Neck flange for trackeostomy tube

Abstract: A neck flange (11) supports a tracheostomy tube (10) inserted into the neck (12) and has a neck engaging portion (21) containing an aperture (25) made of a molded thin flexible flat sheet of a transparent polymer. An interconnection (26) is positioned centrally within the neck engaging portion (21) and carried thereby. It has a ring-shaped body (27) with an opening (28) common to the aperture, and a pair of opposed pivot pins (29) extending inwardly into the opening (28) for carrying the tube (10) passing therethrough. The pair of opposed pins (29) fit for movement within recesses in the tube (10) to permit limited swivel motion about the axis of the pins (29). The interconnection (26) is molded of a transparent polymer material that is less flexible than the neck engaging portion (21) and has a stepped cross section so the pair of opposed pivot pins (29) are raised relative to the ring-shaped body (27). The neck engaging portion (21) is molded about the interconnection (26) so that the raised pair of opposed pins (29) remain exposed. A method for manufacturing the neck flange (11) has the steps of molding a ring-shaped interconnection of a polymer and molding a neck engaging portion (21) about the interconnection (26) by inserting the interconnection into a mold and then molding the neck engaging portion thereabout. A method for using the neck flange (11) has the steps of placing the tracheostomy tube (10) in a patient's neck (12) and swiveling the neck engaging portion (21) relative the tube (10) to conform to the neck (12), flexing the neck engaging portion (21) to conform to the curvature of the neck (12) and observing the condition of the neck (12) under the transparent neck flange (11).

Description: This invention relates to a neck flange for a tracheostomy tube to position and support the tracheostomy tube when inserted into the neck of a human wherein the neck flange contains a flat sheet-like neck engaging portion made of a flexible polymer material and possessing a centrally located aperture and an interconnection made of a polymer material that is less flexible than the polymer material of the neck engaging portion, having a ring-shaped body with an opening therethrough occupying a space that is common to the aperture, and secured to the neck engaging portion, carried as part thereof, the interconnection being connectable to a tracheostomy tube passing through the opening. Such a neck flange, known from US-A-4,304,228, comprises a neck flange with a bushing and an annular collar. The bushing is secured to the neck engaging portion by suitable means such as, for example, an adhesive, whereas the annular collar is rotatably mounted on the bushing. The tracheostomy tube is divided in two parts, the one part being unified with the neck engaging portion and the other part being connectable to said neck engaging portion by said annular collar resulting in a generally non-movable connection between the neck flange and the tracheostomy tube. US-A-5,056,515 discloses a neck flange with a neck engaging portion movably connectable to a tracheostomy tube by an interconnection in the shape of two pivotal tabs integrally formed with said neck engaging portion, i.e. the interconnection and the neck engaging portion are made of the same (flexible or less flexible) material. The invention provides a neck flange according to the preamble of claim 1, the interconnection of which has a pair of opposed pivot pins extending inwardly into the opening towards each other and adapted to carry movably the tracheostomy tube, said ring-shaped body being encapsulated in the polymer of the neck engaging portion with the pair of opposed pivot pins remaining not encapsulated. In such a neck flange all parts meant for engaging the neck of the patient can be made of comfortable flexibly conforming material, whereas the interconnection is made of less flexible material. This is achieved by encapsulating the less flexible material by the flexible material of the neck engaging portion leaving only the pivot pins not encapsulated. Preferably, the interconnection is designed to permit limited swivel motion of the tracheostomy tube relative to the opening and substantially within a plane generally normal to the flat sheet of the neck engaging portion. Further, it is preferred that the interconnection has a stepped cross section so that the pair of opposed pivot pins are raised relative to one of the major surfaces of the ring-shaped body of the interconnection. In case according to a