U.S. patent number 3,688,773 [Application Number 05/029,064] was granted by the patent office on 1972-09-05 for device for performing a tracheostomy and other surgical procedures.
Invention is credited to Sol Weiss, 17227 Queson Place.
United States Patent |
3,688,773 |
|
September 5, 1972 |
DEVICE FOR PERFORMING A TRACHEOSTOMY AND OTHER SURGICAL
PROCEDURES
Abstract
A device for aspiration, ventilation or visualization
comprising: A. an expandable housing having an end portion tapered
so as to form a means for puncturing, B. a plunger carrying a
hollow tube, C. said tube and said plunger adapted to be inserted
in said housing and movable with respect to said housing such that
the depression of the plunger causes said tube to pass through and
expand said tapered end portion of said housing.
Inventors: |
Sol Weiss, 17227 Queson Place
(Encino, CA 91304) |
Family
ID: |
21847028 |
Appl.
No.: |
05/029,064 |
Filed: |
April 16, 1970 |
Current U.S.
Class: |
128/207.29 |
Current CPC
Class: |
A61M
16/0472 (20130101) |
Current International
Class: |
A61M
16/04 (20060101); A61b 017/32 (); A61b
017/34 () |
Field of
Search: |
;128/305,329 |
References Cited
[Referenced By]
U.S. Patent Documents
Primary Examiner: Channing L. Pace
Attorney, Agent or Firm: I. Morley Drucker, Esq.
Claims
I claim:
1. A device for a surgical procedure comprising, in combination: a.
a housing having an enlarged main portion and an end portion of a
substantially smaller normal diameter than the average diameter of
said enlarged main portion, said end portion comprising at least
two sections which, taken together, taper to a cutting edge so as
to form a means for puncturing human skin, means for holding said
sections of said end portion together to form said cutting edge and
to enable said sections of said end portion to be separable from
each other and expand from said smaller normal diameter; and b. a
hollow tube of smaller diameter than said enlarged main portion of
said housing, said hollow tube being movable through said enlarged
main portion of said housing, said hollow tube being of larger
diameter than said normal diameter of said end portion whereby to
expand said end portion outwardly from its normal diameter as said
hollow tube is moved through said end portion.
2. A device as in claim 1 wherein the hollow tube is of a length
such that when the plunger is in its full depressed position the
lower end of said tube does not extend substantially below said end
portion of said housing.
3. A device as in claim 1 wherein said hollow tube is carried on a
plunger and said plunger has an air passage passing longitudinally
through its center, and in air communication with said hollow
tube.
4. A device as in claim 1 having means for introducing air into
said air tube.
5. A device as in claim 1 wherein said end portion is an arcuate
cutting edge.
6. A device for performing a tracheostomy comprising: a. a two
piece, generally conical, expandable housing having an arcuate
cutting end portion suitable for puncturing, said cutting end
portion being held in position by a circumferentially displaced
expandable ring; b. a plunger carrying a hollow air tube, said
plunger and said air tube positioned in said housing by guiding
means and movable with respect to said housing such that, following
the puncturing of the anterior wall of the trachea with said
cutting end portion, the depression of said plunger will cause the
lower terminal end portion of said air tube to move from a first
position wherein the diameter of said housing is larger than the
outside diameter of said terminal end portion of said air tube to a
second position wherein the diameter of the housing is smaller than
the outside diameter of said terminal end portion of said air tube
to thereby cause said housing, at said second position, to expand
by an amount equal to the outside diameter of said terminal end
portion of said air tube.
7. A device as in claim 6 wherein said second position is at the
terminal end portion of said housing.
8. The device of claim 1 wherein said enlarged main portion of said
housing is generally conical.
9. The device of claim 1 wherein said end portion of said housing
is split so as to be expandable.
Description
Tracheostomy is an operation, the origins of which are lost in
antiquity. Such operations were described by the Egyptians and were
well known in the age of Hypocrates. Its use in ancient times, in
fact, until less than a quarter century ago, was reserved for
relief of obstruction of respiratory passages. In this early
period, tracheostomy was usually resorted to as a dramatic
emergency procedure to relieve obstruction of larynx from dyptheria
and occasionally from foreign body aspiration.
