Abstract:
A multilumen tracheal tube or catheter is disclosed. The tube has a plurality of suction lumens, each having a suction port. A rotatable suction port collar is provided. The suction port collar has an inlet and an outlet. The collar overlaps each suction port and is capable of selectively occluding a number of the suction ports while enabling unimpeded passage between a remainder of the ports and the outlet.

Description:
BACKGROUND  
       [0001]     The present invention relates to a tracheal tube used for mechanical ventilation of a hospital patient, by insertion of the tube into the trachea of the patient. In particular, the present invention relates to a tracheal tube having means for irrigating and/or evacuating contaminated secretions accumulating above the tracheal tube cuff and thereby reducing the risk of such contaminated secretions entering the lungs of the patient.  
         [0002]     Tracheal intubation involves the insertion of a tubular device, known as a tracheal tube, into the trachea of a patient. The tracheal tube passes through the trachea and terminates at a position above the carina, anterior to a position between the second and fourth thoracic vertebrate. Gases may then be introduced through the tracheal tube and into the lungs of the patient.  
         [0003]     The primary purposes of tracheal intubation, are to mechanically ventilate the patient&#39;s lungs, when a disease prevents the patient from normal, breathing induced ventilation, or to apply anesthetic gases during surgical intervention. In order to create enough air pressure to accomplish such mechanical ventilation and to prevent escape of gases past the tube, it is necessary to seal the passageway around the tracheal tube. A seal may be produced by the use of an inflatable cuff formed integrally with and surrounding the tracheal tube. When the tracheal tube has been introduced into the patient&#39;s trachea, the inflatable cuff will normally be located about 3 to 5 centimeters above the carina and within the tube-like trachea.  
         [0004]     The inflatable cuff is then inflated so as to engage the wall of the trachea and thereby seal the trachea and prevent gases being introduced through the tracheal tube from simply backing up around the tube. While treatment of this sort has proved successful for patients having chronic or acute respiratory diseases, there is a constant risk of several complications.  
         [0005]     In particular, many patients receiving tracheal intubation develop pneumonia, resulting from an infection of the lungs, possibly induced by contaminated, pooled secretions entering the trachea and the lungs after bypassing the epiglottis during intubation. The epiglottis normally operates as a valve which selectively closes the entry into the trachea and lungs, to prevent the introduction of secretions and particulate matter. However, when a tracheal tube is in place, the epiglottis is held in an open position, and secretions which would normally be directed away from the trachea and into the digestive system, instead follow the path of the tracheal tube and pool above the inflatable cuff of the tracheal tube.  
         [0006]     The greatest risk of such infectious secretions reaching the lungs is upon the cessation of mechanical ventilation. In particular, when the need for tracheal intubation ends, the inflatable cuff of the tracheal tube is deflated so that the tracheal tube may be withdrawn from the patient. The infectious secretions which have pooled above the inflatable cuff are then released and are free to flow into the lungs, where bronchitis or pneumonia may rapidly develop. There is also the risk of the infectious secretions reaching the lungs while intubated, by aspiration of the secretions past the tracheal tube cuff.  
         [0007]     To overcome these risks, it is known in the prior art to combine a single lumen suction tube with a tracheal tube. The suction tube is joined to the tracheal tube in a suitable manner, the end of the suction tube terminating at a position above the inflatable cuff. The suction tube provides means for suction or evacuation of any pooled secretions which accumulate in the trachea above the inflatable cuff. However, such prior art devices have the disadvantage that use of a single lumen for the suction tube often causes direct suction to be exerted on the tracheal mucosa which may then result in damage to the mucosa.  
         [0008]     U.S. Pat. No. 4,840,173 to Porter III, describes an endotracheal tube having a single lumen suction tube merged thereto. In particular, this patent describes a device wherein the suction tube is laminated to the outside of the ventilation tube, so that the suction tube terminates at a position just above the inflatable cuff. The suction tube includes multiple openings which may be used to evacuate secretions which pool above the inflatable cuff. In addition, the inflatable cuff includes a section immediately adjacent to the end of the suction tube that is less flexible than the rest of the inflatable cuff, to insure that the flexible material of the inflatable cuff is not sucked up against the suction tube openings. The endotracheal tube described in the Porter III patent has the disadvantages noted above, that the single lumen suction tube may exert suction on the tracheal mucosa and thereby cause damage to the mucosa. Further, the Porter III device is of a relatively complex design, requiring difficult processing, resulting in expensive production.  
