Tracheostomatic bandage

Abstract

A bandage for laryngotomy patients comprises an air inlet portion having an outer fibrous layer consisting of a fibrous material designed and dimensioned to collect particles and bacteria without forming a substantial resistance to the flow of air inhaled therethrough, said inlet portion including an intermediate portion designed and mounted to permit a large surface contact with the inhaled air and made from a material having heat and moisture exchanging properties so that it receives heat and permits condensation of moisture from the expired air and transfers the received heat and moisture to the inhaled air. Said intermediate portion includes further an inner layer with an attachment means shaped to be placed into sealing engagement with the throat of the patient around the stoma and comprising a net located opposite the intermediate portion and of a relatively large width of the meshes and a stiffness suitable to protect the intermediate portion from deformation and preventing also its being sucked in by breathing.

Description

The present invention relates to a bandage for laryngotomy patients. During recent years, in the treatment of various diseases, it has been necessary to open the trachea in an operational manner in order to allow the patient to get a sufficient amount of air. During the years before 1960 many problems developed with these patients due to the drying of the mucous membranes in the air pipes, and in connection therewith, a substantially increased sensitivity to infections also occurred. The reason for the troubles mentioned above is that by the trachoetomy (the cutting of the trachea), the function of the nose is substituted, i.e. moisturizing, heating and, to some extent, filtering of the inhaled air cease.

During the years 1958-1960 an apparatus was developed at the ear clinics in Lund and the College of Technology in Stockholm to moisten and heat the inhaled air. Principally, this apparatus comprises a tightly sealed metal foil which receives the moisture and, to some extent, also the heat of the expired air, and returns them to the respiratory system in connection with the expiration.

The heat and moisture exchanger mentioned above is attached to a so-called tracheal cannula that is always used in tracheotomy. Tracheotomy is usually a temporary action. Most often after a relatively short period of time the patient may breathe without tracheostoma and the tracheotomy is discontinued, i.e. the hole in the throat is permitted to heal.

In some patients it is necessary, due to a serious illness in the larynx or in the vicinity thereof, to remove the larynx and the upper part of the trachea by a so-called laryngotomy. These patients are also provided with a tracheostoma and must breathe through this for the rest of their lives.

Since the laryngotomy was developed as an operational method, laryngotomy patients have never had any possibilities at all to protect their stomata or their lower air passages in a satisfactory manner. In connection with the excision of the larynx, the purifying, moisturizing and heating function of the nose for the inhaled air is discontinued. Also the oral cavity, naso, oro, and hypopharynx are disconnected, which to some extent have the same function as the nose, but less pronounced. The hitherto used protection comprised a multi-layered gauze dressing hanging loosely in front of the stoma on a string around the neck. The dressing mentioned above was soaked with ordinary water at different intervals. In certain cases the patient himself has made completions to the dressing or bandage for personal use, such as by stabilizing it with coarse plastic nets. Some patients have had perforated silver shields, etc, made for them.

In discussions with the patients it has been revealed that they have several complaints about these bandages. Primarily, the inhaled air is cold and sometimes feels very uncomfortable and causes a cough-provoking action. Sometimes the inhaled air is very dry and for this reason irritates the lower air passages. The particle filtration of the previously mentioned bandage has probably been totally lacking. The most pronounced complaint from the patients is that in connection with a violent expiration the gauze dressing is sucked into the stoma and thereby the stoma is more or less occluded and the patient must, when this occurs, rapidly act to get air. During the night the gauze has substantially no effect.

As may be seen from the above discussion the described gauze bandage has practically no function other than to cover the stoma, and not even this is accomplished in a very appealing manner. Accordingly the purpose of the present invention is to provide a bandage that prevents the patient from inhaling air that is cold and dry, permits the filtration of the particles, and eliminates the risk that the bandage or portions thereof can be sucked into the stoma by inhaling.

The invention will be further described below with reference to the accompanying drawings in which:

FIG. 1 shows the bandage according to the invention cut through the center,

FIG. 2 shows an alternative embodiment of the bandage cut through the center,

FIG. 3 is a front view showing the bandage of FIG. 1 applied in an operative position to the throat of the patient,

FIG. 4 is a front view showing the bandage of FIG. 2 applied in an operative position to the throat of the patient, and

FIG. 5 is a side view of the bandage of FIG. 2 applied to the throat of the patient.

