US3402718A - Endotracheal tube with valved balloon having removable inflation means and balloon rupturing means associated therewith - Google Patents

Description

Sept. 24, 1968 G. o. DOHERTY 3,402,718

ENDOTRACHEAL TUBE WITH VALVED BALLOON HAVING REMOVABLE INFLATION MEANS AND BALLOON RUPTURING MEANS ASSOCIATED THEREWITH Filed Aug. 12, 1965 2 Sheets-Sheet 1 x r I I 2 o u. i

INVENTOR es RGE o OHERTY ATTORNEY Sept. 24, 19 e. o. DOHERTY ENDOTRACHEAL TUBE WITH VALVEI) BALLOON HAVING REMOVABLE INFLATION MEANS AND BALLOON RUPTURING MEANS 2 t e e h a s t e e h s 2 H T I w E R E H T D E T A I C O S S A :U 6 9 l 2 l g u A d e l 1 F INVE N TOR OHERTY ATTORNEY 0&0

United States Patent 3,402,718 ENDOTRACHEAL TUBE WITH VALVED BALLOON HAVING REMOVABLE INFLATION MEANS AND BALLOON RUPTURING MEANS ASSOCIATED THEREWITH George 0. Doherty, 2301 River Road, Missoula, Mont. 59801 Filed Aug. 12, 1965, Ser. No. 479,228 14 Claims. (Cl. 128-351) ABSTRACT OF THE DISCLOSURE An endotracheal tube including an open-ended tube having an aperture opening into an inflatable cuff at one end of the tube. A check valve covers the aperture, and a smaller diameter tubular inflation conduit extends from the aperture, into which its inner end is removably fitted, through the tube for connection to an external source of pressurized gas. A string extends along the external surface of the tube to the cuff, to which it is attached, for rupturing and thereby deflating the cuff.

This invention relates in general to endotracheal tubes and, more particularly, to endotracheal tubes which can be readily installed and easily removed.

In many types of surgical procedures it is the practice to install an endotracheal tube through the patients mouth and into the trachea in order to administer anesthetics or oxygen and to control the patients respiration. The rear or proximal end of the tube which projects externally from the patients mouth is suitably attached to an anesthesia machine which provides a flow of desired gases.

One type of endotracheal tube which has been in use for many years comprises a soft, flexible, relatively largediameter piece of tubing which is of such size as to pass through the larynx and into the vestibular portion of the trachea. At its inserted end, the tubing is provided with a slidably adjustable sleeve-like inflatable rubber cuff and some kind of a secondary tube by which the cuff can be inflated thereon. The opposite end of the secondary tube is usually provided with a syringe bulb for inflating the cuff. Generally, the cuff is positioned on the tubing so that when the latter is fully inserted, the cuff will lie in the trachea beyond the sphincter muscles of the larynx. Such cuffs, however, have proved rather unsatisfactory because the sleeve-like element which forms the cuff frequently slides upwardly over the tube upon encountering a restricted organ such as the sphincter muscles of the larynx, and the small secondary tube leading from the cuff often becomes twisted and tangled. These difficulties led to the development of the so-called Riisch tube which employs an inflatable cuff that is built integrally into, and forms a part of the tube. The small secondary tube used to inflate the cuff passes internally through the Riisch tube to the portion surrounded by the cuff where it is connected through the wall of the tube to the internal chamber of the cuff. However, the Riisch type endotracheal tube is comparatively expensive, and the internally disposed inflation tube can interfere with the insertion of surgical instruments through the tube. This makes it difficult to use in many instances.

It is, therefore, the primary object of the present invention to provide an endotracheal tube which is combined with a removable inflation tube.

It is another object of the present invention to provide an endotracheal tube having a securely attached cuff which can be inserted within the trachea to form a tight seal and can be easily deflated to permit quick and simple removal of the endotracheal tube at the end of the operation or in case of some emergency.