         [0009]     U.S. Pat. No. 5,143,062, issued to Peckham, discloses an endotracheal tube comprising a double lumen through which air may be circulated, creating an indirect gentle suction through a suction eye communicating with the distal ends of the lumens, and located at a position proximal to the inflation cuff. This design, however, does not provide adequate suction necessary for aspirating secretions and is easily occluded.  
         [0010]     The above noted patent references fail to adequately address the suctioning of secretions which have pooled above the inflatable cuff in a manner that is sufficient to accomplish the task but is not so strong so as to cause damage to the mucosa. Moreover, these references and other conventional endotracheal and tracheal tubes lack the ability to suction these secretions, even when a patient is turned according to nationally instituted decubitus prevention protocols. That is, they fail to provide alternative suction capabilities in the event the patient is turned or in the event the desired suction lumen is occluded by secretions.  
         [0011]     As the background devices fail to disclose a tracheal tube and suction catheter system having these structural characteristics, the need for such a device is apparent. The instant invention addresses this by providing a multilumen tracheal tube and suction catheter system comprising a device that enables the surgical team to direct suctioning to any number of lumens within the tracheal tube.  
       SUMMARY OF THE INVENTION  
       [0012]     The present invention improves upon a tracheal tube. In one embodiment, a tube having a first wall and a second wall concentric to the first wall is provided. The first wall surrounds and defines a ventilation lumen which is adjacent to a first surface. The first wall may be attached at a second surface to a first surface of the second wall at a plurality of partitions. This enables a plurality of suction lumens to be defined by the second surface of the first wall, the first surface of the second wall, and surfaces of adjacent partitions. Each suction lumen would have a suction port formed through a portion of the second wall. A suction port collar having an inlet and an outlet is also provided. The collar surrounds the tube and overlaps the suction ports. The collar is selectively positionable so as to enable fluid communication between the inlet and at least one suction port while occluding any remaining suction port. The outlet of the suction port would be adapted to connect to a suction source.  
         [0013]     In some embodiments, the suction port collar is rotatable about the tube. In other embodiments a guide may be provided. Such a guide may be coupled to the tube and disposed over each suction port, the guide would have openings aligned with each suction port, and the suction port collar would be rotationally attached to the guide. The collar may be configured as a cylindrical ring having an inner diameter, an outer diameter, and a tubular conduit affixed substantially normal to a plane tangential to the outer diameter.  
         [0014]     The inlet to the collar is at that end of the conduit coincident with the inner diameter, and the outlet is at the opposite end of the conduit. The inlet may be capable of aligning with only a single suction port at any one point in time, a multiple of such suction ports, or no suction port.  
         [0015]     In another embodiment, a tracheal tube having a plurality of suction lumens, each suction lumen having a suction port; and a suction port collar may be provided. The suction port collar may have an outlet and an inlet. The collar may overlap each suction port, a portion of the collar selectively occluding a number of the ports while enabling unimpeded passage between a remainder of the ports and the outlet. Such a tube may contain a ventilation lumen as well as suction lumens which are radially disposed about an outer diameter of the ventilation lumen. Each suction lumen may have an inlet and an outlet, the outlet corresponding to at least one of the suction ports. Such a tube may be provided with an inflatable cuff sealed to and surrounding the tube at a distal end adapted to seal the trachea of a patient. Each suction lumen would have an inlet port proximal to the inflatable cuff and terminate at one of the suction ports distal from the inflatable cuff.  
         [0016]     Other objects, advantages and applications of the present invention will be made clear by the following detailed description of a preferred embodiment of the invention and the accompanying drawings wherein reference numerals refer to like or equivalent structures. 
