U.S. patent number 3,916,903 [Application Number 05/381,261] was granted by the patent office on 1975-11-04 for cricothyroid puncture apparatus.
Invention is credited to Reta M. H. Pozzi.
United States Patent |
3,916,903 |
Pozzi |
November 4, 1975 |
Cricothyroid puncture apparatus
Abstract
An emergency cricothyroid puncture apparatus for supplying
ventilating gas directly into the trachea of a patient has a small,
short trocar, which comprises a short, straight stylet with a long,
tapered sharp point which protrudes from a close-fitting, thin,
flexible, resilient wall cannula. The opposite end of the cannula
is fitted with an integrally formed frustum conical receiver which
uniformly slopes from a minimal radius near the cannula to a
maximal radius remote from the cannula. The stylet has an abutment
which engages the receiver for preventing further insertion of the
stylet into the cannula beyond a point where the sharpened conical
point just projects from an opening in the distal end of the
cannula. A handle on the end of the stylet permits its easy
withdrawal from the cannula. Radial openings in the cannula near
the distal end permit gas flow when the distal end opening is
blocked. The straight flexible but resilient walls of the cannula
prevent damage to the rear wall of the trachea or to the larynx
during insertion and use. The frustum conical receiver provides
ready coupling with conventional endotracheal tube adapters.
Inventors: |
Pozzi; Reta M. H. (Honolulu,
HI) |
Family
ID: |
23504332 |
Appl.
No.: |
05/381,261 |
Filed: |
July 20, 1973 |
Current U.S.
Class: |
128/207.29;
D24/129; 604/164.01 |
Current CPC
Class: |
A61M
16/0472 (20130101); A61M 16/0484 (20140204) |
Current International
Class: |
A61M
16/04 (20060101); A61B 017/32 (); A61B 017/34 ();
A61M 016/00 () |
Field of
Search: |
;128/347,351,305 |
References Cited
[Referenced By]
U.S. Patent Documents
Other References
Bougas, Tina P. et al., "Pressure-flow Characteristics of Needles
Suggested for Transtracheal Resuscitation," N.E. Jour. Med. 262:
511-513, 1960. .
Jacobs, H. B., "Emergency Percutaneous Transtracheal Catheter and
Ventilator," Jour. Trauma 12: 50-55, 1972..
|
Primary Examiner: Pace; Channing L.
Attorney, Agent or Firm: Wray; James C.
Claims
What is claimed is:
1. Emergency tracheotomy apparatus comprising a single, short,
straight, thin, form-retaining cannula having a lumen extending
from one end to the other and having an axial opening in a distal
end and having opposite lateral openings near the distal end for
flowing a gas from the lumen into a trachea, and having an
outwardly expanded funnel-shaped receiver at a proximal end for
receiving a gas outlet device, the receiver having outwardly sloped
inner walls which extend from a minimum dimension near straight
walls of the lumen to a maximum dimension at the proximal end of
the receiver, and the receiver being formed integrally with the
cannula on an extended axis of the lumen, a rigid flange integrally
formed with the cannula and receiver on the proximal end of the
cannula extending oppositely outward from a junction of the cannula
and receiver for preventing excess insertion of the cannula into
the trachea and having tie receiving openings in remote areas of
the flange for receiving neck encircling ties to hold the flange
against the neck of a patient.
2. The emergency tracheotomy apparatus of claim 1 wherein the
cannula and receiver are integrally formed from a Teflon
material.
3. The apparatus of claim 1 further comprising a short straight
cylindrical walled trocar fitted closely within the lumen and
having a sharp conical point extending from the opening at the
distal end of the lumen and having an abutment means engaging the
receiver and a handle means extending from the receiver, whereby
pushing on the straight trocar with its point adjacent a throat of
a patient having obstructed breathing passages causes the trocar
point to penetrate the throat and a forward wall of a trachea,
supporting the cannula in a rigid condition and carrying the
cannula through the throat and forward tracheal wall into a
position when the distal end of the cannula is positioned within
the trachea and wherein the abutment means quickly releases the
receiver, whereby the handle may be pulled, withdrawing the trocar
from the receiver and cannula, while leaving the cannula in the
throat of the patient in a manner projecting straight into the
throat and trachea along a straight axis.
4. The emergency tracheotomy apparatus of claim 1 wherein the
cannula is a number 10 size tube and wherein the receiver receives
the distal end of a conventional endotracheal tube adapter.
5. The apparatus of claim 1 wherein walls of the receiver have a
first relatively wide outward slope from straight walls of the
lumen and then a second lesser slope to the proximal end of the
receiver.
Description
BACKGROUND OF THE INVENTION
Tracheostomy procedures are well known. Conventional tracheostomy
involves the creation of large and relatively permanent openings
from the trachea to the exterior of the body in a lower portion of
the neck and often involves the insertion of a large tube to
maintain the passageway. Such tracheostomy procedures are
accomplished under operating room conditions. Because of the
potential and inherent dangers to organs and the blood flow, such
procedures are not suitable as emergency procedures by
non-professional personnel.
