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WO2015066765A1 - Dispositif d'intubation et son procédé d'utilisation - Google Patents

Dispositif d'intubation et son procédé d'utilisation Download PDF

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Publication number
WO2015066765A1
WO2015066765A1 PCT/AU2014/050335 AU2014050335W WO2015066765A1 WO 2015066765 A1 WO2015066765 A1 WO 2015066765A1 AU 2014050335 W AU2014050335 W AU 2014050335W WO 2015066765 A1 WO2015066765 A1 WO 2015066765A1
Authority
WO
WIPO (PCT)
Prior art keywords
intubation device
tube
intubation
head portion
shaft
Prior art date
Application number
PCT/AU2014/050335
Other languages
English (en)
Inventor
Vernon Harold VIVIAN
Original Assignee
Vivian Vernon Harold
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Priority claimed from AU2013904270A external-priority patent/AU2013904270A0/en
Application filed by Vivian Vernon Harold filed Critical Vivian Vernon Harold
Publication of WO2015066765A1 publication Critical patent/WO2015066765A1/fr

Links

Classifications

    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61MDEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M16/00Devices for influencing the respiratory system of patients by gas treatment, e.g. ventilators; Tracheal tubes
    • A61M16/04Tracheal tubes
    • A61M16/0488Mouthpieces; Means for guiding, securing or introducing the tubes
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61JCONTAINERS SPECIALLY ADAPTED FOR MEDICAL OR PHARMACEUTICAL PURPOSES; DEVICES OR METHODS SPECIALLY ADAPTED FOR BRINGING PHARMACEUTICAL PRODUCTS INTO PARTICULAR PHYSICAL OR ADMINISTERING FORMS; DEVICES FOR ADMINISTERING FOOD OR MEDICINES ORALLY; BABY COMFORTERS; DEVICES FOR RECEIVING SPITTLE
    • A61J15/00Feeding-tubes for therapeutic purposes
    • A61J15/0003Nasal or oral feeding-tubes, e.g. tube entering body through nose or mouth
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61MDEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M16/00Devices for influencing the respiratory system of patients by gas treatment, e.g. ventilators; Tracheal tubes
    • A61M16/04Tracheal tubes
    • A61M16/0461Nasoendotracheal tubes
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61MDEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M16/00Devices for influencing the respiratory system of patients by gas treatment, e.g. ventilators; Tracheal tubes
    • A61M16/04Tracheal tubes
    • A61M16/0475Tracheal tubes having openings in the tube
    • A61M16/0477Tracheal tubes having openings in the tube with incorporated means for delivering or removing fluids
    • A61M16/0484Tracheal tubes having openings in the tube with incorporated means for delivering or removing fluids at the distal end
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61MDEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M2205/00General characteristics of the apparatus
    • A61M2205/32General characteristics of the apparatus with radio-opaque indicia
    • AHUMAN NECESSITIES
    • A61MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61MDEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M2205/00General characteristics of the apparatus
    • A61M2205/58Means for facilitating use, e.g. by people with impaired vision
    • A61M2205/583Means for facilitating use, e.g. by people with impaired vision by visual feedback
    • A61M2205/584Means for facilitating use, e.g. by people with impaired vision by visual feedback having a color code

