US2765792A - Tracheal devices - Google Patents

Description

E. B. NICHOLS TRACHEAL DEVICES Oct. 9, 1956 Filed April 17, 1953 INZ/ENTOR.

Ma$alf ATTORNE Y TRACHEAL DEVICES Edgar B. Nichols, Moorestown, N. J.

Application April 17, 1953, Serial No. 349,437

4 Claims. (Cl. 128-351) This invention relates to surgical appliances, and more particularly to tracheotomy tubes and the like.

For persons whose respiratory function has been impaired by reason of certain throat or nasal defects, it is common practice for surgeons to make an incision near the base of the afflicted patients throat and thus establish communication between the ambient air and the patents trachea or wind pipe. A tube known as a tracheotomy tube is then inserted into the trachea through this incision to facilitate passage of air into the trachea. Again, there are persons whose larynx may have become diseased and removed by surgery, whereupon they lose the power of speech. Here, too, an incision is made in the throat for reception of a tracheotomy tube in the trachea, an artificial larynx being connected to the tube to enable the afflicted person to speak once more.

Tracheotorny tubes of this sort come in pairs, one fitted within the other. The outer tube is inserted into the trachea and may be held in place by means of a neckband. The inner tube is then slid into the outer one and, to prevent accidental removal therefrom, some sort of locking means is usually employed for holding the two tubes together. The outer tube usually remains in the trachea for relatively long periods, while the inner tube is removed frequently for cleaning. Such tubes are generally made of sterling silver or silver plated brass, but these tubes have many objectionable features. For example, they are comparatively heavy and hence cause the patients who wear them considerable discomfort. To reduce the weight of such tubes, it has been proposed to make them of such materials as aluminum and hard rubber. However, aluminum tubes become roughed by boiling during sterilization and also by contact with glandular secretions of the human throat. This results in formation of granulations which, in time, lead to stenosis. Hard rubber tubes have not only the disadvantage that they cannot be boiled safely, but the walls of such tubes are so thick that they leave too little lumen. Moreover, hard rubber tubes, like many of the metallic tubes, are irritating to the users tissues. Other disadvantages of metallic tubes are that they are expensive to fabricate, they are most difficult to clean and sterilize, they easily become deformed or damaged, and, where the tubes are plated, the plating frequently wears off so that the tubes require constant replating.

The primary object of my present invention is to provide an improved tracheotomy tube structure which will be free from the aforementioned and other disadvantages of prior art tracheotomy tubes.

More particularly, it is an object of my present invention to provide an improved tracheotomy tube structure which is extremely light in weight, which can be put in place very easily by the user and removed, at will, with equal ease, which will cause the wearer a minimum of discomfort, and which can be cleaned and sterilized by well accepted methods without danger of damage thereto.

Another object of my present invention is to provide an improved tracheotomy tube structure as aforesaid which is inert to the human body and therefore will not 2,765,792 Patented Oct. 9, 1956 cause any irritation of the wearer's tissue due to chemical action.

Still another object of my present invention is to provide an improved tracheotomy tube structure which affords complete freedom of motion of the wearers head and neck.

A further and very important object of my present invention is to provide an improved tracheotomy tube structure wherein a complete and tight seal is afforded between the inner or lower ends of the inner and outer tubes when the inner tube is in place within the outer tube to thereby prevent entry of mucous secretions or other liquids between the tube walls.

Still a further and also very important object of my present invention is to provide an improved tracheotomy tube structure the tubes of which can be interchanged with corresponding tubes of any similar tube structure with equal effectiveness. This is in marked contrast to prior art, metallic tube structures the tubes of which come in matched pairs. Thus, should one of the tubes of any matched pair of prior art, metallic tubes become bent, dented, deformed, otherwise damaged, or lost, both tubes become useless. Furtherfore, great care must always be taken to make sure that the tubes of any matched pair of the prior art tubes are not mistakenly interchanged with the corresponding tubes of another pair because of the likelihood of mismatch and consequent lack of proper sealing between the tubes. This possibility is effectively eliminated with my improved, interchangeable tube structure.

Another object of my present invention is to provide an improved tracheotomy tube structure which not only will not become discolored with age, as do the silver tubes, for example, but which can be made of any desired color and can, therefore, be made in various colors to match difierent skin tones and skin colors, and hence will be relatively inconspicuous.

When a patient who wears a metallic tube requires X-ray treatment, it is necessary for him to remove the tube from the trachea since metallic tubes block the X- rays. Because the parts in which the tracheotomy tube is received are usually very tender, removal and subsequent reinsertion of the tube cause the wearer great discomfort. A further and also very important object of my present invention, then, is to provide an improved tracheotomy tube which will not block X-rays and which, therefore, need not be removed by the patient who re quires X-ray treatment.

Still another object of my present invention is to provide an improved tracheotomy tube which can withstand safely much mechanical abuse without becoming deformed or otherwise damaged.

It is also an object of my present invention to provide an improved tracheotomy tube structure as above set forth which can be manufactured easily, which will have a long life, which is sturdy in construction and which is highly efilcient in use.

