Endotracheal tube splitter

An endotracheal tube splitter and a method for removing an endotracheal tube are disclosed. The endotracheal tube splitter includes a handle portion, a cutting edge for cutting the endotracheal tube as it is withdrawn from a patient, and a support member for preventing the cutting edge from turning to either side and for maintaining the cutting edge at least a minimum desired distance from the face of the patient. The endotracheal tube splitter allows the more rapid replacement of the endotracheal tube, and allows a bronchoscope to be used as the guide for placing the tube.

BACKGROUND OF THE INVENTION 
The present invention relates to a device and method for removing and 
replacing an endotracheal tube, and in particular to an endotracheal tube 
splitter for facilitating the replacement of endotracheal tubes. 
The use of endotracheal tubes to facilitate mechanical respiration or 
ventilation in certain hospital and nursing home patients with various 
respiratory problems is well known to those skilled in the art. The tube 
is usually passed through the patient's mouth or nose so that a bottom end 
of the tube fits snugly in the patient's trachea, while a top end remains 
extending out of the patient's mouth or nose. In this position, the 
endotracheal tube enables the patient to be mechanically ventilated or to 
breath freely, uninterrupted by the respiratory disorder or other 
limitations. 
For a variety of reasons, such as the prevention of infections or the 
failure of a cuff disposed along the tube, the endotracheal tube must be 
replaced periodically. Prior to the present invention, this was done by 
sliding one end of an elongate guide down the endotracheal tube and gently 
sliding the endotracheal tube out of the patient and over an opposing end 
of the guide. The replacement endotracheal tube was then slid onto the 
guide, and then down the guide until it lodged in the proper place in the 
trachea. A guide for replacing the endotracheal tube in this manner is 
shown in U.S. Pat. No. 4,960,122. 
As will be appreciated by those skilled in the art, this approach has 
several limitations. First, time is of the essence when replacing the 
endotracheal tube, as removal and replacement of the tube causes 
disturbances to the patient's ability to breath. Taking the old 
endotracheal tube off the guide and threading on the new endotracheal tube 
adds time to the procedure. Second, such an approach inhibits the use of a 
bronchoscope during the procedure, instead relying on a simple guide. If a 
bronchoscope were to be used in accordance with the teachings of the prior 
art, the limitations of the endotracheal tube would require that the end 
of the bronchoscope outside of the patient must have an ending which is no 
bigger than the inner diameter of the endotracheal tube, or an end which 
is detachable. 
In accordance with the present invention, it has been found that splitting 
the endotracheal tube as it is withdrawn from the patient's mouth provides 
a superior method for replacing the tube. First, the time to replace the 
endotracheal tube is reduced by splitting the tube as it is withdrawn so 
that the replacement tube can be prethreaded over the bronchoscope. 
Second, the splitting of the tube allows a bronchoscope to be used to view 
the trachea of the patient as the tube is being withdrawn and as the 
replacement tube is positioned in the trachea. 
The use of a cutting device to remove a tube is not new. For several years 
the thin tubes used for introducing catheters have been cut as they are 
withdrawn from the patient. However, there are several important 
differences between using a cutting device to remove a catheter introducer 
and an endotracheal tube. First, when cutting an introducer, time is 
generally not of the essence. The introducer may be withdrawn at any 
comfortable rate. Second, in most catheter arrangements, the opposing end 
of the catheter is well placed in the body and slight jerks on the 
catheter line will not displace the catheter. Third, the introducer tubing 
is generally soft and flexible. 
In contrast, when removing a endotracheal tube, time is of the essence. 
Typically, the tube must be removed and replaced within about 30 seconds. 
Additionally, the endotracheal tube must be removed very carefully in that 
a sudden jerk will often displace the end of the bronchoscope from the 
trachea into the patient's esophagus. Furthermore, the endotracheal tube 
is relatively rigid and typically much more difficult to cut than is the 
tubing of the introducer. 
