Nasal intubation adjunct

Abstract: Disclosed is a hand-held medical device to facilitate positioning of airway tubes in patient airways. A wide range of nasally placed airway tubes can be attached to the device suited for the manipulation of said airway tubes by rotation and curvature, the latter of which is provided by a soft, flexible manipulator (2) being part of the device to be slidably inserted into the airway tube and containing a spring (27) which is attached at its distal end by a braided wire (28) the pulling of which will cause flexion of the manipulator and said airway tube that surrounds it. The device additionally allows for patient inspiration and expiration to pass unrestricted through the body of the device deflecting one-way (13-14) valves positioned in clear tubes on the sides of the device allowing for visual confirmation of proper final placement of said airway tube by observing movements of valves (13,14) and fogging of tube 9 on expiration. A stethoscope headset attached to the device provides an audible reference for guiding said airway tube and affords an additional reference to confirm proper final placement of said airway tube.

Description: The present invention relates to nasal intubation instruments. US Patent No 4,529,400 describes a nasal intubation instrument having a body supporting a hand operated lever bar and grip support for applying force to an articulating wire that produces a curvature in an airway tube. US Patent No 3,552,384 discloses a device for general and selective angiography having a handle and a controllable tip guide body which can be manipulated by control means through the handle. The object of the present invention is to provide an improved nasal intubation instrument. According to the present invention there is provided an instrument for allowing an operator to insert a nasally placed airway tube into a patient, said instrument comprising: a body having a first opening extending therethrough, tube attachment means for attaching an airway tube to said body and for allowing the airway tube to cooperate with said first opening in said body; manipulator means including adjustable projection means insertable into said body and the airway tube through said first opening; and handle means for allowing the operator of said instrument to control the adjustable projection means in a manner to flex the airway tube, characterised by means attached to a second opening in the body connected to the first opening for detecting breathing sounds; a slide mounted to said manipulator and slidably engaging a slide track located on said body and extending parallel to said first opening, whereby said manipulator may be adjusted to a plurality of positions to accommodate a plurality of airway tube lengths. The instrument to be described provides better control of a nasally placed airway tube conforming it to the patient's anatomy thus minimizing soft tissue trauma and allowing the distal tip of said nasally placed airway tube to be more accurately placed adjacent to the patient's glottic opening, to provide a medical device with a simple means of attaching said nasally placed airway tube to allow for rapid removal of the nasal intubation adjunct from the airway tube as soon as proper placement of said nasally placed airway tube is confirmed, to provide a medical device affording confirmation of proper placement of the distal tip of said nasally placed airway tube adjacent to the patient's glottic opening, when appropriate, by increased audible sounds transmitted to the user's ears through a stethoscope headset attached to the nasal intubation adjunct, to provide a medical device that will allow adequate movement of the patient's inspired and expired air if said nasally placed airway tube is placed through the patient's glottic opening into the patient's trachea, to provide a medical device allowing confirmation of accurate placement of said nasally placed airway tube in the patient's trachea, if appropriate, by audible and visual means, to provide a medical device that will allow the user a safe working distance from the patient's face for between visualization of tube placement plus reducing the risk to the user of contamination from a diseased patient, to provide a medical device that will allow for adjustability to accommodate a wide range of said nasally placed airway tubes. A nasal intubation instrument embodying the present invention will now be described, by way of example, with reference to the accompanying diagrammatic drawings, in which: Figure 1 shows a perspective view of the entire device; Figure 2 shows a view of the device attached to an endotracheal tube (shaded) successfully placed nasally into patient's airway; Figure 3 shows a side view of the device's main body; Figure 4 shows a sectional view of the device's main body with the section indicated in Figure 3 along the line 4--4; Figure 5 shows a sectional view of the device's main body with the section indicated in Figure 6 along the line 5---5; Figure 6 shows a rear view of the device's main body; Figure 7 shows a perspective of the slide track; Figure 8 shows a front view of the manipulator actuating/positioning system in Figure 9 without hidden