Definitions

  • This invention relates to an intubation device, preferably a nasal endotracheal intubation device, and method of use thereof.
  • the invention relates, but is not limited, to the safe and effective placement of an endotracheal tube through a nasopharynx of a patient and therefore will be described in this context.
  • other tubes may be placed through orifices using the intubation device and method.
  • Endotracheal tubes are a popular method for the administration of inhalational anaesthetic agents nto the lungs. These tubes are normally used for either oral intubation or nasal intubation. Oral intubatio is the generally preferred method of intubation as the endotracheal tube can be easily placed through the oropharynx, iaryngo pharynx, and the vocal chords when a patient's head is tilted backwardly. Endotracheal tubes typically have a ' bevelled edge to allow the endotracheal tube to be passed easily through the vocal chords without damage.
  • the bevelled end of the tube may traumatise the mucosa of the turbinates, tonsils, and/or the adenoids to precipitate haemorrhaging.
  • Haemorrhaging may cause the lumen of the endotracheal tube to be covered in blood and cause the lungs to be soiled due to positive pressure ventilation forcing blood from the lumen into the lungs.
  • Biood and secretions/tissue from the nasopharynx may also block the lumen of the endotracheal tube.
  • Another problem with nasal intubation s the difficulty in passing the endotracheal tube through the tortuous nasopharynx which delays intubation.
  • the diff iculties in passing the endotracheal tube through the nasopharynx is due to a number of factors including the bevelled end of the endotracheal tube, the diameter of the endotracheal tube, and the lack, of flexibility of the endotracheal tube. Failure to pass the endotracheal tube quickly into the lungs results in lightening of the anaesthesia which is undesirable as laryngospasm may be precipitated with contact of the endotracheal tube with the vocal chords.
  • the endotracheal tub is often softened by locating the endotracheal tube within warm water, known as thermosoftening, prior to passing the endotracheal tube through the nasopharynx.
  • thermosoftening locating the endotracheal tube within warm water
  • heating of the endotracheal tube is time consuming and in life or death situations, heating the endotracheai tube is not always a viable option.
  • a further solution is to use an introduction device, such as a red rubber, Jacques or modified Foleys catheter, with the flute of the proximal end of the catheter protectin the end of the endotracheal tube.
  • an introduction device such as a red rubber, Jacques or modified Foleys catheter
  • the flute of the proximal end of the catheter protectin the end of the endotracheal tube.
  • modified endotracheal tubes have been developed with a longer flexible tip in an attempt to minimis trauma.
  • this can reduce the effectiveness and efficiency of the endotracheal tube.
  • Other known attempts to overcome these problems include using the finger of a iatex glove or using an inflatable balloon to cover the tip. Such approaches can introduce further complications, particularly if the latex glove finger or inflatable balloon becomes loose or separates from the endotracheal tube.
  • intubation device preferably a nasal intubation device, and method of use thereof which overcomes or ameliorates one or more of the disadvantages or problems described above, or which at least provides a useful o commercial alternative.
  • an intubation device including:
  • head portion includes:
  • At least a portion of the guide portion has a fixed diameter along its length.
  • a majority portion of the guide portion has a fixed diameter along its length.
  • the fixed diameter portion of the guide portion extends longitudinally over a majority of the length of the intubation device.
  • at least the fixed diameter portion of the guide portion is resiliently flexible.
  • at least the guide portion is substantially straight or substantially curved at rest.
  • it is curved to substantially continue a curve of a tube to which it is connected.
  • the tapered portion tapers obtusely with respect to the fixed diameter portion of th guid portion.
  • the tapered portion extends continuously from the flange to the fixed diameter portion of the guide portion.
  • the intubation device is integrally formed.
  • the intubation device has at least one indicator strip.
  • the indicator strip extends along the length of the intubation device from the head portion to the blunt tip of the guide portion.
  • an indicator band is provided at or adjacent at least one end of the intubation device.
  • the indicator strip and/or indicator band is coloured and/or radiopaque.
  • the shaft may further include a protrusion.
  • the protrusion corresponds to an opening in a tube that receives the shaft.
  • the protrusion is substantially circular or ova! in shape.
  • the protrusion extends perpendicularly to the longitudinal axis of the intubation device to approximately the height of the flange.
  • the flange is shaped to correspond to an end of an endotracheal tube, e.g. a straight, bevelled, curved, Murphy, or Magill tipped endotracheal tube.
  • a method of fitting an intubation device as hereinbefore described to an endotracheal tube including: attaching the head portion of the intubation device to an end of an endotracheal tube by locating the shaft of the head portion of the intubation device inside the end of the tube.
  • a nasal intubation assembly including:
  • an endotracheal tube having an inner diameter and an outer diameter
  • an intubation device having a shaft adapted to be received inside the endotracheal tube and a flexible guide portion having a blunt tip;
