHER PUBLICATIONS Bougas, Tina P. et al., Pressure-flow Characteristics of Needles Suggested for Transtracheal Resuscitation, N.E. Jour. Med. 262: 51l513, 1960.
Jacobs, H. B., Emergency Percutaneous Transtracheal Catheter and Ventilator, Jour. Trauma 12: 50-55, 1972.
Primary ExaminerChanning L. Pace Attorney, Agent, or Firm-James C. Wray 57 ABSTRACT An emergency cricothyroid puncture apparatus for supplying ventilating gas directly into the trachea of a patient has a small, short trocar, which comprises a short, straight stylet with a long, tapered sharp point which protrudes from a close-fitting, thin, flexible, resilient wall cannula. The opposite end of the cannula is fitted with an integrally fonned frustum conical receiver which uniformly slopes from a minimal radius near the cannula to a maximal radius remote from the cannula. The stylet has an abutment which engages the receiver for preventing further insertion of the stylet into the cannula beyond a point where the sharpened conical point justprojects from an opening in the distal end of the cannula. A handle on the end of the stylet permits its easy withdrawal from the cannula. Radial openings in the cannula near the distal end permit gas flow when the distal end opening is blocked. The straight flexible but resilient walls of the cannula prevent damage to the rear wall of the trachea or to the larynx during insertion and use. The frustum conical receiver provides ready coupling with conventional endotracheal tube adapters.
5 Claims, 4 Drawing Figures US. Patent N0v.-4, 1975 CRICOTHYROID PUNCTURE APPARATUS BACKGROUND OF THE INVENTION Tracheostomy procedures are well known. Conventional tracheostomy involves the creation of large and relatively permanent openings from the trachea to the exterior of the body in a lower portion of the neck and often involves the insertion of a large tube to maintain the passageway. Such tracheostomy procedures are accomplished under operating room conditions. Because of the potential and inherent dangers to organs and the blood flow, such procedures are not suitable as emer gency procedures by non-professional personnel;
So-called emergency cricothyroid stab procedures have been promulgated for use by professionals when time and equipment is not available to perform regular tracheostomy procedures. The emergency cricothyroid stab procedures involve identifying the location of the cricothyroid membrane by palpating the thyroid and cricoid cartilages. The cricothyroid membrane liesin the area beneath the Adams apple and the next lower cartilage ring, which is the cricoid cartilage. The promulgated emergency procedures then recommend making a rapid incision through the skin with any available pointed instrument and then rotating the pointed instrument 90 around its opening to maintain an airway. Theprocedures are unsuitable for many reasons. There is great difficulty in inserting a blade while the patient exhibits the usually frantic behavior. It is diffi cult to maintain the airway open. The depth of necessary penetration is difficult to ascertain. The procedure may cause the issuance ofa profusion of blood from the area of the incision.
A cricothyrotomy curved cannula has been developed with a curved trocar for inserting the cannula through the cricothyroid membrane into the trachea. The curved cannula is difficult to insert, since it requires a compound motion during insertion. The curved cannula is extremely dangerous in that the direction of the curve is not readily ascertainable during and after insertion. A reversed insertion or turning of t the cannula in place during its use greatly endangers SUMMARY OF THE INVENTION The emergency cricothyroid puncture apparatus of the present invention has a short, small, straight trocar with a short thin-walled, high molecular weight polymeric. material cannula with a short, straight, sharply conically pointed stylet, whose point projects from a distal end opening of the cannula. The proximal end'of thecannula is fitted with a funnel-like, integrally formed structure which opens and expands outward along the extended axis of the cannula for preventing loss of the cannula through the opening into the trachea and for providing a female fitting for receiving an endotracheal tube adapter from anoxygen valve.
The cannula is integrally formed of a highmolecular weightpolymeric material whichis capable of withstanding chemical and thermal sterilization, which is stable under conditions encountered in sterilization,
storage and use, and which maintains its shape, preserving the lumen, while permitting slight bending of the unsupported cannula. The material such as polytetrafluorethylene, which is commonly available under the trademark Teflon, is suitable for use in constructing the cannula. The external dimensions of the cannula are as thin as is commensurate with form stabilization of the cannula after insertion in the trachea and after withdrawal of the stylet. Preferably, the cannula and receiver are integrally formed from a unitary polytetrafluorethylene structure.