3,402,718 Patented Sept. 24, 1968 It is an additional object of the present invention to provide an endotracheal tube which is relatively simple in construction and economical to manufacture.

It is further an object of the present invention to provide an endotracheal tube which is completely disposable.

It is still a further object of the present invention to provide an endotracheal tube which can easily be sterilepacked for simplicity in shipping, storage, and ultimate use.

With the above objects in view, my invention resides in the novel features of form, construction, arrangement, and combination of parts presently described and pointed out in the claims.

In the accompanying drawings (2 sheets):

FIG. 1 is a top plan view of an endotracheal tube constructed in accordance with and embodying the present invention;

FIG. 2 is a sectional view taken along line 2-2 of FIG. 1,

FIGS. 3 and 4 are transverse sectional views taken along lines 3-3 and 44 of FIG. 2;

FIG. 5 is an enlarged fragmentary sectional view of the endotracheal tube showing the cuff inflated and the valve flap closed;

FIG. 6 is a top plan view of a modified form of the present invention,

FIG. 7 is a longitudinal sectional view taken along line 7-7 of FIG. 6, and

FIG. 8 is a longitudinal sectional view of a further modified form of endotracheal tube constructed in accordance with and embodying the present invention.

Referring now in more detail and by reference characters to the drawings which represent practical embodiments of the present invention, A designates an endotracheal tube including a flexible, relatively soft tube 1 made of polyethylene, polypropylene or similar flexible material. Tube 1 is of sufficient length to extend from the vestibular portion of a patients trachea immediately caudad to the larynx and through the patients mouth, projecting outwardly therefrom. Attached externally to and disposed encirclingly around the distal or forward end of tube 1 (reference being made to the right end as shown in FIG. 1) is an inflatable cuff 2 which is preferably constructed from some suitable flexible material which will balloon out under air or gas pressure. The annular margins of cuff 2 are adhesively or otherwise suitably sealed to the wall of the tube 1, thereby creating an annular chamber 3 between the outer surface of tube 1 and the inner surface of cuff 2. Tube 1 is provided with an opening or aperture 4 which provides communication between the internal bore of tube 1 and the air chamber 3. Secured along one margin to tube 1 and completely covering aperture 4 is valve flap 5 which is preferably made of rubber and will normally lie in closure forming position over the aperture 4 but can swing outwardly into open position to admit air or gas into the chamber 3. Thus, valve flap 5 creates a unidirectional air valve over aperture 4, all as best seen in FIG. 2 and for purposes presently more fully appearing.

Extending axially through the tube 1 is a flexible small bore inflation tube or conduit 6 made of a relatively flexible material and being bent over at its inner end in the provision of a small tip 7 which is snugly press-fitted into the aperture 4 and preferably terminates flus'h with the outer surface of the tube 1. At its proximal or rear end, the inflation tube 6 projects outwardly from the tube 1 to provide a sufficiently long external portion for convenient manipulation. Thus when air or gas is injected, by syringe or any other means, through the inflation tube 6, this air or gas will flow through the aperture 4 flexing the valve flap 5 away from closure-forming position and inflating the cuff 2. However, when the cuff 2 is inflated the pressure in the chamber 3 will force the valve flap 5 into-sealing engagement with the outwardly presented margins of aperture 4, thereby preventing the escape of air or loss of pressure within the air chamber 3. In this regard, it should be noted that valve flap 5 should be constructed sothat only a moderate increase in pressure within the tube 1 will lift it away from aperture 4.