In sharp contrast, the current status of this operation is such
that it is utilized much more frequently by any physician. The
indication for its use has become legion and ill defined. Having
become increasingly aware of the number of fatalities and major
complications associated with this procedure, e.g., a major
hospital has reported a mortality rate of 4.8 percent while the
corresponding figure for appendectomy was 0.78 percent, Texas
Medicine, September 1966, doctors have long sought a simple, safe
device for performing a tracheostomy.
Heretofore, a tracheostomy was a major operation since it required
a knife incision to the throat followed by insertion of a breathing
tube. Such an incision usually results in extensive bleeding and
with the insertion of the breathing tube, numerous complications
may result. For example, following the opening of the anterior wall
of the trachea, the posterior walls of the trachea may be
inadvertently perforated, (1) by inserting the scalpel blade too
deeply, (2) when the cartilage is being cut away from the anterior
wall of the trachea, or (3) when the tracheostomy breathing tube is
placed within the incision, if it is too rapidly and forcibly
inserted through an opening. In addition, the tracheostomy tube may
be inadvertently inserted adjacent to the trachea or into the
superior mediastinum. Furthermore, traumatic pneumothorax may
result from a tear in the parietal pleura caused by use of a
retractor placed in the supra sternal notch or the improper
insertion of the tracheostomy tube. Further dangers include
hemorrhage, the formation of a tracheoesophageal fistula caused by
injury to or perforation of the party wall of the trachea and
esophagus and inadvertent severing or injury to the vocal
cords.
The present invention provides a device for performing a
tracheostomy which embraces all of the advantages of similarly
employed devices, but none of the many disadvantages. The present
invention is designed for use on-the-spot, wherever it is needed
and may be used with relative safety by a surgeon, family doctor,
or if necessitated by an emergency, a layman. To attain this, the
present invention contemplates a unique device comprising both a
needle arcuate cutting portion for making the initial incision,
which portion then expands within the trachea wall, under the
influence of a movable hollow tube contained within the confines of
arcuate needle portion, to allow air to enter the passage. The
device, when initially partially inserted into the trachea, has a
relatively small diameter which is expanded after the initial
insertion has been made to provide an adequate breathing opening
for emergency purposes. Later on, at the hospital, a permanent
breathing device would replace the emergency device.
The use of the present device avoids undue damage to the posterior
wall of the trachea. In addition, the expansion of the initial
opening provides an adequate breathing space, acts to stop bleeding
along the sides of the opening, and also acts to hold the device in
position. Furthermore, the initial opening need not be as large as
was heretofore the case (generally a 1 to 2 inch cut) because
cartilage and tough membranous portions of the neck area are easily
expanded by the mechanical advantage afforded by this device. The
needle cutting portion can be readily inserted to the proper depth
by insertion and manipulation until an audible rush of air from the
lungs is heard.
In addition to the use heretofore described, the present device may
be used in a number of medical procedures wherein aspiration,
ventilation or visualization is desired. Thus, for example, the
device may be utilized in an open-window sinus operation to
puncture the sinus cavity, expand the cartilege and drain the
cavity. Likewise, the device may be used in a thorancentisis
operation. Further, the device can be used in a venus puncture
procedure to introduce a large tube into a vein. This is
accomplished by first puncturing the vein with the needle portion
of the device and second, introducing the hollow tube into the vein
by depressing the plunger and thereafter inserting a flexible tube
through the hollow tube into the vein for introduction of fluids,
etc. In addition, in modified form, the device may be used either
open or closed, with or without magnification, in visualization
techniques which employ fiber optics. Further, the device, in
slightly modified form, can be used to expand a collapsed lung by
first essentially performing a tracheostomy and then forcing air or
oxygen through an opening in the hollow tube in any convenient
manner such as, for example, by breathing into the opening. This
device could be used to breathe for drowning victims because air is
gotten into the lungs much more efficiently than with
mouth-to-mouth breathing, in that the so-called "dead space" in the
throat is bypassed.
It is apparent from the foregoing that the present invention has a
great many uses. However, for the purposes of the present
application, only the preferred embodiment as a device for
performing a tracheostomy will be described in detail.