In a preferred embodiment of the invention, flanges are integrally formed on the structure to prevent excessive insertion of the cannula and to provide apertures for securing ties for tying the cannula firmly to the neck of the patient.
The flanges may be formed at the junction ofthe straight walled portion of the cannula and the receiver, or the flanges may be formed at the large proximal end of the receiver. The flanges extend oppositely and radially outward with respect to an axis of the cannula. Apertures may be elongated to receive a flat ribbon or strap and a flattened hook on a free end of an adjustable strap.
A short,'small diameter stylet with a sharp pointed, elongated conical distal end flt's snugly within the cannula. The sharpened end ofthe stylet and its conical portion project from the distal end of the cannula. An abutment means of the stylet engages the receiverto prevent overextension of the stylet through the cannula and to assure insertion of the cannula into the orifice formed by the stylet; A handle projects from the receiver to provide easy withdrawal of the stylet from the cannula once the cannula has been inserted. Preferably, the stylet is made of a strong, hard material which maintains its sharpness through'sterilizations and storage procedures and which will not break when used. A preferred material for the stylet'is stainless steel.
The broad objectives of the invention are accomplis'hed by providing an emergency tracheotomy apparatus comprising the cannula having a straight, smalland short lumen extending from one end to the other and'having anopening in the distal end for flowing gas from the lumen into a body cavity and having an outward extending conically-shaped receiver at a proximal end for preventing overextension of the distal end to a trachea and for receiving and tightly sealing a conventional oxygen valve adapter.
Other objects of the invention are accomplished by constructing such a cannula as an integrally formed structure made of a high molecular weight polymeric material such as polytetrafluoroethylene.
Another object of the invention is the provision of a 9 short, straight, sharply conically pointed trocar fitted closely within the polymeric cannula for penetrating the cricothyroid membrane" for carrying the cannual into the trachea of a patier'it along a straight axis.
This invention has as another object the provision of emergency tracheotomy apparatus having a cannula integrally formed with a receiver and outward extending flanges from a polymeric material with the cannula approximating the size of a number 10 needle andwith a short, straight trocar within the cannula and having a sharp, elongated conical point extending from a distal end of the cannula, having an abutment means engaging the receiver and a handle projecting from the receiver for supporting the cannula and inserting the cannula through a cricothyroid membrane into a trachea and for readily removing the trocar once the cannula has been inserted.
These and other objects and features of the invention are apparent in the disclosure, which includes the specification with its foregoing and ongoing description and the claims and the drawings.
BRIEF DESCRIPTION OF THE DRAWINGS FIG. 1 is an elevation of a trocar and cannula of the present invention, showing the cannula and trocar in approximately twice normal size.
FIG. 2 is a schematic view of the cannula inserted into a trachea and coupled with a conventional oxygen adapter and oxygen control valve.
FIG. 2A is a detail of the cannula having a double tapered receiver for gripping an adapter.
FIG. 3 is a schematic representation of the cannula inserted in a throat of a patient.
DETAILED DESCRIPTION OF THE DRAWING An emergency tracheotomy apparatus is generally indicated by the numeral 1. A trocar, generally indicated by the numeral 2, is closely fitted within a cannula, generally indicated by the numeral 5. A cannula 5 is constructed as a unitary body integrally formed of a polymeric material, such as polytetrafluoroethylene. Cannula 5 has a cylindrical main body portion 6 with a straight lumen 8 formed about a' straight central axis. Lumen 8 extends through body 6 and terminates at distal end 10. A receiver 11 is integrally formed at the proximal end of cannula 5 for inwardly receiving an outlet of a conventional gas valve adapter.
The stylet 2 has an abutment 13 which abuts the surface of receiver 11 to prevent overextension of the stylet through the cannula when pressing on handle 17 to force the trocar and cannula into the body.
The shaft 19 of the stylet fits closely within lumen 8. The elongated cone of sharpened point 20 extends outward from open end of cannula 5. Abutment 13 is positioned such that point just projects from the open end of the cannula. In one form of the invention, the abutment 13 may overlie the proximal end of receiver ll.
Openings 15, which extend laterally through the thin wall 12 of the cannula near the open end 10 provide additional ventilating access to the trachea and provide main access in the event that axial opening 10 is blocked.
