Surgery – Respiratory method or device – Means placed in body opening to facilitate insertion of...
Patent
1992-07-16
1994-01-18
Burr, Edgar S.
Surgery
Respiratory method or device
Means placed in body opening to facilitate insertion of...
12820714, 12820729, A61M 1600
Patent
active
052792854
DESCRIPTION:
BRIEF SUMMARY
This invention relates to the field of tracheostomy and more particularly relates to a method and apparatus whereby a tracheostomy tube may be inserted into the trachea of a patient in a minimum of time and with a minimum risk of secondary injury.
The term patient will be used in this specification in a general sense but may include human or animal subjects.
The surgical procedure of tracheostomy has often to be carried out in emergency situations and thus the operation ideally should be completed in a minimum amount of time. While emergency airway access can be accomplished by making an incision into the trachea the more permanent tracheostomy requires the incision into the trachea to receive a tracheostomy tube which has an inflatable cuff which is inflated after insertion to seal the tube in the trachea so that inspiration and expiration of air is all accomplished by use of the tracheostomy tube.
A number of percutaneous tracheostomy techniques have been described to perform a tracheostomy easily and rapidly for instance at a bedside but many of these have been slow, difficult to perform and/or had a significant likelihood of secondary injury such as injury to the of the trachea at points other than where the incision is made. In general the process requires the forming of a hole in the wall of the trachea by splitting it laterally between the tracheal rings. In the past this has been achieved by the use of a number of dilators of increasing diameter but this process has taken some time and actually on occasion some secondary injury to the trachea because longitudinal as well as lateral forces are applied by such devices.
This present invention proposes an alternative arrangement which will provide substantially lateral splitting between the tracheal rings while providing a minimum risk of secondary damage to the trachea.
In one form the invention is said to reside in a method of inserting a tracheostomy tube into the trachea of a patient, the method including the steps of inserting a hollow needle into the trachea, sliding a cannula over the needle into the trachea withdrawing the needle, threading a guide wire through the cannula and passing the wire into the trachea to extend in the trachea towards the lungs of the patient, removing the cannula and leaving the wire in place, threading a dilator instrument over the wire and sliding the instrument along the wire until it extends into the trachea, the instrument having jaws which may be separated once within the trachea to split the trachea and the jaws being curved so that the jaws can extend into the trachea and extend down the trachea, spreading the jaws to split the trachea wall through which the jaws are inserted transversely, removing the instrument while leaving the wire in the trachea, threading a tracheostomy tube along the wire into the trachea and removing the wire.
Also there is provided according to the invention a tracheostomy instrument for use in the above described method, the instrument comprising a pair of members pivoted to each other intermediate their ends, one end of each of the members being formed as a jaw to cooperate with the jaw of the other member, the pair of jaws being curved, each of the jaws having on a cooperating face a groove extending from the end of the jaw along at least part of the length of the jaw and terminating in an opening on the side of the jaw, the grooves on the two jaws cooperating when the jaws are in a closed position to provide a passage such that a wire can be threaded therethrough, the other end of the members each providing a handle and means to engage each other to lock the jaws in the closed position.
In one preferred embodiment of the invention the members are pivoted together such that moving the handle ends together moves the jaw ends together. Alternatively the instrument may be constructed so that the members are pivoted together such that moving the handle ends together moves the jaws ends apart.
The curve of the jaws may be up to 90.degree..
Preferably the jaws are tapered towards their en
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Burr Edgar S.
Lewis Aaron J.
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