The bandage according to the invention is to be applied to the throat of the patient so that the bandage sealingly engages around the stoma of the patient, meaning that the inhaled and expired air is made to pass through the bandage. According to one embodiment of the invention the bandage comprises three main portions, i.e. an outer fibrous layer 1, an intermediate portion 2 and an attaching means 3. In order to collect particles and any bacteria contained in inhaled air without giving a substantial resistance to the air flowing therethrough, the outer fibrous layer comprises a fibrous cloth having a predetermined thickness and density. A fibrous cloth suitable for this purpose is commercially called a non-woven tissue. As an alternative, however, it is possible to use a glass fiber fabric or another fibrous fabric of synthetic or natural origin.

In order to give the fibrous layer a certain stiffness, it may in itself comprise two outer layers having the fiber orientations disposed in opposite directions and an intermediate portion of a pile material. The fibrous layer 1 engages the intermediate portion 2, which is designed and located to permit a large surface contact with the air flowing therethrough, to receive heat and condense the moisture from the expired air and to transfer the received heat and moisture to the inhaled air. In order to accomplish this purpose, the intermediate portion 2 is made from a so-called corrugated mini cardboard which is rolled to a helical shape to define a cylindrical element which has a height of 1-1.5 cm. As an alternative to this corrugated cardboard it is suitable to use a cellulosic, metallic or plastic element which is designed to permit a large surface contact with the air flowing therethrough.

An attachment means 3 engages the side of the intermediate portion 2 opposite the fibrous layer 1, and may be designed for different applications to attach the bandage to the throat of the patient. According to a first embodiment, the attachment means 3 comprises a plastic foil 3a to engage the skin of the patient, this plastic foil 3a is soft and flexible so that it permits a certain movement in the skin lying therebelow and also prevents abrasion from occurring below or around the bandage. A suitable plastic foil is commercially sold under the name "Lencoflex occlusive." The plastic foil 3a is provided with a hole, and a net 3b is attached thereto and covers the hole. This net 3b is made from a material comprising a synthetic fiber and has, preferably, the width of the meshes of 1-3 mm.

The intermediate portion 2 is kept in position between the outer fibrous layer 1 and the plastic foil 3a by attaching the outer fibrous layer and the plastic foil to each other around the intermediate portion. In order to obtain a soft transition at the edges of the intermediate portion, the outer fibrous layer 1 integrates with the plastic foil 3a at a distance from the jacket surface of the intermediate portion so that a space is defined between the jacket surface, the outer fibrous layer 1 and the plastic foil 3a. An annular cushion 4 made from a plastic foam or similar material is provided in this space.

The bandage described above is to be attached directly to the throat of the patient by bonding. This is accomplished by providing the plastic foil 3a with a skin sensitive adhesive, whereupon the bandage is pressed onto the throat so that the adhesive adheres around the stoma and the net 3b is positioned opposite the stoma. This means that the breathing air is completely caused to flow through the bandage so that the inhaled air is filtered, heated and moisturized at the same time as the outer fibrous layer 1 exteriorly protects the intermediate portion 2 and the net prevents the intermediate portion from being deformed, broken and/or inhaled.

The described bandage is suitable for use at night when the need to suck is minimal, but also during the day for most patients, that is patients who do not have to suck or blow their noses several times a day.

On the other hand patients who need to perform their stoma-tracheal toilet several times a day must be able to remove the bandage and push the same to the side. For this purpose the bandage according to the invention comprises a shield 5 onto which the plastic foil 3a is attached. This shield is made from a plastic material which is sturdy and elastic, such as PVC or nylon, and preferably the plastic material is so selected that it permits a certain degree of flexibility by heating to a temperature exceeding 37.degree.C. The plastic shield 5 has a hole and the intermediate portion 2 of the bandage projects into this hole when the plastic foil 3a has been attached to the shield by means of an adhesive or the like.

In order to permit an anatomically correct location of the shield 5, so that it is also sturdily mounted at all times and gives sealing action around the stoma, and in addition eliminates the risk of producing annoying skin injuries such as dermatitis and abrasion, an annular cushion 6 is mounted to the shield and surrounds the hole of the intermediate portion 2. This cushion comprises a core 6a of a plastic foam or rubber foam and a cover 6b of a material gentle to the skin. As an alternative hereto the cushion 6 may be made from a thin plastic foil filled with a gas, preferably air, which has a low pressure to define a so-called low pressure cushion.