When the cuff 2 has been suitably inflated, the external end of the inflation tube 6 can be sharply pulled to the rear and the tip 7 will become disengaged with the aperture 4. The inflation tube 6 can then be removed and discarded. Subsequently, when the surgical or other procedure requiring the endotracheal tube A is concluded, the endotracheal tube A can be removed by simply inserting a wire or metal rod (not shown) axially through the tube 1 and gently feeling for the aperture 4. When the aperture 4 is located, the wire or rod can be pushed through the aperture 4 far enough to flex the valve flap away from closure-forming position and allow the air or gas which is trapped in the chamber 3 to escape. Thereupon the endotracheal tube A can be easily pulled out of the patients throat. To facilitate location of the aperture 4, a suitable indicia-mark m may be imprinted or otherwise applied to the external face of the proximal end of tube 1 at a point axially outwardly from, and diametrally opposite the aperture 4.

After manufacture and assembly, the endotracheal tube A should be suitably sterilized and cuff 2 should be deflated so that it clings snugly to the wall of tube 1. The endotracheal tube A is then sealed in a sterilized package so that it may be used immediately by a hospital upon removal from the package.

Immediately before the operation, the endotracheal tube A is removed from the package, and smeared with a lubricant such as Xylocaine jelly which has anesthetic properties to lessen irritation upon placement. The anesthesiologist then inserts the forward end of tube 1 into the patients mouth and through the larynx. When the cuff 2 has passed the sphincter muscle of the larynx and entered the vestibular portion of the trachea, the cuff is inflated as above described.

It is possible to provide a modified endotracheal tube B substantially as shown in FIG. 6, which is very similar to endotracheal tube A and includes a soft flexible tube 11, a cuff 12, forming an annular chamber 13. The tube 11 has an aperture 14 opening into the chamber 13. Operatively disposed over aperture 14 and having one lateral margin adhesively or otherwise suitably sealed to tube 11 is a valve flap 15 preferably made from a thin very flexible sheet of soft rubber. The valve flap 15 serves the same function as the valve flap 5 that is to say, it acts as a unidirectional air valve over aperture 14 permitting inflation of cuff 12 through an inflation tube 16 when air or gas pressure is applied in the same manner as previously described.

Extending loosely and axially along the side of the tube 1 11 is a ribbon-like strip 17 made of tough flexible material.

At its rear end the strip 17 projects outwardly beyond the rear or distal end of the tube ;11 to provide an external portion 18 which is long enough for convenient manipulation. The strip 17 is sealed into and extends through the rear annular joint between the tube 11 and the cuff 12, and projects loosely into the chamber 13, being adihesively secured or otherwise firmly attached at its inner end 19 to the interior face of the cult 12.

The endotracheal tube B is inserted within the patients throat in the same manner as the previously described endotracheal tube A and conventionally connected to an anesthesia machine. Its cuff 12 is inflated by directing a pressurized gas such as air through inflation tube 16 and that gas will open valve flap 15 and fill cufl 12. After the cuff 12 has been fully inflated it can be quickly and easily deflated by grasping and pulling the external portion 18 of the strip 17. The force thereby exerted on the strip 17 will rupture the annular marginal seal between the cuff 12 and the tube 11 whereby to deflate the 4 cuff 12 and permit removal of the endotracheal tube B.

It is also possible to provide a further modified form of endotracheal tube C as shown in FIG. 8 which is similar to the endotracheal tube A and includes a soft flexible tube 21 and a cuff 22 forming an annular chamber 23. The tube 21 has an aperture 24 opening into the dhamber 23.

Extending looselyand axially .throughthe tube 21 is a flexible small bore inflation tube 25 made of relatively flexible material and being bent over at its inner end in the provision of a small tip 26' which is snugly pressfitted into the aperture 24 and communicates with the chamber 23. Operatively sealed or otherwise secured across the inner end of the tip 26 is a valve flap 27 which functions as a unidirectional check valve so that air or gas passing under pressure through the tip 26 will flex the valve flap 27 into the open position and permit the air or gas to enter the chamber 23 so as to inflate the cup 22. As in the case of the previously described embodiment, when the flow of air or gas through the inflation tube 25 is stopped, the pressure which is built up within the chamber 23 will cause the valve flap 27 to close and the cuff 22 will remain inflated. In the endotracheal tube C, however, the valve flap 27 forms a part of and is carried by the tip 26 of the inflation tube 25. Moreover, the inflation tube 25 projects outwardly from the proximal or rear end of the tube 21 thereby providing a terminal portion 28 which can be conveniently manipulated. When it becomes necessary to remove the endotracheal tube C, this terminal portion 28 can be grasped and sharply pulled outwardly disengaging the tip 26 from the aperture 24 and pulling it and the valve flap 27 outwardly whereupon the aperture 24 is opened and the cuff 22 will deflate immediately.