  • the intubation device has a flange around at least a portion of the shaft that increases the diameter of the intubation device from approximately the inner diameter of the endotracheal tube to approximately the outer diameter of the endotracheal tube;
  • the intubation device is tapered from the diameter of the flange to a smaller diameter of the guide portion
  • no portion of the intubation device has a diameter greater than the outer diameter of the endotracheal tube.
  • an end of the endotracheal tube abuts the flange providing a substantially continuous surface between the intubation device and the endotracheal tube.
  • a method of nasal intubation using an intubation device preferably as hereinbefore described, the method including:
  • the step of attaching a head portion of the intubation device to an end of a tube includes locating a protrusion of the shaft into an opening of the tube.
  • Figure 1 illustrates a top plan view of an intubation device
  • Figure 2 illustrates a side elevation view of a portion of an intubation device adjacent a tube; . J .
  • Figure 3A illustrates a side elevation view of the intubation device and tube of figure 2 when engaged
  • Figure 3B illustrates a top plan view of Figure 3A
  • Figures 4A-4F illustrate different type of tube ends.
  • Figure 1 illustrates an intubation device 100 having a head portion 120 and a guide portion 140.
  • the head portion 120 has a shaft 1 2 that extends along the longitudinal axis of the intubation device 100 from a flange 124.
  • the guide portion 140 is elongate and flexible with a blunt tip 142.
  • the guide portion 140 in the figures is straight, but it will be appreciated that at least the guide portion 140 of the intubation device 100 may also be curved.
  • the intubation device 100 is preferably a nasal intubation device.
  • the guide portion 140 is of sufficient length so that it is able to pass through a patient's nasopharynx, oropharynx, and into the mouth of the patient before the head portion 120 typically needs to be inserted into a nostril of the patient.
  • the guide portion 140 is flexible so that it is able to pass through the tortuous pathways provided b the nasopharynx and the approximately 90° angl between the nasopharynx and the oropharynx.
  • the guide portion 140 is adapted to negotiate the widest and most safe passage through the inferior meatus of the nasopharynx between the inferior turbinate and nasal surface of the palate.
  • a tapered portion 130 tapers the intubation device 100 from a relatively larger diameter of the head portion 120 to a relatively smaller diameter of the guide portion 140.
  • the tapered portion 130 is generally frustronical in shape and tapers obtusely from the guide portion 140 to the flange 124 of the head portion 120.
  • the head portion 120 has an optional protrusion 126 that extends outwardly from the shaft 122 such that it extends generally perpendicularly to the longitudinal axis of the intubation device 100.
  • the protrusion 1 6 is offset from the flange 124 and the end of the shaft 122.
  • the flange 124 in the illustrated intubation device 100 of figure 1 extends around the shaft 122 and is shaped to correspond with an end of a tube 50 (not shown in figure 1 ),
  • Figure 2 illustrates the head portion 1 0 of the intubation device 100 adjacent to the end of a tube 50, which is preferably an endotracheal tube.
  • the tube 50 ending illustrated in figure 2 is a Murphy's tip, but it will be appreciated that the tube ending may be any suitable shape, such as any of those illustrated in figures 4A to 4F.
  • the Murphy's tip has an opening 52 which is generally oval in shape.
  • the protrusion 126 of the head portion 120 of the intubation device 100 corresponds to the shape of the opening 52 and, accordingly, for the oval opening the protrusion 126 is similarly generally oval in shape.
  • Figures 3A and 3B illustrate the intubation device 100 when connected to the tube 50.
  • the guide portion 140 has a smaller outer diameter than the outer diameter of the tube 50.
  • the outer diameter of the shaft 122 of the head portion 120 of the intubation device 100 is substantially the same as, and preferably no smaller than, the inner diameter of the tube 50 (preferably between 1 -12mm, typically between 2-10.5mm) such that there is an interference fit between the two.
  • the protrusion 126 of the head portion 120 of the intubation device 100 fits inside the opening 5 of the tube 50 illustrated in figures 3A and 3B, further securing the intubation device 20 to the tube 50.
  • the flange 124 of the head portion 120 of the intubation device 100 has an outer diameter that is substantially the same as, and preferably no smaller than, the outer diameter of the tube 50 such that when connected the surface between the intubation device 100 and the tube 50 is substantially continuous providing a smooth contour along the length of the intubation device 100 and the tube 50.
  • Figures 4A to 4F illustrate different tube endings 50.
  • the tube ending in figure 4A has a rounded bevelled tip, commonly known as a Magi!Ps tip.
  • Figure 4B illustrates a Murphy's tip which has an opening 52 commonly known as a Murphy's eye.
  • Figure 4C illustrates a curved tip.
  • Figures 4D to 4F illustrate different types of bevelled tips.
  • the bevel can be downward facing, and as illustrated in figures 4E to 4F the bevel can be at varying angles, typically between 20-45°.
  • figures 4A to 4F illustrate a mere selection of possible tube endings 50, and that other tip shapes could also be utilised.
  • the shaft 122 and/or flange 1 4 of the intubation device 100 ca be readily modified from that illustrated to accommodate different tube endings 50.