     
    
     BRIEF DESCRIPTION OF THE DRAWINGS  
       [0017]      FIG. 1  is diagrammatic illustration of one embodiment of a multilumen catheter placed within a patient in accordance with the present invention;  
         [0018]      FIG. 2  is an isometric view of the  FIG. 1  multilumen catheter in a straightened configuration;  
         [0019]      FIG. 3  is a cutaway of the  FIG. 1  multilumen catheter viewed through the axial centerline of the multilumen catheter so as to depict the passages therethrough;  
         [0020]      FIG. 4  is a cutaway of the  FIG. 1  multilumen catheter viewed through the radial centerline of the multilumen catheter so as to depict one embodiment of the guide and collar; and  
         [0021]      FIG. 5  is a side cutaway of the  FIG. 1  multilumen catheter viewed through the radial centerline of the multilumen catheter, perpendicular to the  FIG. 4  depiction, so as to depict the guide and collar.  
     
    
     DETAILED DESCRIPTION  
       [0022]     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. It is to be understood that the following description is only exemplary of the principles of the present invention, and should not be viewed as narrowing the pending claims. Those skilled in the art will appreciate that aspects of the various embodiments discussed may be interchanged and modified without departing from the scope and spirit of the invention.  
         [0023]     Referring to  FIG. 1 , a tracheal tube  12  is depicted extending through the mouth  14  and the trachea  16  of the upper respiratory system of patient lo. The tracheal tube lo terminates in a distal end  18  well above the point  20  at the first bifurcation of trachea  16  into the right lung  22  through the right mainstem bronchus  24  and into the left lung  26  through the left mainstem bronchus  28 . Typical sub-branchings of the mainstem bronchus are shown in  FIG. 1  for illustrative purposes in relation to the sub-branching of left mainstem bronchus  24  into left lung  26 .  
         [0024]     The distal end  18  of tracheal tube  12  is provided with a balloon  30  which, when inflated, engages the walls of trachea  16  to facilitate mechanical ventilation of patient lo through a connector  32  coupled to a standard tracheal tube adapter  34  at the proximal end  36  of tracheal tube  12 . As would be understood by those of skill in the art, air from the ventilating apparatus for patient lo enters tracheal tube  12  through one leg of the connector  32 , and correspondingly, air is returned to the ventilating apparatus from patient  10  through a second leg of the connector.  
         [0025]     Looking now to  FIG. 2 , a more detailed view of the tracheal tube  12  may be had. This view depicts the tube  12  in a straightened configuration. A collar  38  is positioned on the tube  12 . The collar  38  rotates about the cannula and provides the user or medical personnel with an ability to select functionalities as explained in greater detail below. An inlet port  40  or a plurality of such inlet ports  40  is provided at desirable locations along the tube  12 . In some embodiments, such inlet ports  40  are located above the balloon  30 , i.e., between the balloon  3 o and the proximal end  36 . In other embodiments, a inlet port or inlet ports  40  are located below the balloon  30 , i.e., between the balloon  30  and the distal end  18 . Some embodiments may have inlet ports on each side of the balloon  30 .  
         [0026]     As shown in  FIG. 3 , the tube  12  is configured as a cannula with a plurality of internal lumens that extend at least partially along the length of the tube  12 . In the  FIG. 3  example, a ventilation lumen  42  is provided at the center of the tube  12 . Surrounding the ventilation lumen  42  are a plurality of lumens, including at least one suction lumen  44 . Many embodiments, such as the  FIG. 3  embodiment contain a plurality of such suction lumens  44  arranged radially about the ventilation lumen  42 . A first wall  46  separates the ventilation lumen  42  from the suction lumen  44 . In this embodiment, a second wall  48  forms the exterior wall of the tube  12 . A plurality of partitions  50  are provided to separate each suction lumen  44  from one another. Each of these walls and partitions may be created via extrusion of the material comprising the tube through an appropriate die during formation of the tube  12  and as such may effectively be considered as a single component having a plurality of lumens situated therein. In any event, the placement of lumens in a tracheal tube is a process that would be understood by those of skill in the art  
         [0027]     As seen in  FIG. 3 , additional lumens, such as an inflation lumen  52  and an irrigation lumen  54  may be provided. The inflation lumen  52  connects the balloon  30  to some means capable of inflating the balloon, thus keeping the tracheal tube  12  adequately sealed and positioned desirably within the trachea  16 . An irrigation lumen  54  may also be provided to enable medical personnel to introduce a lavage solution or to medicate the patient  10 . In some embodiments, one or more of the suction lumens  44  may alternatively be used as irrigation lumens. The collar  38  is provided with an outlet  56  which leads to a suction source (not shown). A guide  58  may also be provided within which the collar  38  is allowed to rotate.  