lines to illustrate slot 18; Figure 9 shows a side view of the manipulator actuating/positioning system; Figure 10 shows a bottom view of clamp 19; Figure 11 shows a side view of the manipulator assembly with an indication of movement when braided wire 28 is pulled; and Figure 12 shows an enlarged sectional side view of the manipulator. The nasal intubation adjunct consists of a body Figures 3, 4, 5 and 6, which can be cast as a unit or constructed from its several component parts. Fitting 3 at the bottom is bored vertically with a hole 15.5 mm in diameter with said hole communicating with a hole of similar diameter bore horizontally across the device to form tubes 8 and 9 which should be transparent. Hole 11 is drilled centrally and vertically from the top slightly larger than the outside diameter of the manipulator Figure 11 to communicate with the holes in tubes 8 and 9 and fitting 3. One-way valves 13 and 14 are placed in positions in tubes 8 and 9 to be visible looking at the sides of transparent tubes 8 and 9. One-way valve 13 should be inserted to allow air movement into tube 8 while one-way valve 14 should be inserted to allow air movement out of the device through tube 9. Port 7 is comprised of a tube of outside diameter that will accommodate the tube of a one-tube stethoscope angled at approximately 45° to the main body with a hole drilled through to communicate with the holes forming tubes 8 and 9 and the hole in fitting 3. Tapped holes 12 allow for the attachment of the slide track 15. Slide track 15 is attached with a flathead machine screw at countersunk hole 16 and a stud and slotted nut that will be flushed when tightened into the countersunk hole 17 with the threaded stud extending far enough to accommodate wing nut 4 which holes the manipulator actuating/positioning system Figures 8 and 9 with the threaded stud protruding through slot 18 which allows for adjustability. The manipulator actuating/positioning system Figures 8 and 9 is comprised of slide 5, handle 6, lever 10 and clamp 19. Slide 5, handle 6 and clamp 19 can be assembled with rivets or appropriate fasteners at positions 22 and 23. Holes 25 and 26 in clamp 19 align with holes in slide 5 and handle 6 at position 22. The combination of slide 5, handle 6 and clamp 19 could also be formed as a unit. Lever 10 is attached by a hinge or other suitable means to allow pivoting at the end nearest handle 6. Hole 21, countersunk at top and bottom, should align with a line formed by opening 24 in clamp 19 and the holes in position 20 drilled large enough in slide 5 to accommodate the proximal end of the manipulator Figure 11 but smaller in handle 6 to restrict the movement of the spring 27 and the proximal end of the manipulator Figure 11 with a Teflon tube inserted in the hole in position 20 in handle 6 that will provide a smooth bearing surface for braided wire 28. Slot 18 should be long enough to allow adjustment to accommodate the full range of tube lengths the device is constructed to accomdate. The manipulator Figure 11 is comprised of a soft, flexible tube 2 surrounding a flat spring 27 of appropriate width and thickness to properly fit the nasally placed airway tubes the device is constructed to accommodate with said spring having a thickness adequate to prevent inappropriate distortion yet allowing adequate flexibility of the airway tubes it is constructed to accommodate and appropriate buckle/ripple if resistance is met in the patient's airway thus preventing trauma. A braided wire 28 is included inside the soft, flexible tube 2 lubricated with silicon and attached to the distal end of spring 27. Tip 1 can be formed of florescent red powdered acrylic mixed with solvent then flowed far enough into tube 2 to cover the distal point of attachment between spring 27 and braided wire 28. Tip 1 can be formed into a round, smooth tip after the acrylic sets up. The proximal end of spring 27 should have the temper drawn and be bent over the end of tube 2 to provide a smooth bearing surface for braided wire 28. The loop formed by bending spring 27 over the end of tube 2 will also help prevent the manipulator Figure 11 from moving from its clamped position. The manipulator Figure 11 is assembled into the manipulator actuating/positioning system Figure 9 by inserting braided wire 28 through opening 24 in clamp 19 and through the holes in slide 5 and the hole in the Teflon tube at position 20. Then braided wire 28 is passed through the countersunk hole 21 in lever 10. Soft tube 2 along with spring 27 are advanced with braided wire 28 through opening 24 in clamp 19 into the hole at position 20 in slide 5 and clamp 19 is tightened. A round brass ball drilled through the center is soldered to braided wire 28 just above lever 10 or some other suitable device attached to braided wire 28 which won't move along braided wire 28 once attached. A variation of construction could also allow the manipulator Figure 11 to be snapped into the manipulator actuating/positioning system Figure 9 making it more easily serviced or disposable. The manipulator Figure 11 is inserted through hole 11 and protrudes out the hole in fitting 3. Slot 18 is placed over the stud protruding from slide track 15 at hole 