It is readily apparent that endotracheal tubes A, B, and C, being relatively simple in design are obviously economical to manufacture. Because of the low cost the hospital can discard the used tubes upon completion of the operation, and it need not worry over transferring infections from one patient to another through reuse of the tubes. The tubes, being simple in construction, have few parts which interfere with the conduct of the operation, or obstruct the anesthesiologists view and interfere with his movements. Moreover, the simple construction is adapted to reduce patient irritation to an absolute minimum. It should be noted that endotracheal tubes and analogous tubes of similar design but differing in size can 'be constructed for use with patients of different sizes as well as for insertion in other body canals such as the ureter.

It should be understood that changes and modifications in the form, construction, arrangement, and combination of the several parts of the endotracheal tubes may be made and substituted for those herein shown and described without departing from the nature and principle of my invention.

Having thus described my invention, what I claim and desire to secure by Letters Patent is:

1. Means for establishing an artificial passageway through a duct in the human body such as the trachea, ureter, or the like; said means comprising an open-ended tube having proximal and distal ends and a cross-sectional size and shape substantially similar to the crosssectional size and shape of the duct, a pressure-expensible membrane marginally secured to the tube adjacent its distal end and being disposed externally with respect thereto whereby to form a chamber, said tube being provided with an opening establishing communication between the interior of the tube and the interior of the chamber, check valve means Operatively associated with the opening for permitting unidirectional flow of a fluid medium into the chamber where-by to distend the membrane and create a bulbous external enlargement on the tube for retentive engagement with the tissues along a portion of the duct, and conduit means removably inserted within said opening for causing a fluid medium under pressure to flow through the opening and distend the membrane.

2. Means for establishing an artificial passageway through a duct in the human body such as the trachea, ureter, or the like; said means comprising an open-ended tube having proximal and distal ends and a cross-sectional size and shape substantially similar to the crosssectional size and shape of the duct, a pressure-expansible membrane marginally secured to the tube adjacent its distal end and being disposed externally with respect thereto whereby to form a chamber, said tube being provided with an opening establishing communication between the interior of the tube and the interior of the chamber, check valve means operatively associated with the opening for permitting unidirectional flow of a fluid medium into the chamber whereby to distend the membrane and create a bulbous external enlargement on the tube for retentive engagement with the tissues along a portion of the duct, and conduit means removably fitted within said opening at one end and being adapted to be operatively connected to a source of pressurized fluid at its opposite end.

3. Means for establishing an artificial passageway through a duct in the human body such as the trachea, ureter, or the like; said means comprising an open-ended tube having proximal and distal ends and a cross-sectional size and shape substantially similar to the crosssectional size and shape of the duct, a pressure-expansible membrane marginally secured to the tube adjacent its distal end and being disposed externally with respect thereto whereby to form a chamber, said tube being provided with an opening establishing communication between the interior of the tube and the interior of the chamber, check valve means operatively associated with the opening for permitting unidirectional flow of a fluid medium into the chamber whereby to distend the membrane and create a bulbous external enlargement on the tube for retentive engagement with the tissues along a portion of the duct, and an inflation tube removably inserted within said open-ended tube for conveying said fluid medium to said chamber, said inflation tube having one end removably connected to said opening and its other end projecting beyond the proximal end of said tube for operative connection to a source of pressurized fluid medium.