Thus, the present invention may be described as a device
comprising: a. an expandable housing, an end portion of said
housing tapering so as to form a means for puncturing, b. a plunger
carrying a hollow tube, c. said tube and said plunger adapted to be
inserted in said housing and movable with respect to said housing
such that the depression of said plunger causes said tube to pass
through and expand said tapered end portion of said housing.
More particularly, the invention may be described as a device for
performing a tracheostomy comprising: a. an expandable housing
having an end portion adapted to be forcibly inserted into a
trachea, b. a plunger carrying a hollow air tube, said plunger and
said air tube adapted to be inserted in said housing and movable
with respect to said housing such that the depression of said
plunger will cause said air tube to pass through and expand said
end portion of said housing by an amount equal to the outside
diameter of said air tube.
FIG. 1 shows the inserted device and a connector tube leading to an
oxygen supply;
FIG. 2 shows a partly sectional plan view of the device with the
plunger in the retracted position;
FIG. 3 shows a partly sectional plan view of the device with the
plunger in the depressed position with accessory for pumping air
into the trachea;
FIG. 4 is a view taken in section on the plane 4,4 in FIG. 2
looking in the direction of the arrows;
FIG. 5 is a view taken in section on the plane 5,5 in FIG. 2,
looking in the direction of the arrows;
FIG. 6 is a view taken in section on the plane 6,6 in FIG. 3,
looking in the direction of the arrows; and
FIG. 7 is an exploded view of the device.
DESCRIPTION OF THE PREFERRED EMBODIMENT
Referring now to the drawings, where like reference characters
designate like or corresponding parts throughout the several views,
FIG. 7 illustrates an exploded view of the device comprising (1) a
plunger 12 moveably mounted within (2) a conical housing 18. The
housing 18 is provided with a needle-like cutting edge 32 for
making the initial incision in the trachea. Under the influence of
the forward movement of the plunger 12, within the housing 18, the
cutting edge 32 being of a 2-piece construction, as will be
described, expands and allows the plunger 12 to be positioned
within the trachea. The plunger 12 is provided with an air passage
and thereby, when properly positioned, allows air to enter the
trachea.
More specifically, the plunger 12 is provided with an enlarged end
portion 17. The end portion 17 is also provided with an elongated
hollow air passage 13, passing longitudinally through its center.
Air passage 13 promotes air exchange with hollow tube 24, the upper
end portion of the tube 24 being fixedly connected into the lower
end portion of plunger 12. Said upper end portion of tube 24 is
truncated so as to form an elliptical cross-section and is seated
in the lower end portion of plunger 12 such that the truncated
portion rests adjacent to opening 26 further promoting air
exchange. Likewise fenestrations 42 carried by said upper end
portion of tube 24 also promote air exchange. A neck ring 14 is
seated on flange 40 of the housing 18 and carries opening 19, as
will be described. The overall length of tube 24 is such that when
plunger 12 is in its fully depressed position, i.e., the enlarged
end portion 17 of plunger 12 is positioned immediately adjacent to
neck ring 14, the lower end portion of tube 24 will not extend
substantially past the leading edge of arcuate cutting edge 32, as
shown in FIG. 3. This is necessary so that potential damage to
tissue that might be caused by inadvertent penetration of the
posterior wall of the trachea by the lower end portion of tube 24
is avoided, when plunger 12 is in its fully depressed position.
Plunger 12 carrying tube 24 is designed to pass downwardly through
opening 19 in neck ring 14. Opening 19 is of the same diameter as
the elongated portion of plunger 12 and thus acts to guide plunger
12 in its movement within the housing 18. The lower end portion of
plunger 12 carries a flange 15 which is of a width such that it
will not pass through opening 19, thereby preventing plunger 12
from being inadvertently withdrawn from device 10. Neck ring 14
carries openings 30 which further promote air exchange. These
openings may be on the side portions of neck ring 14 as well as on
the top portion as shown in FIG. 7.