  • the nasal intubation device 100 is typically integrally formed from latex free rubber. However, it should be appreciated that other flexible materials such as plastic may be used. At least a portion of the intubation device 100 may be hollow to improve flexibility and/or reduce material costs.
  • An indicator strip in the form of coloured and/or radiopaque strip (not shown) preferably extends along the length of the intubation device.
  • the intubation device 100 is connected to an endotracheal tube 50 by fitting the shaft 122 of the head portion 120 of the intubation device 100 into the tube 50. If the tube 50 has an opening 52, the protrusion 126 of the intubation device is located in the opening 52 of the tube 50 as shown in figures 3A and 3B.
  • Lubricating gel may be applied to at least a portion of the intubation device 100 and/or to the patient directly (e.g. the patient's nostrils).
  • the intubation device 100 starting with the guide portion 140, is then inserted through the nasopharynx of the patient.
  • the patient's mouth is opened so that after the intubation device 100 has passed through the nasopharynx it can be visualised by looking through the mouth and oropharynx of the patient.
  • the intubation device 100 is sighted, for example with a laryngoscope, it is grasped, preferably by a set of 'Magiil * forceps.
  • the intubation device 100 is then pulled through the oropharynx and out of the mouth of the patient.
  • the endotracheal tube 50 is pulled through the nasopharynx until the head portion 1 0 of the nasal intubation device 100 can be viewed through the oropharynx.
  • the shaft 122 of the head portion 120 of the intubation device 100 is removed from the end of the endotracheal tube 50.
  • the intubation device 100 can be removed through the mouth of the patient and discarded.
  • the endotracheal tube 50 can then be passed into the trachea through the vocal chords towards its normal resting position in the lungs of the patient.
  • the intubation device 100 provides safer, quicker, and easier intubation, particularly nasal intubation of an endotracheal tube 50, than is otherwise possible.
  • the intubation device 100 is inexpensive and is intended to be disposable.
  • the intubation device 100 is more easily inserted through the nasopharynx than an endotracheal tube alone. Furthermore, the blunt tip 142 and smal!er diameter of the guide portion 140 prevent, or at least minimise, the chances of inadvertently causing tissue damage or creating a haemorrhage.
  • the intubatio device 100 avoids the need to thermosoften the endotracheal tube 50 which not only reduces the time needed to prepare the tube 50 for insertion, but also avoids the associated problems such as tube collapse.
  • the guide portion 140 initiates the pathway through the patient's orifice, and the tapered portion 130 provides a gentle and gradual increase in diameter to the diameter of the tube 50 allowing for gradual dilation of the nasopharynx to accommodate the diameter of the endotracheal tube 50.
  • the tube 50 is connected securely to the intubation device 100 by the head portion 120 ensuring that the tube 50 follows the intubation device 100 through the patient. Where a tube 50 has an opening 52 and the protrusion 126 of the shaft 122 of the intubation device 100 is provided, the engagement of the protrusion 126 within the opening 52 further secures the intubation device 100 to the tube 50.
  • the abutment of the end of the tube 50 with the flange 124 of the head portion 1 0 of the intubation device 100 not only provides a continual surface between the tube 50 and the intubation device 00, but also provides a stable connection between the two.
  • the flange 124 also prevents sliding of the intubation device 100 further into the tube 50 as the tube 50 is pushed through an orifice.
  • the diameter of the intubation device is no larger, or at least not substantially larger, than the diameter of the tube 50 itself further reducing the possibility of haemorrhage and avoiding the need to use a smaller diameter tube 50 to accommodate the intubation device.
  • the intubation device 100 enables guiding of tubes 50 through smaller passageways, such as for smaller children and patients with small nostrils, than would otherwise be possible with the tube 50 itself or wit a guide that has a greater diameter than the tube 50, Therefore, i any anaesthetic procedure, the patient is less likely to have a reduced anaesthetic load due to a smaller tube 50,
  • the indicator strip allows for eas identification of the intubation device 100, particularly to ensur it is complete and undamaged after removal Should the intubation device 100 suffer a breakage, or the like, then the indicator strip, particularly radiopaque portions, allows for easy identification and removal.
  • shaft 122 of the intubation device 100 fits inside the tube 50, it also prevents any soiling of the lumen of the tube 50. Furthermore, shaft 122, particularly with a protrusion 126, effectively seals any openings, such as a Murphy's eye, in the tube 50, further preventing any contamination or soiling of the lumen of the tube 50 in use. The protrusion 126 also prevents rotation and assists in removing any sharp edges that are created by the opening 52 of the tube 50.
  • adjectives such as first and second, left and right, top and bottom, and the like may be used solely to distinguish one element or action from another element or action without necessarily requiring or implying any actual such relationship or order.
  • reference to an integer or a component or step (or the like) is not to be interpreted as being limited to only one of that integer, component, or step, but rather couid be one or more of that integer, component or step etc.