In accordance with my present invention, I make the tubes out of synthetic resins or so-called plastic materials which are light in weight and are free from attack by the mucous fluids or other glandular secretions of the human body- Among the materials which I have found useful are those known commercially'as nylon and Lucite, the former being especially advantageous, since it is light in weight, is extremely tough, yet resilient to an advantageous degree, can be molded easily for facile manufacture, and can be colored readily to match various skin colors and skin tones. Because these materials are light in weight (from one-seventh to one-tenth the weight of metals commonly employed), and also because they are inert to glandular secretions, they cause the wearer a minimum of discomfort.

Further in accordance with my invention, 1 make the inner or lower end of the outer tube of a smaller internal diameter for a short distance than the remainder thereof, this smaller diameter being of such dimension as to frictionally receive the corresponding end of the inner tube to releasably, yet firmly, hold the two tubes in mated relation. Thus, the need for'extraneous locking elements is entirely eliminated, thereby further'reducing the overall weight of the structure and also reducing its complexity. The upper, outer end of the outer tube has a plate which is curved to conform to the front of the neck and helps to hide the incision. A neckband is connected to this plate at its opposed ends with n floating connection. This affords the wearer much freedom of movement of the neck and head and helps to minimize discomfort. The upper, outer end of the inner tube is also provided with a plate, but the opposed ends of this latter plate extend forwardly in divergent relation with respect to each other and to the plate of the outer tube to provide gripping wings or flanges. By simply placing the thumb and forefinger behind these wings with the nails of these digits against the plate of the outer tube and pressing the two digits against the two wings, the inner tube is forced outwardly to be released from the outer tube for easy withdrawal therefrom, as when cleaning is necessary.

The invention itself, as well as additional objects and advantages thereof, may be better understood from the following description of one embodiment thereof, when read in connection with the accompanying drawing in which:

Figure l is an exploded view of a tracheotomy tube structure according to my present invention,

Figure 2 is a pictorial view showing the tracheotomy tube of Figure l worn by a user,

Figure 3 is a side elevation, partly in section, of the two tubes in assembled or mated relation,

Figure 4 is a fragmentary, top plan view of the assembled tube structure, partly in section, and showing particularly the manner in which the floating coupling clips connect the neckband to the plate of the outer tube, and

Figure 5 is a fragmentary, top plan view of the assembled tube structure showing the manner in which the side wings of the inner tube plate may be grasped when it is desired to withdraw the inner tube.

Referring more particularly to the drawing wherein the same reference numerals indicate like parts throughout, there is shown a tracheal device comprising an outer tube 1 which is curved longitudinally to conform to the shape of the outlet end of the trachea, and 2. correspondingly curved inner tube 3 which is insertable into the tube 1 for mating relation therewith. The outer tube 1 is adapted to be inserted into the trachea through an opening formed in the neck 5 of a user. This is done in well known manner with the aid of a suitable pilot (not shown), after which the pilot is removed. The inner tube 3 is then inserted into the outer tube.

At its upper end, the outer tube 1 is provided with a plate 7 which is curved to conform to the shape of and fits against the neck 5 of the user when the tube 1 is fully inserted into the trachea. The tube 1 thus helps to conceal the incision or opening at the front of the neck. The plate 7 is provided with a pair of transverse slots 9 adjacent the ends thereof. A neckband 11, connected to the plate 7 by means of a pair of clips 13, serves to retain the tube 1 in place. To permit the user to turn his head freely while affording him a maximum degree of comfort, the clips 13 are designed to provide a floating, yet positive, connection to the plate 7. For this purpose, the clips 13 are made of resilient material and are bifurcated at one end to provide spaced fingers 13a. The facing surfaces of the fingers 13a are provided with opposed, aligned projections 13b the proximate ends of which are spaced apart, if at all, a distance less than the thickness of the plate 7, as best seen in Figure 4. By slipping the fingers 13a over the ends of the plate 7, they are separated somewhat, due to their resilience, and the clips can be moved along the plate 7 until their projections snap into the slots '9. The projections 13b are of a diameter to fit loosely in the slots 9. Thus, a loose or swivel, floating connection is provided between the clips 13 and the plate 7 to afford the user freedom of movement of the head and neck. The neckband 11 can be coupled to the clips 13 in any suitable manner, as by passing each end thereof through a slot 15 in each clip, turning the end back, and fastening it in place by means of a snap fastener 17 or the like.

For the major portion of its length, the internal diameter of the outer tube 1 is just slightly larger than the external diameter of the inner tube 3, as best seen in Figures 3 and 4, although this difference is somewhat exaggerated in these figures for the sake of clearness. Thus, the inner tube is freely insertable into the outer tube for this major length portion. At its lower or inner end, however, the inner diameter of the tube 1 is constricted by a thick-end, internally extending wall portion 19 (Figure 3). The internal diameter of the Wall portion 19 is of such dimension that it frictionally receives and grips the inner or lower end or" the inner tube 3 when the latter is inserted into the tube 1. Thus, the inner tube 3 is held in place securely within the outer tube 1 without the use of any extraneous locking means. At the same time, the inner tube can be released readily from the outer tube in a manner to be set forth shortly. The inner tube 3 is slightly longer than the outer tube 1 so that, when the tube 3 is fully inserted into the tube 1 for full mating relation therewith, the lower end of the inner tube 3 will extend beyond the lower end of the outer tube 1 slightly (about $4 to inch). This, in view of the tight iit between the tubes 1 and 3 at the constricted portion 19, prevents the formation of a mucous plug at the lower end of the outer tube 1.

