Abstract:
A system for the management of medical tubing, the system includes a tube holder adapted for receiving and retaining medical tubes, and a clip adapted to be engaged with a substrate, in which the tube holder may be releasably engaged with the clip.

Description:
[0001]    This application claims the benefit of United Kingdom Patent Application Ser. No. 0908691.9, filed May 20, 2009, which is hereby incorporated by reference in its entirety. 
       FIELD 
       [0002]    This invention relates to improvements in the management of medical tubing, and in particular to apparatus for improving the organization of tubes that connect a patient to one or more items of medical equipment. 
       BACKGROUND 
       [0003]    In clinical environments, a patient may be connected to one or more items of medical equipment by a number of tubes of various kinds For instance, breathing circuits, pressure or data lines may connect the patient to equipment such as ventilators or anaesthesia machines. As a result, a multitude of tubes of varying lengths and diameters may be draped over the bed or operating table on which the patient lies, as well as over equipment in the vicinity of the bed or operating table and over the patient himself. 
         [0004]    Not least for reasons of patient safety, it is considered good practice for such a multiplicity of tubes to be organized into tidy and manageable groups, and many attempts have been made in the past to facilitate management of medical tubes in this way. Many different designs of clip have been proposed, the effects of which have been to couple together bundles of tubes into a group. Other designs have included the facility to fix the clip to an external support, such as a metal clamp. 
         [0005]    Hitherto, no entirely satisfactory system for the management of medical tubes has been provided, and it is an object of this invention to provide a system that improves upon previously-disclosed attempts to address this need. 
       SUMMARY 
       [0006]    According to a first aspect of the invention, there is a provided a system for the management of medical tubing, the system including a tube holder adapted to receive and retain at least one medical tube, and a clip adapted to be engaged with a substrate; wherein the tube holder and the clip are provided with cooperating formations such that the tube holder may be releasably engaged with the clip. 
         [0007]    The tube holder may itself constitute a clip with resilient limbs that define a tube-receiving space. Such a holding clip may be engaged with a tube at a point intermediate the ends of the tube. Most preferably, the tube holder has the form of a holding clip with resilient limbs that define a plurality of tube-receiving spaces, and so is adapted to couple together a plurality of medical tubes. The tube holder may be configured such that the tube-receiving spaces are of dimensions appropriate to types of differing medical tubes that are commonly used together, e.g., the tube holder may be adapted to couple together a plurality of tubes having various standard diameters. 
         [0008]    Alternatively, the tube holder may have the form of a closure adapted to be engaged with the open end of a tube that is not in use, thereby closing the open end of the tube and preventing ingress of dust or the like during the period in which the tube is not being used. 
         [0009]    The substrate with which the clip may be engaged may be any suitable surface or item conventionally found in the vicinity of a patient in a clinical setting. In certain embodiments, the clip may have a pair of resiliently biased jaws that may be caused to part to enable the clip to be attached to a substrate such as bed linen on the patient&#39;s bed, or to the patient&#39;s clothing or to surgical drapes, or to the frame of the patient&#39;s bed or to other suitably shaped hardware in the vicinity. In other embodiments, the clip may be configured such that it can be engaged with a rail of the type that is commonly present on medical equipment used at a patient&#39;s bedside or in an operating theatre, such as a ventilator or an anaesthesia machine. Other forms of fastening may also be used, e.g., adhesive pads or hook-and-loop fasteners. 
         [0010]    The cooperating formations of the clip and the tube holder most conveniently take the form of a projection, i.e., a lug or stud, on one of those components that is releasably received within a recess or opening in the other. Most commonly, the projection is formed on the tube holder. The projection advantageously has an enlarged head and the recess or opening is configured in such a way as to retain that enlarged head. 
         [0011]    The projection may be releasably received within the corresponding recess or opening with a push-fit engagement. For example, the projection may be retained within the corresponding recess or opening by the action of gravity. Alternatively, the projection may be retained within the corresponding recess or opening by a latch or the like. 
         [0012]    Typically, the system according to the first aspect of the invention is for the management of respiratory tubing. 
         [0013]    Thus, in another aspect of the invention, a holder for a medical tube includes a pair of limbs that define a tube-receiving space into which the medical tube may be inserted, wherein the holder is provided with a projection that may be engaged with a clip that is, or may be, fastened to a substrate. 
         [0014]    Typically, the holder further includes a pair of resilient limbs for receiving one or more wires, and most preferably a plurality of wires, therebetween. These wires may be wires that lead to sensors or the like. In presently preferred embodiments, where the holder has two or more tube-receiving spaces, the wire-receiving space defined by these resilient limbs is located between adjacent tube receiving spaces defined by the holder. Each of the resilient limbs may include a plurality of recesses which define depressions for receiving the wires. The ends of the limbs may be bent outwardly to define an entrance for the wires. 