17. Slide 5 is rested in slide track 15 and wing nut 4 is threaded onto the protruding stud protruding from slide track 15 hole 17 and made snug. Wing nut 4 is loosened and slide 5 is moved up or down in slide track 15 to adjust the position of the manipulator Figure 11. In operation, the distal end beginning with tip 1 of the manipulator Figure 11 is inserted through the endotracheal tube adapter then through the endotracheal tube and the adapter inserted into fitting 3. Wing nut 4 is loosened and the device adjusted to position tip 1 just inside the distal end of the endotracheal tube and wing nut 4 is re-tightened. After visualizing both nasal passages with a nasal speculum, applying a vasoconstrictor, lubricating the outside of the endotracheal tube and inserting a quantity of lubricant into the patient's nostril selected for tube passage, the tip of the endotracheal tube is inserted into the nostril. Lever 10 is squeezed together with handle 6 causing the proximal end of braided wire 28 to be drawn up toward handle 6 and providing potential flexion as illustrated in Figure 11. The endotracheal tube is advanced over the hard palate and soft palate and will curve over the soot palate into the posterior nasal pharynx then oral pharynx. At this point it ould probably be best to discontinue squeezing lever 10 and handle 6 to avoid stimulating a gag reflex. While listening through a stethoscope headset attached to port 7 and while advancing the endotracheal tube, rotate the device gently, gradually squeezing and/or releasing lever 10 and handle 6 until the loudest breath sounds are heared near the patient's glottic opening. Advance the endotracheal tube through the patient's vocal cords into the patient's trachea as the patient breathes in. Movement of one-way valve 13 on inspiration, movement of one-way valve 14 on expiration, fogging of tube 9 on expiration and continued loud breath sounds in the stethoscope headset attached to port 7 will confirm proper final placement of the endotracheal tube in the patient's airway. The nasal intubation adjunct is removed by holding the adapter on the endotracheal tube with one hand and with a turning/pulling motion removing the nasal intubation adjunct with the other hand. As per standard operating procedures, breath sounds over both right and left fields should be auscultated to confirm proper placement of the endotracheal tube. If breath sounds indicate one or the other main stem bronchi, usually the right, has been entered, withdraw the tube slightly until the problem is corrected. The endotracheal tube cuff is inflated, the tube is secured in place and the procedure is complete. Many variations of the hereinbefore described embodiment are possible for example, an audible tone generated in the nasal intubation adjunct, a bright light at the distal end of the manipulator with batteries contained in the body of the unit, an attachment for nasal pharyngeal airways, electronic amplification of sounds heard through the nasal intubation adjunct, a disposable section, a variety of materials and methods of fabrication.

Claims: An instrument for allowing an operator to insert a nasally placed airway tube into a patient, said instrument comprising: a body having a first opening (11) extending therethrough, tube attachment means (3) for attaching an airway tube to said body and for allowing the airway tube to cooperate with said first opening (11) in said body; manipulator means including adjustable projection means (2, 27, 28) insertable into said body and the airway tube through said first opening (11); and handle means (10) for allowing the operator of said instrument to control the adjustable projection means (2, 27, 28) in a manner to flex the airway tube, characterised by means (13, 14) attached to a second opening in the body connected to the first opening for detecting breathing sounds; a slide (5) mounted to said manipulator and slidably engaging a slide track (15) located on said body and extending parallel to said first opening (11), whereby said manipulator may be adjusted to a plurality of positions to accommodate a plurality of airway tube lengths. An instrument according to Claim 1 characterised in that said means attached to a second opening further comprises a first one way valve (14) connected to allow air to be exhaled by the patient through the airway tube; and a second one way valve (13) connected to allow air to be inhaled by the patient through the airway tube. An instrument according to Claim 2 characterised in that said first one way valve (14) is mounted to direct exhaled air in a direction substantially perpendicular to said first opening (11). An instrument according to Claim 2 characterised in that said second one way valve (13) is mounted to receive air in a direction substantially perpendicular to said first opening (11). An instrument according to any preceding claim characterised in that said adjustable projection means (2, 27, 28) further comprises a soft tube (2) having a top opening at one end thereof, a closed tip at an other end thereof, and a hollow centre extending from said top opening to said tip, a spring (27) extending from said top opening toward said tip and having a distal