An additional concern with the catheter introducer cutting devices of the 
prior art is that many have a relatively exposed blade. Because of the 
introduction location of most catheters, significant protection around the 
blade is not needed. Even if a slip does occur, the cutter will only cause 
a small cut to the skin of the patient. In contrast, the use of such a 
cutter to split an endotracheal tube would be extremely dangerous adjacent 
the face, as a slip could result in cutting the patient's lip, nose, or 
worse, putting out the patient's eye. 
Thus, there is a substantial need for a endotracheal tube splitter which 
safely and efficiently splits an endotracheal tube as it is removed from a 
patient so that a replacement tube may be quickly positioned in the 
trachea. 
SUMMARY OF THE INVENTION 
It is an object of the invention to provide an endotracheal tube splitter 
for use in replacing endotracheal tubes. 
It is another object of the invention to provide such a tube splitter which 
is inexpensive and easy to use. 
It is another object of the invention to provide a method for removing and 
replacing an endotracheal tube. 
It is a further object of the invention to provide an endotracheal tube 
splitter which protects the face of the patient from accidental 
lacerations as the tube is withdrawn and replaced with a new endotracheal 
tube. 
The above and other objects of the invention are realized in specific 
illustrated embodiments of an endotracheal tube splitter including a 
handle for holding the tube splitter, and a cutting portion attached to 
the handle. The cutting portion includes a cutting blade, a guide and a 
plurality of curvatures to cut the endotracheal tube, and to prevent the 
cut tube from accidentally catching on the bronchoscope and dislodging the 
bronchoscope from the trachea of the patient as the tube is removed. 
In accordance with another aspect of the invention, a support is provided 
to prevent the cutting portion of the endotracheal tube splitter from 
accidentally contacting the face of the patient. The support may be a 
member extending from the handle which contacts the face of the patient, 
or may be a restraining device which attaches to some other object in 
order to prevent the endotracheal tube splitter from passing below a 
certain point and into contact with the patient's face. 
In accordance with yet another aspect of the invention, the endotracheal 
tube splitter includes an alignment mechanism to ensure that the 
endotracheal tube is withdrawn and cut at the proper angle.

DETAILED DESCRIPTION 
Reference will now be made to the drawings in which the various elements of 
the present invention will be given numeral designations and in which the 
invention will be discussed so as to enable one skilled in the art to make 
and use the invention. Referring to FIG. 1, there is shown an endotracheal 
tube splitter, generally designated at 10. The tube splitter 10 includes a 
handle portion 14, a cutting portion 18, and a support member 22 which 
extends from the handle portion in a manner discussed in FIG. 2. The 
support member 22 is typically attached to the handle portion 14 by a 
screw 26 or some other convenient fastening device. 
As shown in FIG. 1, the handle portion 14 has a plurality of holes, such as 
hole 30, which are present to enable the handle portion to be of a 
comfortable size to be gripped by a human hand without excess weight or 
waste of materials. Typically, the handle portion 14, the support member 
22 and most portions of the cutting portion 18 will be made of a 
lightweight, durable polycarbonate material. However, other materials such 
as surgical steel could also be used. 
On the handle portion 14, adjacent the cutting portion 18 may be disposed a 
sight alignment 34 for ensuring that the endotracheal tube splitter 10 is 
properly aligned as it moves along the endotracheal tube, represented by 
the dashed lines 40. 
As will be explained in additional detail with respect to FIG. 2, the 
cutting portion 18 has several curvatures which help the endotracheal tube 
splitter 10 to cut the endotracheal tube 40 quickly and with little 
disturbance to the bronchoscope (not shown) which is used to place the 
replacement endotracheal tube. The curvature 50, in the forwardmost end 54 
of the cutting portion 18 is generally concave so as to protect the 
bronchoscope which is typically made of a fiber optic cable covered in a 
vinyl sheath. Its radius of curvature is typically slightly larger than an 
outer radius of curvature for a bronchoscope. A pair of curvatures 58 
slightly behind the forwardmost end 54 of the cutting portion 18 form a 
wedge so as to force apart opposing sides of the split endotracheal tube 
40 so that the sides do not grab the bronchoscope as the endotracheal tube 
is pulled out of the patient's mouth and off of the bronchoscope. 
