US2862498A - Endotracheal tube - Google Patents

Description

D. :1. WEEKES ENDOTRACHEAL TUBE Filed June 14, 1957 INVENTOR. 00/7 J Wee/ es PM (Lam A T TORN Y atent United States ENDOTRACHEAL TUBE 'Don J. Weekes, Brookline, Mass.

Application June 14, 1957, Serial No. 665,732 6 Claims. (Cl."128--'351) This invention relates to anendotracheal tube.

The invention has for an object tojprovide .a novel and improved endotracheal tube for administering general anesthesia'and which is characterizedby a novel distal "end portion designed to facilitate intubation and which is adapted to be-introduced into the larynx with minimum liability of injury or damage'to the. vocal chords.

Another object of the invention is to provide a novel and improved endotracheal tube of non-traumatic structure having a tip or leading end portion adapted to,flex when an obstruction is encountered during intubation whereby to prevent traumatic injury to the larynx.

A further object of the invention is to provide a novel and improved endotracheal tube of the character specified having a catheter tube associated therewith which is adapted to extend through and beyond the inner or distal end ofthe endotrachealtube.

With these general objects in -view and such others as may hereinafter appear, the invention consists in the endotracheal tube hereinafter described and particularly defined in the claims at the'end of this specification.

In the drawings illustrating the preferred embodiments of the invention:

Fig. l.is aside elevation of an endotracheal tube embodying thepresent invention;

Fig. 2 is an enlarged detail view of the novel'end portion;

Fig. 3 is a plan view of the same;

Fig. 4 is a cross; sectional view taken onithe line 4-4 Fig. 5' is across sectional view taken on the. line.55 of'Fig. 2;

Fig. 6 is-a front elevation of the novel end portion; and Fig. 7 is aplanview detail of a catheter tubeshown in Fig. 1. I

In general the present invention contemplates an endotracheal tube for administering general anesthesia and which is provided-with a novel distal end or tip structure of a shape such as to facilitate intubation and to" besubstantially'nomtraumatic and which is' particularly designed to enable it to pass through thelarynx with minimum. liability of injury to the vocal chords.

Prior endotracheal tubes of whichI am aware are provided with a relatively sharp curved end made by slicing or cutting the tube at an angle resulting in a relatively sharp leading edge portion. The tube material which may comprise rubber or plastic tubular material is supplied in coil form so that when unwound from the coil the tube is provided with a set curvature corresponding generally to the curvature the tube assumes during intubation either orally or intranasally. Such prior tubes were cut to form the distal end along an inclined plane either on the right or left hand side of the tube relative to the set curvature in accordance with the preference of the operator.

In accomplishing the usual intubation through a Flagg or other open laryngoscope it is often impossible to visualize the entire larynx, and only the posteriorof the -arytenoids are seen. As a result one of the problems associated with intubation when using such prior endotracheal tubes is the frequent occurrence of im- 5 proper intubation effecting traumatic injury to the larynx caused by the relatively sharp and rigid character of the distal end of such prior tubes. Other conditions which may occur as ,a resultof improper intubation are the development of granulomas and contact 'ulcers ofthe 10 larynx.

In accordance with the present invention the distal end of the endotracheal tube is tapered on two sides relative to the set curvature of the tube in plan elevation terminating in a solid vertically central transverse strut defining with the tapered sides two elliptical openings communicating with the interior or orifice of the tube. In side elevation theicentral strut follows an. inclined. plane from the upper side of the tube terminating at its lower portion vin'a relatively small straight extension with the lower surface coextensive with the underside of the tube and providing a flexible tip rounded at its leading end. Such relatively-small and flexible tip. extension is adapted to flex ormushroom to one side or the other when meeting with an obstruction during intubation whereby to prevent 5 traumatic injury to the larynx and touassist in properly guiding the tube into the trachea.

In practice a catheter tube isfalso usually employed with the endotracheal tube which .may be extended tthrough andibeyond the distal end of .theendotracheal tube. 'In order to facilitate passage of the catheter tube :through either the i left or right hand opening of the :endotracheal tube, the edge ofthe'transverse strut defin- ;ing the ends of the openings may bev tapered and rounded. The catheter tube is also made from coiled tubingwhich acquires a set curvature so "that when inserting the icatheter tube it may be initially extended at the set curvature conforming to the curvature of the endotracheal .tube. until it reaches the strutportionwhereupon slight rotation of the catheter tube will direct the same through 0 the right'or left hand opening as desired. A mark provided at the outer end of the. catheter tube aligned with the upper curved surface may be provided to indicate the. position of the inner end of the tube, and rotation of the tube to move the mark in one direction or the other willeifect passage of the tube through the opening desired.

.It will be understood that the outer end of the endotracheal tube will be operatively connected to an anesthesia machine, and the outer end of the catheter Ltube may beoperatively connected to a conventional suction device in the usual manner.

Referring now to the drawings, 10 indicates the present .endotracheal tube which may comprise a suitable plastic tubular material, such as vinyl plastic, or a-natural or synthetic rubber of suitable diameter which diameter may vary in accordance with the size and age of the-patient aupon which it is to be used. The tube- -1G,as illustrated, is provided with a set curvature, the upper surface of the tube relative to the set curvature being indicated at 12 and the lower surface at 14. The novel distal end indicated 0 generally at 16 may be molded to provide a tapering end portion defined by tapered surfaces on two opposedsides 18, 20 relative to the set curvature to provide anopening 22, 24 on each side of the tube, the tapered end terminating in a transverse inclinedcentral strut 26 defining the 5 forward ends of theopenings 22, 24. As illustrated in Fig. 2, theinclined surface 28 of thetransverse strut 26 is disposed a short distance forwardly of the side openings defined thereby and extends from theupper surface 12 of the tube forwardly and downwardly terminating at 7 its lower end in a relatively small straight tip or leadingend portion 30 extending parallel to the tube, the underside of thetip 30 being coextensive with the lower surface.