The inner tube 3 is provided at its upper or outer end with a plate 21 which abuts the plate 7 when the tube 3 is in mated relation with the tube 1, that is, in fully inserted position therein. The opposed end portions of the plate 21 extend forwardly from the intermediate portion thereof in angular relation thereto and in divergent relation with respect to each other and with respect to the plate 7, as best seen in Figures 4 and 5, to provide gripping wings or flanges 21a. When it is desired to remove the inner tube 3 from the outer tube 1, the user merely places the thumb 23 and forefinger 25 behind the wings 2111, as shown in Figure '5, with the nails of these digits against the plate 7. Then, by forcing or wedging these digits in slightly between the Wings 21a and the plate 7, pressure is applied to the Wings 21.2 from behind in the direction of the arrow A (Fig. 5) to force the inner tube out of frictional engagement with the wall portion 19 and thereby free it for facile removal from the tube 1.

The tubes 1 and 3 are made of synthetic materials which are light in Weight and which are immune from attack by the mucous or other glandular secretions of the body to further minimize any discomfort to which the user might be subjected. I have found, after extensive study and investigation, that a number of synthetic resin materials are suitable in varying degrees, among them being polyamide resin, acrylic resin, tetrafiuoroethylene resin, polyethylene and polystyrene. These vary in characteristics depending upon the specific formulas and sources. In general, however, it may be stated that they all meet the requirements of light weight, freedom from attack by body secretions, ease of sterilization without damage, stability of form and color, freedom from mechanical abuse in ordinary handling, resilience necessary to conform readily to the structural form described above and particularly to the frictional gripping action at the constricted portion 19, and long life. Of these various materials, I have found the so-called nylon materials, which are polyamide resins, most suitable and, therefore, preferable. These materials are light in weight, having from one-seventh to one-tenth the weight of metals out of which prior art tracheal tubes are customarily made, and being entirely immune from attack by glandular secretions. They possess the requisite resilience, can be molded or machined easily, as desired, are available in many suitable colors, do not interfere with X-ray treatment, and can be sterilized readily by any of the well known methods of sterilization without becoming damaged. Considering all these advantages, the nylon materials are especially well suited for use in tracheal tubes, although I have also found the acrylic resins to have many of the desirable properties indicated above. The other types of materials mentioned are also considered suitable but may be found less so when some one or another specific characteristic is considered.

From the foregoing description, it will be apparent to those skilled in the art that I have provided an improved tracheotomy tube structure which has many advantages over, and none of the previously listed disadvantages of, prior art tracheal devices. My improved device can be mounted and secured in place quickly and easily. By merely applying slight pressure behind the wings 21a, the inner tube is quickly released from the outer tube for easy removal thereof, as when cleaning or sterilization is necessary. Also, by merely pulling on the clips 13, they can be unsnapped from the plate 7 very easily to permit removal of the neckband 11. These and the advantages of the particular materials and the physical structure set forth above impart to my improved tracheal device improved features not found in prior art devices of this sort.

Although I have shown and described a specific tube structure and have specified certain materials of which the structure may be made, it will be obvious that other, equivalent structures and materials are possible. I therefore desire that the foregoing shall be taken merely as illustrative and not as limiting.

I claim as my invention:

1. A tracheal device comprising an outer tube adapted to be inserted into the trachea of a user, and an inner tube freely insertable into said outer tube through one end thereof, at least one of said tubes being made of a resilient material, said outer tube having a reduced internal diameter at its opposite end of such dimension as to frictionally receive and grip said inner tube at the corresponding end thereof by reason of the resilience of said one tube whereby to releasably hold said tubes in mated relation.

2. A tracheal device comprising an outer tube adapted to be inserted into the trachea of a user, and an inner tube insertable into said outer tube through one end thereof, at least one of said tubes being made of a resilient material, said outer tube having an internal diameter for the maior length thereof of such dimension as to freely receive the major length of said inner tube and being constricted at its other end to provide a portion of smaller internal diameter of such dimension as to frictionally receive the corresponding end portion of said inner tube by reason of the resilience of said one tube.

3. A tracheal device according to claim 2 wherein said outer tube has a relatively thick, inwardly extending wall at its said other end to provide said smaller internal diameter.

4. A tracheal device according to claim 2 characterized in that said inner tube is somewhat longer than said outer tube whereby, When said inner tube is fully inserted into said outer tube, said inner tube extends slightly beyond said outer tube at said other end thereof.

References Cited in the file of this patent UNITED STATES PATENTS 507,813 Hartstein Oct. 31, 1893 1,389,173 Watkins Aug. 30, 1921 2,285,980 Jeckel June 9, 1942 2,599,521 Berman June 3, 1952

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