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  • Health & Medical Sciences (AREA)
  • Pulmonology (AREA)
  • Public Health (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • General Health & Medical Sciences (AREA)
  • Veterinary Medicine (AREA)
  • Emergency Medicine (AREA)
  • Engineering & Computer Science (AREA)
  • Anesthesiology (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Hematology (AREA)
  • Otolaryngology (AREA)
  • External Artificial Organs (AREA)

Abstract

L'invention concerne un dispositif d'intubation, de préférence un dispositif d'intubation nasale, pour aider à faire passer un tube à travers le nasopharynx d'un patient, et un procédé d'utilisation. Le dispositif d'intubation comprend une partie tête et une partie de guidage souple ayant une pointe émoussée. La partie tête comprend une tige reçue à l'intérieur d'un tube et une bride autour d'au moins une partie de la tige. Une partie du dispositif d'intubation est effilée d'un diamètre de la bride de la partie tête à un diamètre plus petit de la partie de guidage pour aider à faire passer le tube à travers des orifices, ou analogue.
PCT/AU2014/050335 2013-11-05 2014-11-04 Dispositif d'intubation et son procédé d'utilisation WO2015066765A1 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
AU2013904270A AU2013904270A0 (en) 2013-11-05 Intubation device and method of use thereof
AU2013904270 2013-11-05

Publications (1)

Publication Number Publication Date
WO2015066765A1 true WO2015066765A1 (fr) 2015-05-14

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ID=53040707

Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/AU2014/050335 WO2015066765A1 (fr) 2013-11-05 2014-11-04 Dispositif d'intubation et son procédé d'utilisation

Country Status (1)

Country Link
WO (1) WO2015066765A1 (fr)

Cited By (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN105853237A (zh) * 2016-04-20 2016-08-17 韩锋 线绳引导式鼻空肠营养管
EP3914327A4 (fr) * 2019-01-23 2022-11-02 Genesis Airway Innovations Pty Ltd Appareil d'intubation et procédé d'utilisation

Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20090030426A1 (en) * 2007-07-24 2009-01-29 Innovative Medical Devices, Llc Catheter Tunneler and Method of Using Same
US20100083957A1 (en) * 2007-04-11 2010-04-08 Davis John J Atraumatic introducer for nasal endotracheal tubes and its method of use
GB2465621A (en) * 2008-11-26 2010-06-02 Phillip Alan Coles Nasogastric tube introducer rod or stylet with bung and light source.
WO2012061220A1 (fr) * 2010-11-01 2012-05-10 Cook Medical Technologies Llc Sonde de gastrostomie endoscopique percutanée (peg) présentant une pointe de traction sans fil
US20130206138A1 (en) * 2010-12-29 2013-08-15 Zhiyang Chen Tracheal tube with flat mouth and side opening and guide core

Patent Citations (5)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20100083957A1 (en) * 2007-04-11 2010-04-08 Davis John J Atraumatic introducer for nasal endotracheal tubes and its method of use
US20090030426A1 (en) * 2007-07-24 2009-01-29 Innovative Medical Devices, Llc Catheter Tunneler and Method of Using Same
GB2465621A (en) * 2008-11-26 2010-06-02 Phillip Alan Coles Nasogastric tube introducer rod or stylet with bung and light source.
WO2012061220A1 (fr) * 2010-11-01 2012-05-10 Cook Medical Technologies Llc Sonde de gastrostomie endoscopique percutanée (peg) présentant une pointe de traction sans fil
US20130206138A1 (en) * 2010-12-29 2013-08-15 Zhiyang Chen Tracheal tube with flat mouth and side opening and guide core

Cited By (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
CN105853237A (zh) * 2016-04-20 2016-08-17 韩锋 线绳引导式鼻空肠营养管
EP3914327A4 (fr) * 2019-01-23 2022-11-02 Genesis Airway Innovations Pty Ltd Appareil d'intubation et procédé d'utilisation

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