further embodiment of the invention the neck engaging portion and the interconnection are substantially transparent, it is possible for medical practitioners to observe entry of the tube into the neck of the patient. The interconnection can be molded of a polymer having a hardness of approximately 70-100 Shore D per ASTM D-785 and the hardness of the neck engaging portion can be in the range of approximately 85-90 Shore A per ASTM D-2240. The invention further relates to a method for manufacturing a neck flange having a flat sheet-like neck engaging portion of a flexible material and a ring-shaped interconnection of a less flexible material being separately molded from a polymer and then secured to the neck engaging portion, as known from US-A-4,304,228. According to the present invention it is proposed that the ring-shaped interconnection is, during molding, provided with a pair of opposed pivot pins extending inwardly into a central opening of the ring-shaped interconnection, and, after molding, inserted into a mold for molding the neck engaging portion, whereafter polymer is injected in the mold to form the neck engaging portion about the ring-shaped interconnection such that of the ring-shaped interconnection all but the pair of opposed pivot pins is encapsulated in the flat sheet-like neck engaging portion. By overmolding, with exception of the pivot pins, the interconnection made of a less flexible material by the more flexible neck engaging portion, the result is a neck flange that can be used together with a tracheostomy tube having a distal end to be placed in the neck of a human to be a passage and aid for breathing, a proximal end to be positioned outside the neck of the human and a central part between its ends, wherein the central part includes recesses on opposite sides thereof across from one another, the pair of opposed pivot pins being arranged to be fit for movement into said recesses. With reference to the accompanying drawings a preferred embodiment of the neck flange according to the invention will now be further discussed and elucidated. Figure 1 is a perspective view of a neck flange of the preferred embodiment shown with a tracheostomy tube in position against and within the patient's neck and, for clarity, part of the neck and neck flange is sectioned away. Figure 2 is a front end view of the preferred neck flange and again the tracheostomy tube is shown, including a referenced inner cannula and cuff with its inflation tube. Figure 3 is a side view in cross section of the neck flange of Figure 2 as would be seen if the cross section were taken along line 3-3 in Figure 2 and the tracheostomy tube were not included. Figure 4 is a side view in cross section of the neck flange of Figure 3 or as would be seen if the cross section were taken along line 4-4 in Figure 3 and the tracheostomy tube were not included. Figure 5 is front view of the interconnection that is less flexible than the neck engaging portion and insert molded within the neck engaging portion. The invention has as its objectives an improvement in a neck flange system for a tracheostomy tube that includes a relatively flexible neck engaging portion and a relatively rigid interconnection from which the tracheostomy tube is positioned and methods of its manufacture. The invention is not to be construed as limited to the structure for the neck flange described and illustrated by way of example and the methods of manufacture specifically explained. Figure 1 is a perspective view of a tracheostomy tube 10 and neck flange 11 of the preferred embodiment shown with the tracheostomy tube 10 in position against and within the patient's neck 12. For clarity of illustration, part of the neck 12 is shown removed. The tracheostomy tube 10 and neck flange 11 may be used with a tracheostomy procedure on the neck 12 of a human. The tracheostomy tube 10 has a distal end 13 for placement in the neck 12 of the patient to form a passage 14 from the proximal end 15 open to an air source to aid breathing. The tracheostomy tube 10 includes a proximal end 15 positioned outside the human's neck 12 when the tracheostomy tube 10 is in place for use. A central part 16 is between the ends 13 and 15 of tracheostomy tube 10. The central part 16 includes recesses 17 on opposite sides thereof across from one another. Figure 2 is a front end view of the preferred neck flange 11 and the tracheostomy tube 10 is shown including an inner cannula 18 and cuff 19 with its inflation tube 20. As can be seen in Figures 1 and 2 the neck flange 11 has a neck