So-called emergency cricothyroid stab procedures have been
promulgated for use by professionals when time and equipment is not
available to perform regular tracheostomy procedures. The emergency
cricothyroid stab procedures involve identifying the location of
the cricothyroid membrane by palpating the thyroid and cricoid
cartilages. The cricothyroid membrane lies in the area beneath the
"Adam's apple" and the next lower cartilage ring, which is the
cricoid cartilage. The promulgated emergency procedures then
recommend making a rapid incision through the skin with any
available pointed instrument and then rotating the pointed
instrument 90.degree. around its opening to maintain an airway. The
procedures are unsuitable for many reasons. There is great
difficulty in inserting a blade while the patient exhibits the
usually frantic behavior. It is difficult to maintain the airway
open. The depth of necessary penetration is difficult to ascertain.
The procedure may cause the issuance of a profusion of blood from
the area of the incision.
A cricothyrotomy curved cannula has been developed with a curved
trocar for inserting the cannula through the cricothyroid membrane
into the trachea. The curved cannula is difficult to insert, since
it requires a compound motion during insertion. The curved cannula
is extremely dangerous in that the direction of the curve is not
readily ascertainable during and after insertion. A reversed
insertion or turning of the cannula in place during its use greatly
endangers the larynx, potentially causing irreparable harm. The
body of the known curved cannula is relatively large in diameter,
which is a drawback to quick and easy insertion, and the body is
sufficiently long to permit jamming of the distal end of the
cannula into the opposite tracheal wall, sealing the lumen and
damaging the trachea.
Under quiescent conditions, the insertion of the curved cannula is
a difficult procedure. Under the frantic behavioral conditions of a
patient experiencing anoxia, the thick, long, curved cannula
presents unusual difficulties and hazards.
SUMMARY OF THE INVENTION
The emergency cricothyroid puncture apparatus of the present
invention has a short, small, straight trocar with a short
thin-walled, high molecular weight polymeric material cannula with
a short, straight, sharply conically pointed stylet, whose point
projects from a distal end opening of the cannula. The proximal end
of the cannula is fitted with a funnel-like, integrally formed
structure which opens and expands outward along the extended axis
of the cannula for preventing loss of the cannula through the
opening into the trachea and for providing a female fitting for
receiving an endotracheal tube adapter from an oxygen valve.
The cannula is integrally formed of a high molecular weight
polymeric material which is capable of withstanding chemical and
thermal sterilization, which is stable under conditions encountered
in sterilization, storage and use, and which maintains its shape,
preserving the lumen, while permitting slight bending of the
unsupported cannula. The material such as polytetrafluorethylene,
which is commonly available under the trademark Teflon, is suitable
for use in constructing the cannula. The external dimensions of the
cannula are as thin as is commensurate with form stabilization of
the cannula after insertion in the trachea and after withdrawal of
the stylet. Preferably, the cannula and receiver are integrally
formed from a unitary polytetrafluorethylene structure.
In a preferred embodiment of the invention, flanges are integrally
formed on the structure to prevent excessive insertion of the
cannula and to provide apertures for securing ties for tying the
cannula firmly to the neck of the patient.
The flanges may be formed at the junction of the straight walled
portion of the cannula and the receiver, or the flanges may be
formed at the large proximal end of the receiver. The flanges
extend oppositely and radially outward with respect to an axis of
the cannula. Apertures may be elongated to receive a flat ribbon or
strap and a flattened hook on a free end of an adjustable
strap.
A short, small diameter stylet with a sharp pointed, elongated
conical distal end fits snugly within the cannula. The sharpened
end of the stylet and its conical portion project from the distal
end of the cannula. An abutment means of the stylet engages the
receiver to prevent overextension of the stylet through the cannula
and to assure insertion of the cannula into the orifice formed by
the stylet. A handle projects from the receiver to provide easy
withdrawal of the stylet from the cannula once the cannula has been
inserted. Preferably, the stylet is made of a strong, hard material
which maintains its sharpness through sterilizations and storage
procedures and which will not break when used. A preferred material
for the stylet is stainless steel.
The broad objectives of the invention are accomplished by providing
an emergency tracheotomy apparatus comprising the cannula having a
straight, small and short lumen extending from one end to the other
and having an opening in the distal end for flowing gas from the
lumen into a body cavity and having an outward extending
conically-shaped receiver at a proximal end for preventing
overextension of the distal end to a trachea and for receiving and
tightly sealing a conventional oxygen valve adapter.
Other objects of the invention are accomplished by constructing
such a cannula as an integrally formed structure made of a high
molecular weight polymeric material such as
polytetrafluoroethylene.
Another object of the invention is the provision of a short,
straight, sharply conically pointed trocar fitted closely within
the polymeric cannula for penetrating the cricothyroid membrane for
carrying the cannual into the trachea of a patient along a straight
axis.
