Surgery – Respiratory method or device – Respiratory gas supply means enters mouth or tracheotomy...
Reexamination Certificate
1999-09-20
2003-09-09
Lo, Weilun (Department: 3761)
Surgery
Respiratory method or device
Respiratory gas supply means enters mouth or tracheotomy...
C128S200260, C128S207150, C128S207160
Reexamination Certificate
active
06615835
ABSTRACT:
BACKGROUND OF THE INVENTION
1. Field of the Invention
The present inventions relate to adaptors for use with intubated patients, and more particularly to novel multiple port access adaptors which may be used with a variety of different medical treatment devices simultaneously. Such treatment devices may include those designed for ventilation, aspiration, monitoring, visualizing, imaging, sampling and therapeutic delivery devices which are used on intubated patients.
2. State of the Art
There are a variety of different circumstances under which a person may be intubated. In intubation, an artificial airway, such as an endotracheal tube, is placed in the upper respiratory system of a patient to facilitate respiration. In some circumstances, such as surgery, the artificial airway is temporary and is used for anesthesia and proper ventilation and oxygenation. In many other situations, however, the endotracheal tube will be left in the patient for a prolonged period of time. With many traumatic accident victims, for example, the artificial airway will remain in place to sustain mechanical ventilation for the life of the patient.
Respiratory patient care has changed dramatically over the past three decades. Advances in medical technology have greatly increased the number of medical devices which are available for addressing problems associated with respiratory care. For example, if an endotracheal tube is to be left in place for more than a brief period of time, it is critical that respiratory secretions be periodically removed. This is most often accomplished with the use of a respiratory suction catheter which is advanced into the endotracheal tube. As the suction catheter is withdrawn, a negative pressure is applied to the interior of the catheter to draw mucus and other obstructions from the patient's respiratory system.
Advanced medical devices which are available for use in respiratory care are not limited to endotracheal suction catheters. Improvements have been made in devices, such as bronchoscopes, which are used for visualizing the patient's respiratory system. Other advances have facilitated the introduction of catheters to provide medical fluids to and from the lungs. Yet other advances have facilitated the sampling of respiratory tissues and secretions, therapeutic delivery of medication and other procedures.
The availability of these advanced medical devices has greatly improved the quality of life for those who must be intubated. Procedures today are generally less discomforting to the patient and are more efficacious. A dilemma is presented, however, in providing access to each of a number of medical devices to the patient at the same time. Traditionally, if a certain respiratory treatment device was needed, the patient was removed from other devices until the procedure was completed.
An extreme example of this practice is present in the use of open suction catheters. Until the 1980s, each time the patient's respiratory system needed to be suctioned, it was common to disconnect the patient's artificial airway from the manifold and ventilator tubes which supplied the patient with air. Interference with the air supply to the patient, even if only for a few seconds, was often severely distressing to the patient. These problems were initially overcome in the invention disclosed in U.S. Pat. No. 3,991,762 to Radford.
Radford developed what is commonly referred to as a closed suction catheter system. In a closed suction catheter system, a catheter is maintained within a protective sleeve which is attached to a manifold which also receives the tubing of the ventilator which delivers air to the patient's lungs. When suctioning is desired, the catheter is advanced through the manifold and into the artificial airway. Negative pressure is then applied to the catheter and secretions within the patient's respiratory system are evacuated.
The Radford system and its successors are advantageous in that they allow the patient's ventilation to continue throughout the suctioning procedure. Additionally, they do not require the closed circuit to be broken (i.e. opened to outside air) for each suctioning procedure.
It is highly desirable to have these closed suction catheter systems attached to the endotracheal tube or other artificial airway of the patient. Doing so in the conventional manner, however, requires the closed suction catheter system to be disconnected from the patient to allow use of other devices such as bronchoscopes, oxygen supplementation catheters, tissue sampling devices, and the like. The endotracheal catheter system must then be reattached once the other device is no longer needed.
Breaking the circuit in this manner increases the risk of nosoccomial infections and increases the risk that clinicians will come into contact with mucus and other secretions of the patient. Additionally, it consumes time which the clinician could use to treat other patients.
In order to alleviate the safety and productivity issues, numerous attempts have been made to develop multiple port adaptors for use with endotracheal tubes. While not an exhaustive analysis of the configurations which have been set forth in the art,
FIGS. 1A and 1B
show typical attempts to provide a multi-port adaptor for use with endotracheal tubes and are discussed in detail below.
The adaptors of the prior art fall into two general categories—fixed and rotatable. In the fixed category, as shown in
FIGS. 1A
, the adaptor, generally indicated at
10
, is typically made from a single piece of rigid material, such as acrylic or polypropylene. The adaptor
10
forms a generally T-shaped, elbow-like housing
14
with a first barrel
18
having an open distal end
18
a
forming a first, distal port to the housing
14
. The interior surface
22
of the first barrel
18
forms a distal channel for receiving the proximal end of an endotracheal tube (not shown).
A fourth barrel
60
providing a fourth port
66
extends from the housing
14
on a side of the housing opposite the second barrel
26
. The fourth port
66
allows for a second catheter assembly
70
to be used with the housing
14
. As shown in
FIG. 1A
, the catheter assembly is configured to provide medical fluids directly into and from the patient's lungs. To this end, a catheter
74
of the catheter assembly
70
is connected to an oxygen source
20
.
A third port
34
is formed by a third barrel
38
which is disposed along a common axis with the first barrel
18
. The orientation of the third barrel
38
facilitates the advancement of a catheter
42
of an endotracheal suction catheter assembly, generally indicated at
46
, through the third and first barrels
34
and
18
, respectively. The catheter
42
may thus be advanced down the endotracheal tube and used to suction mucus and other secretions from the patient's respiratory system.
If desired, a lavage port
50
can be provided on the third barrel
38
to facilitate cleaning of the catheter
42
. Most such catheter assemblies, however, include a lavage port for cleaning.
A fourth barrel
60
providing a fourth port
64
extends from the housing
14
on a side of the housing opposite the second barrel
26
. The fourth port
64
allows for a second catheter assembly
70
to be used with the housing
14
. As shown in
FIG. 1A
, the catheter assembly is configured to provide medical fluids directly into and from the patient's lungs. To this end, a catheter
74
of the catheter assembly
70
is connected to an oxygen source
78
.
The configuration of shown in
FIG. 1A
is a significant improvement over the prior configurations which required the endotracheal suction catheter assembly
46
to be removed prior to use of another device. The housing
14
, however, has a disadvantage. In order to operate both the first and second catheter assemblies, or other devices, at least one of the assemblies must be brought or taken out of alignment with the long axis of the housing (i.e. the axis along which the first and third barrels
18
and
38
are disposed). Th
Cise David M.
Lorenzen Rick D.
Smith V. Roland
Ballard Medical Products
Dority & Manning P.A.
Erezo Darwin P.
Lo Weilun
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