3 14 of thetube 10. Theinclined surface 28 may and preferably will be rounded to provide a smooth edge, and the tip portion 39 may also be rounded at the leading end and along its longitudinal edges. I p

The noveldistal end portion 16 thus constructed'is designed to thread its way between the vocal chords even though they are not visualized during intubation, and the relatively small and substantially cylindrical leadingtip portion 30 is adapted to flex to one side or the other if more than the usual resistance is encountered whereby to avoid traumatic injury to the vocal chords and to guide the tip through the larynx and into the trachea, the tube assuming a substantially medial position therein. As indicated, the edges of theopenings 22, 24 may be rounded to provide smooth edge surfaces. The .openings 22, 24 may be of any suitable length, preferably about one and one-half to two times the inside diameter of the tube, and the width of the openings may be substantially equal to the inside diameter of the tube as shown.

As indicated in Figs. 1 and 4, acatheter tube 32, also having a set curvature, is usually employed with an endotracheal tube and is extended through and beyond thedistal end 16 for the purpose of removing excess mucus, and in practice the inner end of the catheter tube is normally extended and directed into one or the other of the bronchial tubes disposed to the left or to the right of the trachea. In order to facilitate passage of the end of thecatheter tube 32 through one or the other of theopenings 22, 24 of the endotracheal tube, theinner edge 34 of the strut which defines the forward edges of theopenings 22, 24 is preferably rounded and tapered, as shown, to serve as a guide for the catheter tube in a direction to enter the left or right hand bronchial tube. The slight set curvature of the catheter tube facilitates passage of the inner end of the tube in the direction desired by merely applying a slight twisting rotation to the outer end of the tube. Thus, rotation of the outer end in a clockwise direction will divert the inner end through the left hand opening 22, and conversely, rotation in a counterclockwise direction will divert the inner end through the right hand opening 24. Amark 36 placed at the outer end'of the catheter tube in longitudinal alignment with the upper surface of the tube relative to its set curvature, as shown in Fig. 7, may serve as an indicator to show the position of the inner end of the tube so that the catheter tube may be rotated in the direction desired.

While the preferred embodiment of the invention has been herein illustrated and described, it will be understood that the invention may be embodied in other forms within the scope of the following claims.

Having thus described the invention, what is claimed is:

1. An endotracheal tube comprising an elongated tube having a distal end tapered on two opposed sides and terminating in a transverse strut, openings in said tapered sides communicating with the tube, said strut having a forwardly and downwardly inclined surface terminating in a relatively small and substantially straight tip por- 'curved surface of said catheter tube to serve as a guide tion adapted to flex when more than is encountered'during intubation.

2. An endotracheal tube comprising an elongated tube having a distal end tapered on two opposed sides and terminating in a central transverse strut, openings in said tapered sides communicating with the tube, said strut defining the forward ends of said openings, the leading portion of said strut having a forwardly and downwardly inclined surface terminating in a relatively small flexible extension.

3. An endotracheal tube comprising an elongated flexible tube having a set curvature and provided with a distal end tapered on two opposed sides relative to said curvature and terminating in a central transverse strut, openings in said tapered sides communicating with the tube, said strut defining the forward ends of said openings, the leading portion of said strut having a forwardly and downwardly inclined surface relative to the upper and lower tube surfaces of said set curvature and termin ating in a relatively small flexible extension coextensive with said lower tube surface.

4. An endotracheal tube as defined in claim 3 wherein the surfaces of said central strut defining the forward ends of said openings are rounded and tapered to facilitate passage of a catheter tube therethrough.

5. An endotracheal tube comprising an elongated flexible tube having a set curvature and provided with a distal end tapered on two opposed sides relative to said curvature and terminating in a central transverse strut, openings in said tapered sides communicating with the the usual resistance tube, said strut defining the forward ends of said open-' ings, the leading portion of said strut having a forwardly and downwardly inclined surface relative to the upper and lower tube surfaces of said set curvature and terminating in a relatively small flexible extension coextensive with said lower tube surface, and a catheter tube inserted within the endotracheal tube, said catheter tube also having a set curvature corresponding to the curvature of the endotracheal tube, and a mark on the outer end of said catheter tube aligned longitudinally with the upper for rotating said catheter tube in a direction to effect passage of the same through the distal opening desired, the inner surface of said central strut defining the forward ends of said openings'being rounded and tapered to facilitate passage of the catheter tube through the opening desired.

6. An endotracheal tube comprising an elongated tube having a distal end tapered on two opposed sides in plan elevation and terminating in a relatively narrow central strut, openings in said opposed sides communicating with the tube, said strut having a forwardly and downwardly inclined surface in side elevation terminating in a relatively small flexible extension.

References Cited in the file of this patent UNITED STATES PATENTS 2,458,305 Sanders Jan. 4, 1949 FOREIGN PATENTS 855,318 Germany Nov. 13, 1952

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