         [0015]    According to a further aspect of the invention, there is provided a clip for use with a system according to the first aspect of the invention, wherein the clip is adapted to be engaged with a substrate, and the clip includes a recess or opening adapted to releasably receive a projection of the tube holder. Typically, the tube holder has an enlarged head and the recess or opening of the clip is configured in such a way as to retain that enlarged head. 
         [0016]    For many applications, the clip incorporates a retainer for preventing disengagement of the tube holder from the clip. Such a retainer may take the form of a latch or the like that prevents inadvertent disengagement, but which can be released in order to permit disengagement. 
         [0017]    In a particular embodiment of the clip according to the invention, the clip includes a pair of jaw members that are biased by a spring to an operative condition in which the jaw members grip a substrate located, in use, between them, and at least one of said jaw members includes a recess adapted to receive and retain a projection provided on a holder for a medical tube, and a latch mechanism retains the projection within the recess, wherein the spring and the latch mechanism are integrally formed such that the spring may be resiliently deformed in a first plane, and the latch mechanism may be resiliently deformed in a second plane that is substantially transverse to the first plane. Such embodiments permit, in a particularly convenient manner, independent opening of the jaw members to permit engagement of the clip with a substrate and release of the latch mechanism to permit disengagement of the tube holder from the clip. 
         [0018]    Most conveniently, the components of the present invention are manufactured in plastics material, most commonly by injection moulding. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0019]    Embodiments of the invention will now be described in greater detail, by way of illustration only, with reference to the accompanying drawings, in which: 
           [0020]      FIG. 1  is a side view of a first embodiment of a clip according to the invention; 
           [0021]      FIG. 2  is a plan view of the clip of  FIG. 1 ; 
           [0022]      FIG. 3  is a sectional view on the line III-III in  FIG. 2 ; 
           [0023]      FIG. 4  is a sectional view on the line IV-IV in  FIG. 3 ; 
           [0024]      FIG. 5  is a perspective view of a second embodiment of a clip according to the invention; 
           [0025]      FIG. 6  is a side view of the clip of  FIG. 5 ; 
           [0026]      FIG. 7  is a perspective view of a first embodiment of a tube holder according to the invention; 
           [0027]      FIG. 8  is a side view of the tube holder of  FIG. 7 ; 
           [0028]      FIG. 9  is a perspective view of a second embodiment of a tube holder according to the invention; 
           [0029]      FIG. 10  is a side view of the tube holder of  FIG. 9 ; 
           [0030]      FIG. 11  is a perspective view of a tube cap according to the invention; 
           [0031]      FIG. 12  is a side view of the tube cap of  FIG. 11 ; 
           [0032]      FIG. 13  is a perspective view of the tube holder of  FIG. 7  engaged with the clip of  FIG. 1 ; 
           [0033]      FIG. 14  is a perspective view of the tube holder of  FIG. 7  engaged with the clip of  FIG. 5 ; and 
           [0034]      FIG. 15  shows schematically a number of different ways in which tubes may be organized using tube holders of the form illustrated in  FIGS. 7 and 9 . 
       
    
    
     DETAILED DESCRIPTION 
       [0035]    Referring first to  FIGS. 1 to 4 , a first embodiment of a clip according to the invention is generally designated  10 . The clip includes first and second jaws  11 ,  12  that are formed as a single component by injection moulding and are pivotally connected by an integral hinge  13  in a central region thereof. The jaws  11 ,  12  are biased to a closed, operative condition (as shown in the drawings) by a resilient leaf spring  14 . The jaws  11 ,  12  are dimensioned and configured such that they can be squeezed together, against the action of the spring  13 , between the thumb and forefinger of a user&#39;s hand. The outwardly directed surfaces of the jaws  11 , 12  are provided with ridged finger grips  15 ,  16  to facilitate such action. By squeezing the jaws  11 ,  12  together, the distal ends of the jaws  11 ,  12  are moved apart, enabling the clip  10  to be engaged with, for instance, the patient&#39;s bed linen (e.g., a pillow, blanket or sheet) or to a surgical drape or the patient&#39;s clothing or any other convenient substrate. Release of the jaws  11 ,  12  causes the clip  10  to return to the closed, operative condition, the bed linen or other substrate being held securely between the distal ends of the jaws  11 ,  12 , such that the clip  10  is anchored to that substrate. To further enhance the secure attachment of the clip  10  to the substrate, the juxtaposed distal ends of the jaws  11 ,  12  are provided with teeth  17 ,  18  that engage with the substrate. 