4. Means for establishing a passageway through a duct in the human body according to claim 3 in which said check valve means is a flap-like valve element disposed within said chamber and adapted to cover said opening.

5. Means for establishing an artificial passageway through a duct in the human body such as the trachea, ureter, or the like; said means comprising an open-ended tube having proximal and distal ends and a cross-sectional size and shape substantially similar to the cross-sectional size and shape of the duct, a pressure-expansible membrane marginally secured to the tube adjacent its distal end and being disposed annularly with respect thereto whereby to form an annular chamber, said tube being provided with an opening establishing communication between the interior of the tube and the interior of the chamber, check valve means operatively associated with the opening for permitting unidirectional flow of a fluid medium into the chamber whereby to distend the membrane and create a bulbous external enlargement on the tube for retentive engagement with the tissues along a portion of the duct, and an inflation tube removably inserted within said open-ended tube for conveying said fluid medium to said chamber, said inflation tube being provided at one end with an elbow adapted for snug-fitting engagement with said opening, the other end of said inflation tube projecting beyond the proximal end of said open-ended tube for operative attachment to a source of pressurized fluid medium.

6. Means for establishing an artificial passageway through a duct in the human body such .as the trachea, ureter, or the like; said means comprising an open-ended tube having proximal and distal ends and a cross-sectional size and shape substantially similar to the cross-sectional size and shape of the duct, a pressure-expansible membrane marginally secured to the tube adjacent its distal end and being disposed externally with respect thereto whereby to form a chamber, said tube being provided with an opening establishing communication between the interior of the tube and the interior of the chamber, an inflation tube removably inserted within said open-ended tube for conveying said fluid medium to said chamber, said inflation tube being removably and snugly fitted within said opening, and a unidirectional air valve carried by said inflation tube for permitting a fluid medium to enter said chamber but not escapte therefrom.

7. Means for establishing an artificial passageway through a duct in the human body such as the trachea, ureter, or the like; said means comprising an open-ended tube having proximal .and distal ends and a cross-sectional size and shape substantially similar to the cross-sectional size and shape of the duct, a pressure-expansible membrane marginally secured to the tube adjacent its distal end and being disposed externally with respect thereto whereby to form a chamber, said tube being provided with an opening establishing communication between the interior of the tube and the interior of the chamber, an inflation tube removably inserted within said open-ended tube for conveying said fluid medium to said chamber, said inflation tube being removably and snugly fitted within said opening, and a unidirectional air val e carried by the end of said inflation tube disposed within said opening.

8. Means for establishing an artificial passageway through a duct in the human body such as the trachea, ureter, or the like; said means comprising an open-ended tube having proximal and distal ends and a cross-sectional size and shape substantially similar to the cross-sectional size and shape of the duct, a pressure-expansible membrane marginally secured to the tube adjacent its distal end and being disposed externally with respect thereto whereby to form a chamber, said tube provided with an opening establishing communication between the interior of the tube and the interior of the chamber, check valve means operatively associated with the opening for permitting unidirectional flow of a fluid medium into the chamber whereby to distend the membrane and create a bulbous external enlargement on the tube for retentive engagement with the tissues along a portion of the duct, conduit means removably inserted in said opening and extending through said tube for introducing a pressurized fluid medium into the chamber, and means attached to said membrane for rupturing said membrane while the same is operatively disposed within the duct.