engaging portion 21 made of a thin flexible sheet. The sheet is preferably flat but may be curved. It contains a pair of generally parallel major surfaces 22 and 23 defined by an edge 24 around it, and a generally central aperture 25 extending through it. The neck engaging portion 21 of the preferred embodiment is molded of a flexible, transparent polymer material. The preferred polymer material should have a hardness of less than 85 Shore A, as measured per ASTM D-2240. A hardness in the range of 70 to 85 Shore A with a minimum tensile strength of 138 x 10 5 N/m 2 (2000 psi) as measured per ASTM D-638 is desired. Polymers such as polyvinylchloride, polyurethane or other flexible transparent medical grade polymers may be used for molding the neck engaging portion 21. Preferably, the particular polymer selected should have additives to maintain the relative transparency during and after sterilization by retort, gas or radiation of up to 0,035 J/kg (3.5 rads). Figure 3 is a side view in cross section of the neck flange 11 of Figure 2 as would be seen if the cross section were taken along line 3-3 in Figure 2 with the tracheostomy tube 10 removed or not shown. Interconnection 26 is positioned centrally within neck engaging portion 21 and carried thereby as shown in Figure 3. Interconnection 26 has a ring-shaped body 27 containing centered opening 28 as shown in Figures 3, 4 and 5. A pair of opposed pivot pins 29 extend toward one another in a radial direction inwardly into opening 28 for supporting central part 16 of the tracheostomy tube passing therethrough, as illustrated in Figures 1 and 2. As shown in Figure 3, interconnection 26 has a stepped cross section with the pair of opposed pivot pins 29 raised relative to its ring-shaped body 27. The pair of opposed pins 29 are arranged to be fit for movement into recesses 17 in the tracheostomy tube 10 for permitting limited swivel motion thereof as depicted by arcuate arrows A in Figure 1 and substantially within a plane generally normal to major surface 22 of the neck engaging portion. The interconnection 26 is molded of a transparent polymer material less flexible than the neck engaging portion 21. The preferred polymer material for the interconnection 26 should have a hardness of about 85 Shore D, as measured per ASTM D-785 and an Izod notched of at least 0,0214 Nm/m (4.0 ft lb/in.) tested per ASTM D-256. Polymers, which are relatively strong, rigid and non-yielding, such as polycarbonate or other transparent medical grade polymers are useful for the interconnection 26. The polymer selected should preferably have additives to maintain the relative transparency during and after sterilization by retort, gas or radiation of up to 0,035 J/kg (3.5 rads). Figure 4 is a side view in cross section of the neck flange 11 of Figure 3, or as would be seen if the cross section were taken along line 4-4 in Figure 3 and the tracheostomy tube 10 were not included. Interconnection 26 is injection molded to be used as an insert in the molding of the neck engaging portion 21. The shape of interconnection 26 is shown in Figure 5. As shown there, the mold designs for the interconnection and the neck engaging portion are such that the neck engaging portion 21 leaves the raised pair of opposed pins 29 exposed. Thus, interconnection 26 is made first having the preferred shape depicted in Figure 5. Interconnection 26 is then inserted into an injection mold cavity, having the shape of the neck engaging portion 21 and also accommodating the positioning of interconnection 26. The softer, more flexible polymer is injected into that cavity to form neck engaging portion 21. The resulting neck flange 11 is a combination of materials with neck engaging portion 21 surrounding interconnection 26 with the exception of pivot pins 29. The cross sectional view of Figure 3 shows neck engaging portion 21 encapsulating the ring-shaped body of interconnection 26, and shows that pivot pins 29 are not encapsulated. Figures 2 and 3 illustrate a pair of D shaped holes 30 in neck engaging portion 21. The pair of D shaped holes 30 are used for attachment of a neck band (not shown) which is fitted around neck 12 to hold tracheostomy tube 10 in the entry through neck 12 of the patient. Although D shaped holes 30 are preferred, any shape including oval, elliptical or square, that would conveniently attach to a neck band can be used. Each hole 30 is spaced from the areas in neck engaging portion 21 that encapsulate interconnection 26. The trached 31 is shown with an inflated cuff 19 near the distal end 13.