         [0036]    The leaf spring  14  is formed integrally with a latching mechanism that is accommodated within a hollow interior of the first jaw  11  and is shown most clearly in  FIG. 4 . The latching mechanism includes a detent  19  that is biased by a resilient limb  20  into the position shown in  FIG. 4 . An extension of the detent  19  constitutes an actuator  21 , that protrudes through an opening in the side of the first jaw  11 . By depression of the actuator  21 , the detent  19  can be displaced from the position shown in  FIG. 4 , against the action of the resilient limb  20 . The detent  19  is formed with an arcuate recess that constitutes a lug receiving space  22 . The underside of the detent  19  is undercut such that the recess denoted  22  in  FIG. 4  is of greater dimension than the arcuate recess in the upper surface of the detent  19  (which is visible in  FIG. 2 ). 
         [0037]    The first limb  11  is formed with a slot  23  that terminates in registration with the lug receiving space  22 . As can be seen in  FIG. 2 , the detent  19  is visible in the space beneath the slot  23 , but can be displaced from the slot  23  by depression of the actuator  21 . The edge of the detent  19  is angled relative to the slot  23  so that when a tube holder is engaged with the clip  10  by insertion of a lug into the slot  23 , as described below, the lug bears against the detent  19  with a camming action, so that the detent  19  is displaced against the action of the resilient limb  20 . 
         [0038]    The clip  10  includes just two components: the hingedly connected first and second jaws  11 ,  12  and the leaf spring  13 /latching mechanism assembly. The clip  10  is assembled by snap-fitting the latter assembly into the hollow interior of the first limb  11 . The end of the leaf spring  14  is formed with a slot  24  that engages a small peg  25  on the internal surface of the first jaw  11 , to anchor the leaf spring  14  in place. 
         [0039]    The clip  10  is used in association with tube holders of the type illustrated in  FIGS. 7 to 10  and/or the tube cap of  FIGS. 11 and 12 . 
         [0040]    Referring to  FIGS. 7 and 8 , a first embodiment of a tube holder is generally designated  40 . The tube holder  40  is formed by injection moulding in plastics material and includes outer resilient limbs  41 ,  42  that are together arranged generally in a C-shape. A third, intermediate limb  43  is disposed between the outer limbs  41 ,  42  and divides the space between those outer limbs  41 ,  42  into several tube receiving spaces. A first tube receiving space  40 A is defined between the limbs  41  and  43 . The space  40 A is dimensioned such that a first, relatively large diameter (e.g. 22 mm) tube can be closely received within it. The juxtaposed surfaces of the limbs  42  and  43  are countoured in such a way that three further tube receiving spaces  40 B,  40 C and  40 D are defined. These spaces are dimensioned to receive relatively small diameter tubes. 
         [0041]    The rear face of the clip  40  is formed with a stud-like projection or lug  44  with an enlarged head  45 . 
         [0042]    In use, the tube holder  40  is engaged with the clip  10  by insertion of the lug  44  into the slot  23 . The lug  44  bears against the edge of the detent  19 . When the lug  44  is pressed into the slot  23 , the detent  19  is displaced , allowing the lug  44  to travel fully into the slot  23 . When the lug  44  clears the end of the detent  19 , the detent  19  returns to the position shown in  FIG. 2 , where it acts as a latch, captivating the lug  44  within the slot  23 . The enlarged head  45  of the lug  44  is held within the enlarged space  22  in the underside of the detent  19 . 
         [0043]      FIG. 13  shows a tube holder  40  engaged with a clip  10  in this manner. 
         [0044]    In order to bundle medical tubes together, and secure them to, for instance, a patient&#39;s bed, the following operations are carried out: 
         [0045]    a) the tubes are inserted into the tube-receiving spaces in the tube holder  40 ; 
         [0046]    b) the tube holder  40  is engaged with the clip  10 ; and c) the clip  10  is fastened to the bed linen. 
         [0047]    These operations may be carried out in any order. For instance, the tubes may be inserted into the tube holder  40  and/or the clip  10  attached to the bed linen, before the tube holder  40  is engaged with the clip  10 , or the tube holder  40  may be connected to the clip  10  before the tubes are inserted into the tube holder  40  and/or the clip  10  is engaged with the bed linen. 
         [0048]    To release the tube holder  40  from the clip  10 , the actuator  21  is depressed, thereby displacing the detent  19  and allowing the lug  44  to be drawn out of the slot  23 . 