Flanges 24 are integrally formed with cannula 5 and receiver 11 near the junction of the straight-walled lumen 8 and the sloping-walled receiver 11. Alternatively, the flanges may be integrally formed at the proximalwide end of receiver 11. Straps or ties 23 are attached to the flange 24 at openings 25. The ties hold the cannula in place in the trachea as shown in FIG. 3.
In FIG. 2, a cannula S'is shown projected into a trachea. Oxygen is supplied through the cannula to the trachea by oxygen control valve which has a discharge controlling button 31 mounted centrally on a face of body 33. Hose 35 leads to a source of oxygen under regulated pressure. An adapter 36, which isa conventional endotracheal tube adapter, fits on an outlet of valve 30. A discharge end 37 of adapter 36 fits tightly in the inner surface of receiver 11 to complete the passageway between valve 30 and cannula 5.
When flanges 24 are pressed against the outer skin 42 of throat 40, the open end 10 of cannula Sis positioned between a mid and rear portion of the trachea. Auxiliary openings 15 in the thin wall 12 of cannula 5 provide auxiliary passages for gas flow to the trachea.
In FIG. 2, the throat of the patient is generally indicated by the numeral 40, and 42 indicates the skin on the frontal area of the neck. 43 indicates the cricoid cartilage. The lumen 45 of trachea 47 is schematically illustrated with the open end 10 of cannula 5 centrally positioned in lumen 45.
Like elements are identified with like numerals in FIGS. 2 and 2A. The stylet shown in FIG. 2A has a sloping wall which prevents excess travel into the cannula. Preferably a stylet which abuts the outer edge of the receiver is employed.
The cannula in FIG. 2A has a receiver 11 with a relatively wide angle taper for receiving an end of an adapter, and a relatively narrow taper similar to the wall of the adapter for holding the adapter in place.
In FIG. 3, a patient is generally indicated by the numeral 50. The neck of a patient 51 has a plurality of curved cartilages surrounding the trachea. The trocar of the present invention is inserted between the thyroid cartilage 53 and the cricoid cartilage 54. The location of the cricothyroid membrane is determined by palpating the neck and determining the position of the large thyroid cartilage, its lower neighboring cricoid cartilage and finding the space in between, which is the locus of the cricothyroid membrane.
Tie 23 holds the flanges 24 against the neck 51 of the patient, steadying receiver 11' for insertion of the oxygen valve adapter to supply oxygen into the trachea of the patient.
Although the invention has been described with reference to specific embodiments, it will be obvious to one skilled in the art that modifications of the invention may be made without departing from its spirit and scope. The scope of the invention is defined in the following claims.
What is claimed is:
Emergency tracheotomy apparatus comprising a single, short, straight, thin, form-retaining cannula having a lumen extending from one end to the other and having an axial opening in a distal end and having opposite lateral openings near the distal end for flowing a gas from the lumen into a trachea, and having an outwardly expanded funnel-shaped receiver at a proximal end for receiving a gas outlet device, the receiver having outwardly sloped inner walls which extend from a minimum dimension near straight walls of the lumen to a maximum dimension at the proximal end of the receiver, and the receiver being formed integrally with the cannula on an extended axis of the lumen, a rigid flange integrally formed with the cannula and receiver on the proximal end of the cannula extending oppositely outward from a junction of the cannula and receiver for preventing excess insertion of the cannula into the trachea and having tie receiving openings in remote areas of the flange for receiving neck encircling ties to hold the flange against the neck of a patient.
2. The emergency tracheotomy apparatus of claim 1 wherein the cannula and receiver are integrally formed from a Teflon material.
3. The apparatus of claim 1 further comprising a short straight cylindrical walled trocar fitted closely within the lumen and having a sharp conical point ex tending from the opening at the distal end of the lumen and having an abutment means engaging the receiver and a handle means extending from the receiver, whereby pushing on the straight trocar with its point adjacent a throat of a patient having obstructed breathing passages causes the trocar point to penetrate the throat and a forward wall of a trachea, supporting the cannula in a rigid condition and carrying the cannula through the throat and forward tracheal wall into a position when the distal end of the cannula is positioned ventional endotracheal tube adapter.
5. The apparatus of claim 1 wherein walls of the receiver have a first relatively wide outward slope from straight walls of the lumen and then a second lesser slope to the proximal end of the receiver.