This invention has as another object the provision of emergency
tracheotomy apparatus having a cannula integrally formed with a
receiver and outward extending flanges from a polymeric material
with the cannula approximating the size of a number 10 needle and
with a short, straight trocar within the cannula and having a
sharp, elongated conical point extending from a distal end of the
cannula, having an abutment means engaging the receiver and a
handle projecting from the receiver for supporting the cannula and
inserting the cannula through a cricothyroid membrane into a
trachea and for readily removing the trocar once the cannula has
been inserted.
These and other objects and features of the invention are apparent
in the disclosure, which includes the specification with its
foregoing and ongoing description and the claims and the
drawings.
BRIEF DESCRIPTION OF THE DRAWINGS
FIG. 1 is an elevation of a trocar and cannula of the present
invention, showing the cannula and trocar in approximately twice
normal size.
FIG. 2 is a schematic view of the cannula inserted into a trachea
and coupled with a conventional oxygen adapter and oxygen control
valve.
FIG. 2A is a detail of the cannula having a double tapered receiver
for gripping an adapter.
FIG. 3 is a schematic representation of the cannula inserted in a
throat of a patient.
DETAILED DESCRIPTION OF THE DRAWING
An emergency tracheotomy apparatus is generally indicated by the
numeral 1. A trocar, generally indicated by the numeral 2, is
closely fitted within a cannula, generally indicated by the numeral
5. A cannula 5 is constructed as a unitary body integrally formed
of a polymeric material, such as polytetrafluoroethylene. Cannula 5
has a cylindrical main body portion 6 with a straight lumen 8
formed about a straight central axis. Lumen 8 extends through body
6 and terminates at distal end 10. A receiver 11 is integrally
formed at the proximal end of cannula 5 for inwardly receiving an
outlet of a conventional gas valve adapter.
The stylet 2 has an abutment 13 which abuts the surface of receiver
11 to prevent overextension of the stylet through the cannula when
pressing on handle 17 to force the trocar and cannula into the
body.
The shaft 19 of the stylet fits closely within lumen 8. The
elongated cone of sharpened point 20 extends outward from open end
10 of cannula 5. Abutment 13 is positioned such that point 20 just
projects from the open end of the cannula. In one form of the
invention, the abutment 13 may overlie the proximal end of receiver
11.
Openings 15, which extend laterally through the thin wall 12 of the
cannula near the open end 10 provide additional ventilating access
to the trachea and provide main access in the event that axial
opening 10 is blocked.
Flanges 24 are integrally formed with cannula 5 and receiver 11
near the junction of the straight-walled lumen 8 and the
sloping-walled receiver 11. Alternatively, the flanges may be
integrally formed at the proximal wide end of receiver 11. Straps
or ties 23 are attached to the flange 24 at openings 25. The ties
hold the cannula in place in the trachea as shown in FIG. 3.
In FIG. 2, a cannula 5 is shown projected into a trachea. Oxygen is
supplied through the cannula to the trachea by oxygen control valve
30 which has a discharge controlling button 31 mounted centrally on
a face of body 33. Hose 35 leads to a source of oxygen under
regulated pressure. An adapter 36, which is a conventional
endotracheal tube adapter, fits on an outlet of valve 30. A
discharge end 37 of adapter 36 fits tightly in the inner surface of
receiver 11 to complete the passageway between valve 30 and cannula
5.
When flanges 24 are pressed against the outer skin 42 of throat 40,
the open end 10 of cannula 5 is positioned between a mid and rear
portion of the trachea. Auxiliary openings 15 in the thin wall 12
of cannula 5 provide auxiliary passages for gas flow to the
trachea.
In FIG. 2, the throat of the patient is generally indicated by the
numeral 40, and 42 indicates the skin on the frontal area of the
neck. 43 indicates the cricoid cartilage. The lumen 45 of trachea
47 is schematically illustrated with the open end 10 of cannula 5
centrally positioned in lumen 45.
Like elements are identified with like numerals in FIGS. 2 and 2A.
The stylet shown in FIG. 2A has a sloping wall which prevents
excess travel into the cannula. Preferably a stylet which abuts the
outer edge of the receiver is employed.
The cannula in FIG. 2A has a receiver 11' with a relatively wide
angle taper for receiving an end of an adapter, and a relatively
narrow taper similar to the wall of the adapter for holding the
adapter in place.
In FIG. 3, a patient is generally indicated by the numeral 50. The
neck of a patient 51 has a plurality of curved cartilages
surrounding the trachea. The trocar of the present invention is
inserted between the thyroid cartilage 53 and the cricoid cartilage
54. The location of the cricothyroid membrane is determined by
palpating the neck and determining the position of the large
thyroid cartilage, its lower neighboring cricoid cartilage and
finding the space in between, which is the locus of the
cricothyroid membrane.
Tie 23 holds the flanges 24 against the neck 51 of the patient,
steadying receiver 11' for insertion of the oxygen valve adapter to
supply oxygen into the trachea of the patient.
Although the invention has been described with reference to
specific embodiments, it will be obvious to one skilled in the art
that modifications of the invention may be made without departing
from its spirit and scope. The scope of the invention is defined in
the following claims.
* * * * *