         [0028]     Turning to  FIG. 4 , a partial cutaway view depicting the internal configuration of one embodiment of the collar  38  is shown. It may be seen that a plurality of suction lumens  44  are shown radially disposed about the ventilation lumen  42 . The suction lumens  44 , in this embodiment, three such lumens extend substantially around the entire cannula with the exception of a region containing the inflation lumen  52 . Each suction lumen  44  contains a suction port  60  that extends through the tube wall or second wall  48 . The collar  38  contains a passage or conduit  62  connecting the outlet  56  to an inlet  64 . Rotating the collar  38  about the tube  12  enables the user or medical personnel to selectively align the inlet  64  within the collar  38  with a specific suction port  6 o within a specific suction lumen  44 . Of course each suction lumen  44  is provided with an inlet port  40  as described above as well as a suction port  60 . By rotating the collar into the desired position, the user or medical personnel is provided with a selectable means with which to suction fluids from the patient  10 .  
         [0029]     The inlet  64  within the collar  38  may be configured so that it accesses more than one suction lumen  44  simultaneously. One manner with which to accommodate this configuration would be to place the suction ports  60  of adjacent lumens  44  proximate to the partitions  5 o between the lumens  44 . Alternatively, the partition  50  may be eliminated at the intersection of the adjacent suction ports  60 . In any event, if the inlet  64  has access to more than one suction lumen  44  at a time, suction on more than one lumen may take place. Furthermore, the collar  38  may be capable of occluding all suction ports  60 . This would effectively eliminate any suctioning capabilities.  
         [0030]     Looking finally to  FIG. 5 , a partial cutaway view normal to the  FIG. 4  view depicts the internal configuration of one embodiment of the collar  38  for additional clarity. This view depicts the tube  12 , the ventilation lumen  42 , one suction lumen  44  separated from the ventilation lumen by the first wall  46  and bounded on the opposite side by second wall  48 . One of the partitions  50  is depicted as well. The suction port  60  may be clearly seen as forming a passage through the second wall  48 . In this view, the inlet  64  of the collar  38  is not aligned with the suction port  60  of lumen  44 , therefore flow or suctioning would be prevented. It should be easy to envision that appropriate rotation of the tubular component forming the passage or conduit  62  to the suction port  60  would enable suctioning.  
         [0031]     In this FIG., details with respect to the guide  58  as well as the collar  38  may be seen. In some embodiments, the guide  58  is secured to the tube  12  such that rotational movement of the guide with respect to the tube is prevented. Appropriate measures should be taken to ensure that the collar  38  is capable of rotation with respect to the guide  58 . For example, a flanged interface  66  between the two components may be used. Such an interface should be fluid tight so as not to enable air leakage into the system when suctioning or to have fluid leakage from the system to the environment. As such, those skilled in the art would understand and be capable of providing an appropriate fluid tight seal to these areas.  
         [0032]     During use, the collar  38  would be rotated to the desired suction lumen  44 . An indicator  68 , for example, such as the one depicted in  FIG. 3  may be provided. An indicator would enable a user to appropriately align the passage or conduit  62  with a specific suction lumen. As such, an indicator may be provided which corresponds to each suction lumen. In lieu or in addition, the collar  38  may be made to incrementally click, lock, or snap into each suctioning position as well as a non-suctioning position. This may be accomplished by any number of means known to those with skill in the art. As can be seen from the FIGs., each suction lumen  44  may be used bi-directionally, that is, each suction lumen may be used to introduce a fluid into the patient. Some such fluids may comprise medicaments, lavage to clean the lumen or the patient&#39;s trachea, as well as other fluids.  
         [0033]     As used herein and in the claims, the term “comprising” is inclusive or open-ended and does not exclude additional unrecited elements, compositional components, or method steps.  
         [0034]     While various patents have been incorporated herein by reference, to the extent there is any inconsistency between incorporated material and that of the written specification, the written specification shall control. In addition, while the invention has been described in detail with respect to specific embodiments thereof, it will be apparent to those skilled in the art that various alterations, modifications and other changes may be made to the invention without departing from the spirit and scope of the present invention. It is therefore intended that the claims cover all such modifications, alterations and other changes encompassed by the appended claims.