Referring now to FIG. 2, there is shown a fragmented perspective view of 
the endotracheal tube splitter 10 discussed regarding FIG. 1 and numbered 
accordingly. The forwardmost end 54 of the cutting portion 18 extends 
downward to a elongate point so as to form a lip guide 62. The lip guide 
62 helps to prevent the cutting portion from rotating to either side while 
cutting through the tube. 
Those skilled in the art will recognize that a significant problem in 
removing endotracheal tubes is a small hole formed in the tube near its 
end, commonly referred to as a Murphy's eye (290 FIG. 4D). If the cutting 
device is not designed properly, the cutting blade may come out of the 
endotracheal tube as it passes through Murphy's eye. This can cause two 
major problems. First, the sudden change in resistance may cause the 
medical personnel withdrawing the tube to slip and lacerate the face of 
the patient. Second, the removal of the cutting blade leaves a small 
length of tube uncut and prevents rapid replacement with another 
endotracheal tube. By providing the elongate lip guide 62, the problem 
presented by Murphy's eye is overcome, as the guide keeps the cutting 
blade 66 in the proper position so as to finish the cutting. 
Above the cutting blade 66, the curvatures 58 taper to a point 70 so as to 
form a wedge. As the cutting blade 66 passes through a wall of an 
endotracheal tube, the wedge formed by the curvatures 58 forces the two 
sides of the cut endotracheal tube apart so that they will not catch on 
the bronchoscope as the endotracheal tube is removed (See FIG. 4C). The 
rearward most portion 74 of the curvatures 58 is broadly rounded so that 
it will not catch on the inflatable cuff (FIG. 4A) near the bottom of the 
endotracheal tube as it is drawn past the cutting blade 66. 
Also shown in FIG. 2, the support member 22 will typically have a broad 
base layer 80 made of a force absorbing, slip resistant material. As the 
endotracheal tube splitter 10 is used to cut the endotracheal tube being 
removed, a significant amount of force can be placed on the face of the 
patient. The material prevents bruising to the face of the patient, and 
prevents the support member 22 from slipping on the patient's face during 
removal of an endotracheal tube. The material used for the base layer 80 
will typically be foam rubber or an elastomeric material. Preferably, the 
support member 22 and base layer 80 will hold the cutting blade 66 between 
one and three inches from the face of the patient. However, any distance 
of at least one inch will generally be sufficient. 
The broad base layer 80 also rests snugly against the patient's face to 
minimize the tendency of the cutting portion 18 to turn to either side. By 
keeping the cutting blade 66 balanced and oriented straight down, the tube 
is cut more efficiently and correctly on the first attempt. 
Referring now to FIG. 3, there is shown another embodiment of the present 
invention. The endotracheal tube splitter 110 includes a handle portion 
114, and a cutting portion 118, including curvatures 122, and a cutting 
blade 126 adjacent the forwardmost end 130. A sight alignment 134 is also 
provided in a position generally parallel to a cutting plane of the 
cutting blade 126 so that the user may be assured that the cutting blade 
is not rotating to either lateral side. 
In contrast to the embodiment discussed in FIGS. 1 and 2, however, a 
support member does not extend downward from the handle portion 114 so as 
to rest on the face of a patient. Instead, a support band 140 is provided 
which extends from the upper surface of the handle portion. The support 
band 140 may be made of several different lengths so that it may be 
attached to a convenient base, such as an IV bottle stand or some sort of 
stable overhead device. The length of the support band 140 is selected so 
that at full extension, the band holds the handle portion 140 one to three 
inches above the patient's face. In the event the person using the 
splitter 110 slips while cutting the endotracheal tube, the support band 
140 will prevent the cutting blade 126 from contacting the patient. The 
support band 140 also helps the user to prevent rotation of the blade 126, 
as would be evidenced by the slight alignment 134. 