end located substantially at said tip, constricting means (28) for pulling said distal end of said spring (27) toward said top opening, said constricting means (28) being attached to said spring (27) at said distal end, and extending through said soft tube (2) to said top opening to attach to said handle means (10) whereby said adjustable projection means is flexed by adjusting said handle means (10). An instrument according to Claim 5 characterised in that said constricting means comprises a cable (28). An instrument according to any preceding claim characterised in that said means for detecting breathing sounds comprises a stethoscope. An instrument for allowing an operator to insert a nasally place airway tube into a patient, said instrument comprising: a body having a first opening (11) extending therethrough, tube attachment means (3) for attaching the airway tube to said body and for allowing the airway tube to cooperate with said first opening (11) in said body, said tube attachment means (3) comprising a connecting fitting for receiving the airway tube, manipulator means for flexing the airway tube, said manipulator means being insertable into said body and the airway tube through said first opening (11), said manipulator means further comprising an adjustable projection means (2, 27, 28) extending into the airway tube for flexing the airway tube, said adjustable projection means comprising a soft tube (2) having a top opening at one end thereof, a closed tip at an other end thereof, a hollow centre extending from said top opening toward said tip, a spring (27) extending from said top opening towards said tip, and constricting means (28) for pulling said distal end of said spring (27) towards said top opening, said constricting means being attached to said spring (27) at said distal end, and extending through said soft tube (2) and said top opening to attach to handle means (10) for allowing the operator of said instrument to control said adjustable projection means, whereby said adjustable projection means (2, 27, 28) is flexed by adjusting said handle; characterised by means (13, 14) attached to a second opening in the body connected to the first opening for detecting breathing sounds, said means comprising a first one way valve (14) connected to a central passageway (9) in the fitting cooperating with the first opening (11) and for allowing air exhaled by the patient through the airway tube to exit said instrument in a direction away from said first opening (11), and a second one way valve (13) connected to said central passageway (9) for allowing air inhaled by the patient through the airway tube to enter said instrument. An instrument according to Claim 8 characterised in that said constricting means comprises a cable. An instrument according to Claim 8 or to Claim 9 characterised in that said means for detecting breathing sounds comprises a stethoscope. An instrument according to any one of Claims 8 to 10 characterised in that said second opening is connected to said central opening. An instrument for allowing an operator to insert a nasally placed airway tube into a patient, said instrument comprising: a body having a first opening (11) extending therethrough; tube attachment means for attaching the airway tube to said body and for allowing the airway tube to cooperate with said first opening (11) in said body, said tube attachment means (3) comprising a connecting fitting for receiving the airway tube, manipulator means for flexing the airway tube, said manipulator means being insertable into said body and the airway tube through said first opening (11), said manipulator means comprising handle means (10) for allowing the operator of said instrument to control said manipulator means, adjustable projection means (2, 27, 28) extending into the airway tube for flexing the airway tube and comprising a soft tube (2) having a top opening at one end thereof, a closed tip at an other end thereof, and a hollow centre extending from said top opening to said tip, said soft tube (2) being attached to said handle means (10), a spring (27) having a first end attached to said top opening and having a distal end located substantially at said tip, cable means (28) for pulling said distal end of said spring (27) towards said top opening, said cable means (28) being attached to said spring (27) at said distal end, and extending through said soft tube (2) and said top opening to attach to said handle means (10) characterised by a first one way valve (14) connected to a central passageway in the fitting cooperating with the first opening (11) and for allowing air exhaled by the patient through the airway tube to exit said instrument in a direction away from said first opening (11), and a second one way valve (13) connected to said central passageway for allowing air inhaled by the patient through the airway tube to enter said instrument, stethoscope means attached to said central passageway for detecting breathing sounds, and means slidably attaching said handle means (10) to the body.

Inventors: CHENOWETH DAVID, CHENOWETH, DAVID
Applicants: MEDICAL DEVICES INC, MEDICAL DEVICES, INC.
Application year: 1990
Main classification: A61M16
IPC codes: A61M16