Claims: A neck flange (11) for a tracheostomy tube (10) to position and support the tracheostomy tube (10) when inserted into the neck (12) of a human wherein the neck flange (11) contains a flat sheet-like neck engaging portion (21) made of a flexible polymer material and possessing a centrally located aperture (25) and an interconnection (26) made of a polymer material that is less flexible than the polymer material of the neck engaging portion (21), having a ring-shaped body (27) with an opening (28) therethrough occupying a space that is common to the aperture (25), and secured to the neck engaging portion (21), carried as part thereof, the interconnection (26) being connectable to a tracheostomy tube (10) passing through the opening (28), characterized in that the interconnection (26) has a pair of opposed pivot pins (29) extending inwardly into the opening (28) towards each other and adapted to carry movably the tracheostomy tube (10), said ring-shaped body (27) being encapsulated in the polymer of the neck engaging portion (21) with the pair of opposed pivot pins (29) remaining not encapsulated. A neck flange according to claim 1, characterized in that the interconnection (26) permits limited swivel motion of the tracheostomy tube (10) relative to the opening (28) and substantially within a plane generally normal to the flat sheet of the neck engaging portion (21). A neck flange according to claim 1 or 2, characterized in that the interconnection (26) has a stepped cross section so that the pair of opposed pivot pins (29) are raised relative to one of the major surfaces of the ring-shaped body (27) of the interconnection (26). A neck flange according to any one of the preceding claims, characterized in that the neck engaging portion (21) and the interconnection (26) are molded of different polymers. A neck flange according to any one of the preceding claims, characterized in that the neck engaging portion (21) and the interconnection (26) are substantially transparent. A neck flange according to claim 5, characterized in that the neck engaging portion (21) and the interconnection (26) retain transparency after sterilization. A neck flange according to claim 5 or 6, characterized in that the neck engaging portion (21) and the interconnection (26) are such that they remain imperceptibly less transparent after a radiation sterilization process of up to 0,035 J/kg (3.5 rads). A neck flange according to any one of the preceding claims, characterized in that the interconnection (26) is molded of a polymer having a hardness greater than that of the polymer of the neck engaging portion (21). A neck flange according to any one of the preceding claims, characterized in that the hardness of the interconnection (26) is 85 Shore D per ASTM D-785 so that the pair of opposed pivot pins (29) are less flexible than the neck engaging portion (21). A neck flange according to any one of the claims 1-8, characterized in that the hardness of the pair of opposed pivot pins (29) is 85 Shore D per ASTM D-785. A neck flange according to any one of the preceding claims, characterized in that the hardness of the neck engaging portion (21) is in the range of 70 to 85 Shore A per ASTM D-2240. A method for manufacturing a neck flange (11) having a flat sheet-like neck engaging portion (21) of a flexible material and a ring-shaped interconnection (26) of a less flexible material being separately molded from a polymer and then secured to the neck engaging portion (21), characterized in that the ring-shaped interconnection (26) is, during molding, provided with a pair of opposed pivot pins (29) extending inwardly into a central opening (28) of the ring-shaped interconnection (26), and, after molding, inserted into a mold for molding the neck engaging portion (21), whereafter polymer is injected in the mold to form the neck engaging portion (21) about the ring-shaped interconnection (26) such that of the ring-shaped interconnection (26) all but the pair of opposed pivot pins (29) is encapsulated in the flat sheet-like neck engaging portion (21). A method according to claim 12, characterized in that the molding process includes the steps of selecting polymers that are flexible and transparent so that the neck engaging portion (21) is more flexible than the ring-shaped interconnection (26) and the combination is transparent. An assembly of a neck flange (11) according to any one of the claims 1-11 and a tracheostomy tube (10) for use in a tracheostomy procedure in the neck of a human, said tracheostomy tube (10) having a distal end (13) to be placed in the neck of a human to be a passage (14) and aid for breathing, a proximal end (15) to be positioned outside the neck of the human and a central part (16) between its ends (13, 15), characterized in that the central part (16) includes recesses (17) on opposite sides thereof across from one another, the pair of opposed pivot pins (29) being arranged to be fit for movement into said recesses (17).

Inventors: CRANDALL NORMAN, DEILY MICHAEL, CRANDALL, NORMAN, DEILY, MICHAEL
Applicants: MALLINCKRODT MEDICAL INC, MALLINCKRODT MEDICAL, INC.
Application year: 1992
Main classification: A61M16
IPC codes: A61M16