         [0049]      FIGS. 9 and 10  show a second form of tube holder, generally designated  50 . This embodiment is similar in concept to that of  FIGS. 7 and 8 , save that its outer limbs  51 ,  52  are configured to define two receiving spaces  50 A and  50 B, for relatively large diameter tubes. Two intermediate limbs  53 ,  54  are provided, and are contoured such that three further tube-receiving spaces  50 C,  50 D,  50 E are defined between them, for relatively small diameter tubes. The tube holder  50  can thus accommodate up to five tubes. Like the embodiment of  FIGS. 7 and 8 , the tube holder  50  is formed with a lug  55  having an enlarged head  56 . The tube holder  50  can be coupled to the clip  10  in exactly the same manner as the tube holder  40  of  FIGS. 7 and 8 . 
         [0050]      FIG. 15  shows schematically the manner in which bundles of medical tubes of various diameters may be held within tube holders of the form depicted in  FIGS. 9 and 10  ( FIG. 15(   a )-( c )) or the form depicted in  FIGS. 7 and 8  ( FIG. 15(   d )), as follows: 
         [0051]      FIG. 15(   a ): arrangement of two tubes with an approximate 10 mm diameter and two smaller tubes in a tube holder of the form shown in  FIGS. 9 and 10 , and having a first (smallest) size; 
         [0052]      FIG. 15(   b ): arrangement of five tubes, two with and approximate 15 mm diameter and three smaller tubes in a tube holder of the form shown in  FIGS. 9 and 10 , and having a second (intermediate) size; 
         [0053]      FIG. 15(   c ): arrangement of five tubes, two with an approximate 22 mm diameter and three smaller tubes in a tube holder of the form shown in  FIGS. 9 and 10 , and having a third (largest) size; and 
         [0054]      FIG. 15(   d ): arrangement of four tubes, one with an approximate 22 mm diameter and three smaller tubes in a tube holder of the form shown in  FIGS. 7 and 8 . 
         [0055]    Referring now to  FIGS. 5 and 6 , a second form of clip according to the invention is designated  60 . The clip  60  includes front and rear downwardly depending limbs  61 ,  62 , with a space between them that permits the clip  60  to be hooked over a rail (not shown), as commonly forms part of medical equipment, e.g., a ventilator or anaesthesia machine, disposed alongside a patient&#39;s bed of an operating table. The rear limb  62  is formed with an inwardly projecting lip  65  to facilitate retention of the clip  60  on such a rail. The clip  60  may alternatively be fastened to a substrate by an adhesive pad (not shown) applied to the back of the rear limb  62 . 
         [0056]    The front limb  61  of the clip  60  has a greater depth than the rear limb  61 , and is hollow. The front surface of the clip  60 , including an inclined upper face of the front surface, is formed with a slot  63  having an enlarged upper part that is able to receive the enlarged head  45 ,  56  of the lug  44 ,  55  of a tube holder  40 ,  50 . The lower part of the slot  63  is narrower, such that the enlarged head  45 ,  56  is retained behind it. Thus, a tube holder  40 ,  50  can be coupled to the clip  60  simply by inserting the lug  44 ,  55  into the slot  63 . Since the clip  60  incorporates no means for positive retention of the tube holder  40 ,  50 , but instead relies on gravity, the clip  60  can generally only be used in an upright orientation, unlike the clip  10  of  FIGS. 1 to 4 . An exception to this would be where the head  45 ,  56  of the lug  44 ,  55  is received within the slot  63  with an interference fit. In another alternative, the lug  45 , 56  could have a snap fit with the slot  63 . 
         [0057]      FIG. 14  shows a tube holder  40  engaged with a clip  60 . 
         [0058]    Finally,  FIGS. 11 and 12  depict a tube cap  70  that may also be used with a clip according to the invention. The tube cap  70  is generally cylindrical, with one closed end  71  and being open at the other end  72 . The open end  72  of the cap  70  has a peripheral flange  73 , and carries a projecting lug  74  with an enlarged head  75  (similar to the lug  44 ,  55  and enlarged head  45 ,  56  of the tube holders described above). 
         [0059]    The tube cap  70  is used particularly where medical tubes are disconnected from a patient but are to be reused, or where a breathing system is set up and rested on the machine prior to use. The end of the tube is inserted into the open end of the cap  70 , which prevents ingress of dust or the like during the period in which the tube  70  is not in use. The cap  70  may then be coupled to a clip of one of the types described above, such that the tube is stowed in an orderly fashion. It is envisaged that the clip that is used in this way will most commonly be the clip  60  of  FIGS. 5 and 6 . 
         [0060]    Although preferred embodiments have been depicted and described in detail herein, it will be apparent to those skilled in the relevant art that various modifications, additions, substitutions, and the like can be made without departing from the spirit of the invention and these are therefore considered to be within the scope of the invention as defined in the claims which follow.