In order to apply the shield 5 to the throat of the patient, the shield is provided with two extended holes 5a to anchor a rubber band 7 or the like placed around the neck of the patient. This rubber band 7 may be applied to the shield by tying end hooks thereof over the edges of the holes 5a. However, the shield may be so designed and the rubber band applied in such a manner that the shield, by a lever action, obtains an advantageous engagement with the throat. To this end, the shield has a somewhat tapering shape so that the narrower portion may be made to project to some extent between the collar bone of the patient. The hole for the intermediate portion is displaced in relation to the center of the shield so that it is positioned substantially in the narrower part of the shield. In opposition thereto the holes 5a for the band 7 are provided on the opposite side of the shield center in the wider part thereof and adjacent two side edges engaging each other. By locating the band 7 over the edge portions of the shield, through the holes 5a and below the shield between the holes 5a, the last mentioned portion of the band will act upon the upper portion of the shield in an outward direction, and as a result the lower, narrower portion of the shield will be acted upon inwardly in a direction towards the stoma of the patient. In other words, the described attachment means permits the bandage to be easily moved when so desired and thereafter it may be easily returned to the operative position.

In order to make the foil 3a so as to permit direct application to the throat and to make it project downwardly between the collar bones of the patient and also permit its attachment to the shield 5 free from contact with the holes 5a, the foil suitably has a tapering shape.

The bandage described above provided with two alternative attachment means only describes one of several possible embodiments lying within the scope of the following claims. Thus, it is possible to make the net as an integral part of the shield, to eliminate the foil 3a and apply the outer fibrous layer 1 to the shield directly or by means of an attachment foil.

Claims

What is claimed is:

1. A bandage for laryngotomy patients who have a tracheostoma, having an air inlet portion comprising:

a. an outer fibrous layer,

b. an intermediate portion adjacent to said outer fibrous layer,

c. said intermediate portion comprising a material having heat and moisture exchanging properties whereby heat and moisture are transferred from exhaled air to inhaled air passing therethrough,

d. said intermediate portion having a large surface in contact with the air,

e. said intermediate portion engaging an inner layer,

f. said inner layer comprising means for sealing said bandage in engagement with the patient's throat around the stoma so that all breathing air is caused to flow through said bandage, and

g. said inner layer comprising separating means for preventing the sucking in of any portion of the bandage by the patient.

2. A bandage as recited in claim 1 wherein said separating means comprises a net.

3. A bandage as recited in claim 1 wherein:

a. said intermediate portion is cylindrical in shape,

b. a jacket is provided enveloping said intermediate portion,

c. said outer and inner layers are attached to each other at a point spaced apart from said jacket, and

d. a ring of elastically yieldable material is placed in the space between said jacket and said layers.

4. A bandage as recited in claim 3 wherein:

a. said inner layer comprises a foil having a hole therein for adhesive application to the patient's throat, and

b. said separating means is mounted onto said foil covering the hole.

5. A bandage as recited in claim 4 wherein said foil comprises a soft and flexible material whereby the skin below the foil is permitted some movement, and abrasion below or around the foil is prevented.

6. A bandage as recited in claim 3 wherein:

a. said inner layer comprises a foil and a shield, said foil being attached to said shield by a binder,

b. said shield has an annular cushion mounted thereon, said cushion being of a height such as to engage the throat of the patient around the stoma when said bandage is applied, and

c. a band of elastic material in contact with said shield and the patient's neck maintains said shield in a preselected position.

7. A bandage as recited in claim 6 wherein:

a. said intermediate portion projects into a hole in said shield,

b. said band is inserted through two holes in said shield, and

c. said foil has a tapering shape so that it is free from engagement with the holes for said band when used and so that alternatively it may be directly applied to the throat of the patient with the tapering portion thereof projecting between the collar bones of the patient.

8. A bandage as recited in claim 7 wherein:

a. the hole provided in said shield for said intermediate portion is located substantially below the center of said shield when mounted in the operative position on the patient's throat,

b. the holes provided in said shield for said band are located above the center of said shield and adjacent two opposite edges thereof,

c. said band is mounted over the portions of said shield between said holes for said band and the outer edge closest thereto and under the portion of said shield between said holes for said band, whereby lever action is applied to said shield.

9. A bandage according to claim 7, wherein the shield is made of a plastic material having relatively low flexibility properties and may permit some deformation if subjected to a temperature in excess of 37.degree.C.

10. A bandage according to claim 9, wherein the annular cushion of the shield comprises a plastic foam or a rubber foam covered with an outer layer of a material gentle to the skin.

11. A bandage according to claim 9, wherein the annular cushion of the shield comprises a thin plastic foil filled with a gas that has a relatively low pressure.

12. A bandage according to claim 11, wherein said separating means constitutes an integral portion of the shield.

13. A bandage according to claim 12, wherein the intermediate portion comprises a corrugated cardboard material rolled into a helical shape.

14. A bandage recited in claim 12 wherein said outer fibrous layer comprises a fabric of non-woven tissue.

15. A bandage as recited in claim 12 wherein said outer fibrous layer comprises a glass fiber fabric.