'9. Means for establishing an artificial passageway through a duct in the human body such as the trachea, ureter, or the like; said means comprising an open-ended tube having proximal and distal ends and a cross-sectional size and shape substantially similar to the cross-sectional size and shape of the duct, a pressure-expansible membrane marginally secured to the tube adjacent its distal end and being disposed externally with respect thereto whereby to form a chamber, said tube being provided with an opening establishing communication between the interior of the tube and the interior of the chamber, check valve means operatively associated wi h the opening for permitting unidirectional flow of a fluid medium into the chamber whereby to distend the membrane and create a bulbous external enlargement on the tube for retentive engagement with the tissues along a portion of the duct, conduit means removably inserted in said opening and extending through said tube for introducing a pressurized fluid medium into the chamber, and means attached to said membrance for rupturing said membrane while the same is operatively disposed within said duct, said last-named means being disposed externally of the open-ended tube and being operable from the proximal end of said tube. v I

V10. v ,Means for establishing an artificial passageway through a duct in the human body such as the trachea, ureter, or the like; said means comprising an open-ended tube having proximal and distal ends and .a cross-sectional size and shape substantially similar to the cross-sectional size and shape of the duct, a pressure-expansible membrane marginally secured to the tube adjacent its distal end and being disposed externally with respect thereto whereby to form a chamber, said tube being provided with an opening establishing communication between the interior of the tube and the interior of the chamber, check valve means operatively associated with the opening for permitting unidirectional flow of a fluid medium into the chamber whereby to distend the membrane and create a bulbous external enlargement on the tube for retentive engagement with the tissues along a portion of the duct, conduit means removably inserted in said opening and extending through said tube for introducing a pressurized fluid medium into the chamber, and a ribbon-like strip adapted to lay against the outside of said open-ended tube and extend beyond the proximal end thereof when said tube is operatively inserted within the duct, said ribbon-like strip being operatively secured to the wall of said membrane so as to rupture the same when said strip is pulled with respect to the open-ended tube.

-11. Means for establishing an artificial passageway through aduct in the human body such as the trachea, ureter, or the like; said means comprising an open-ended tube having proximal and distal ends and a cross-sectional size and shape substantially similar to the cross-sectional size and shape of the duct, a pressure-expansible membrane marginally secured to the tube and being disposed externally with respect thereto whereby to form a chamber, said tube being provided with an opening establishing com munication between the interior of the tube and the interior of the chamber, check valve means operatively associated with the opening for permitting unidirectional flow of a fluid medium into the chamber whereby to distend the membrane and create a bulbous external enlargement on the tube for retentive engagement with the tissues along a portion of the duct, conduit means removably inserted in said opening and extending through said tube for introducing a presurized fluid medium into the chamber, and a ribbon-like strip adapted to lay against the outside of said open-ended tube and extend beyond the proximal end thereof when said tube is operatively inserted within the duct, said ribbon-like strip extending through the juncture of said open-ended tube and said membrane and being secured to said membrane within said chamber whereby to rupture said membrane when pulled with respect to said open-ended tube.

12. Means for establishing an artificial passageway through a duct in the body; said means comprising an open-ended tube having proximal and distal ends and being sized for at least partial insertion into the duct, a flexible cuff fitted around the tube adjacent its distal end for insertion into the duct and being in sealingwise engagement with the tube at two spaced locations so as to form a fluid chamber intermediate the walls of the tube and cuff, the tube having an aperture opening into the chamber, a check valve at the aperture for permitting a unidirectional fiow of fluid into the chamber through the aperture, and a tubular conduit extending from the proximal end of the tube through the tubes interior and terminating within the tube at a tip sized for forcibleinsertion into the aperture, the tip being removable from the aperture so that the conduit can be withdrawn whereby an unobstructed passageway exists through the open-ended tube while it is in the duct.

13. Means for establishing an artificial passageway according to claim 12 wherein the conduit extends substantially axially through the tube and the tip is presented substantially perpendicular to the axially extending portion pf the conduit.

14. Means for establishing an artificial passageway according to claim 13 wherein the check valve is located over the opening on the outwardly presented surface of the tube.

References Cited UNITED STATES PATENTS 281,043 7/1883 Finney 128246 1,887,392 11/1932 Bacon 128-2 2,813,531 11/1957 Lee 12835O 2,876,767 3/1959 Wasserman 128-151 DALTON L. TRULUCK, Primary Examiner.

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