Neck ring 14 is fixedly connected to collar 22 in any convenient
manner, e.g., adhesively. Collar 22 is designed to enable the
operator to conveniently position the device by curling the second
and third fingers, respectively, on the underside portions 23 and
25 of collar 22 as shown in FIG. 2. As further shown in FIG. 2, the
operator's thumb is simultaneously placed on enlarged end portion
17 of plunger 12 for support and to enable the operator to apply a
downward force on enlarged end portion 17.
The housing 18 preferably comprises two sections 18a, 18b forming a
generally conical shape and having flanges 40a, 40b at its upper
end. Collar 22 abuts the underside of flanges 40a, 40b and is
retained, preferably by adhesive means, by the flanges. Collar 22
is provided with an interior annular space 21. A sealing O-ring 16
is press-fitted within said space and seals the upper end of the
housing 18.
As mentioned, the lower end portions of housing 18 a, 18b terminate
in an arcuate cutting edge 32 for making the initial incision in
the trachea.
Upon depression of plunger 12 by the application of downward force
to enlarged end portion 17, tube 24 is caused to pass through and
expand the lower cutting end portions 35, 37 of housing 18a, 18b
allowing air transfer to occur through tube 24 and fenestrations 42
with air openings 26, 28 and 30. Fenestrations 38 carried by the
lower end portion of tube 24 function to prevent blockage of tube
24 by blood which may have leaked into tube 24, by allowing said
blood to flow out of tube 24 into the space provided by housing
18a, 18b. O-ring 20 is circumferentially positioned generally about
the lower end portion of housing 18a, 18b so as to maintain the
configuration of arcuate cutting edge 32, during insertion of the
cutting edge 32 into the trachea. The O-ring 20 also permits
expansion of lower end portions 35 and 37 of housing 18 a, 18b upon
the operation of the device. Housing 18a, 18b need not be comprised
of two parts, but may be generally a single piece having an
expandable lower end portion.
The device and its various parts, aside from the elastic O-rings,
may be constructed of any rigid material such as plastic, e.g.,
polypropylene; metal or combination thereof, e.g., metal needle
portion and plastic housing portion. The diameter of hollow tube 24
will depend on the use to which the device is put. Generally, it
will have an inner diameter of from 3 to 6mm and preferrably 4 to
5mm. The gauge of arcuate cutting edge portion 32 also varies with
the use of the device. In a tracheostomy, a 13 to 14 gauge is
preferred.
To perform a tracheostomy, device 10 is held as shown in FIG. 2
with plunger 12 in its retracted position. Arcuate cutting edge 32
is then pushed into the trachea and manipulated until a rush of air
is heard. The enlarged end portion 17 of plunger 12 is then
depressed by the operator's thumb, his second and third fingers
being positioned about the undersides 23 and 25 of collar 22 for
support, thereby causing tube 24 to move downward through
expandable housing 18a, 18b such that end portions 35 and 37 of
housing 18a, 18b are caused to be expanded by an amount equal to
the outer diameter of tube 24. This final resting position, as
shown in FIG. 3, accomplishes several things. In the first place,
the lower end portions 35 and 37 of housing 18a, 18b adjacent to
the arcuate cutting edge 32 are pressed tightly against the inside
edges of the wound caused by the initial puncturing of the skin.
This pressure acts to prevent hemorrhaging. In addition, if arcuate
cutting edge 32 is inserted in a cartilagenous or membranous
portion of the neck, which is typically the case, the depression of
plunger 12 causes tube 24 to expand the lower end portions 35 and
37 of housing 18a, 18b adjacent to arcuate cutting edge 32,
overcoming any natural resistance of such tissue to be expanded.
Small fenestrations 38 allow any blood which has seeped into the
puncture area to be partially removed into housing 18a, 18b rather
than possibly blocking tube 24. If fenestrations 38 are used in
tube 24, then housing 18a, 18b should preferably be made of a
transparent material so that blood leakage can be seen and attended
to. Larger fenestrations 42 allow air exchange through openings 26,
28 and 30 to occur more readily.
FIG. 3 shows, additionally, adapter 34 connected to tube 36 which
leads to an oxygen source. Adapter 34 carrying tube 36 may be
connected into opening 28 if desired, after it is apparent that the
tracheostomy has been successfully performed.
* * * * *