In FIGS. 4A through 4E, there is shown the steps which would normally be 
conducted in removing an endotracheal tube from a patient and replacing it 
with a new endotracheal tube. Referring specifically to FIG. 4A, there is 
shown a cross-sectional view of human head 200 and neck 204. An 
endotracheal tube 208 is placed so that a first end 210 is positioned in 
the patient's trachea 216 and a second end 214 extends out of the 
patient's mouth 212. An inflatable cuff 220 is provided to seal between 
the endotracheal tube 208 and the trachea, thereby allowing protection of 
the airway against aspiration and allowing mechanical ventilation. 
Referring now to FIG. 4B, a bronchoscope 230 is slid into the endotracheal 
tube 208 so that a proximal end 234 of the bronchoscope extends slightly 
past the endotracheal tube in the trachea 216. Prior to the present 
invention, an elongate guide (not shown) would be positioned into the 
endotracheal tube 208 as is the bronchoscope 230. The endotracheal tube 
208 would be slid out of the patient's mouth and off of the guide. A 
replacement endotracheal tube would then be slid onto the guide and slid 
into the position previously occupied by the removed endotracheal tube 
208. In the present invention, however, there is no need to use a simple 
guide, and no need to remove the old endotracheal tube before loading the 
replacement endotracheal tube. As is shown in FIG. 4B, the replacement 
endotracheal tube 242 is preloaded on a bronchoscope 230 which can be used 
to view the trachea 216 during the procedure. 
Referring now to FIG. 4C, the endotracheal tube splitter 250 is positioned 
so that the lip guide 254 extends down into the endotracheal tube 208. A 
pair of forceps 260 or a similar holding device is used to grab the 
endotracheal tube and slowly remove it from the patient thereby drawing 
the endotracheal tube away from the patient's face. The forceps 260 are 
helpful because the tubing of the endotracheal tube 208 is slippery and 
difficult to cut and hold by hand. 
As the old endotracheal tube 208 is pulled from the patient's mouth 212, 
the endotracheal tube splitter 250 cuts the endotracheal tube 208 and 
pushes apart the cut sides 258 of the tube so that they do not catch on 
the bronchoscope 230. This is important because jarring the bronchoscope 
230 could dislodge it from the trachea 216 and cause it to become lodged 
in the esophagus 264. 
For additional stability, and to prevent the lip guide 254 or the cutting 
blade (not shown) from contacting the patient, the support member 270 is 
positioned so that the base layer 274 extends transverse with respect to 
the handle 256 and rests on the chin or other portion of the patient's 
face. The base layer 274 prevents the force accompanying the cutting of 
the old endotracheal tube 208 from bruising the patient, and also prevents 
the support member 270 from slipping on the patient's skin. 
Because the old endotracheal tube 208 has been cut through its entire 
length (including Murphy's eye 290), it may be removed from the 
bronchoscope 230 quickly and easily, as is shown in FIG. 4D. Once the old 
endotracheal tube 208 has been removed, the endotracheal tube splitter 250 
is put away and the new endotracheal tube 242 is slid along the 
bronchoscope 230 until the cuff 246 of the endotracheal tube 242 is lodged 
properly in the trachea 216. The bronchoscope 230 is then withdrawn, as 
shown in FIG. 4E, leaving the new endotracheal tube 242 in its proper 
place. 
The endotracheal tube splitter 250 allows the removal and replacement of 
the old endotracheal tube 208 safely and efficiently in about 30 to 40 
seconds or less. This small amount of time is easier on the patient, and 
is less complicated for medical personnel. 
Thus there is disclosed an endotracheal tube splitter for removing 
endotracheal tubes and a method for replacing endotracheal tubes. Those 
skilled in the art will recognize numerous modifications which can be made 
to the splitter without departing from the scope and spirit of the 
invention. The appended claims are intended to cover such modifications.