MXPA00002225A - Tracheotomy cannula with shield - Google Patents

Abstract

The invention relates to a tracheotomy cannula (100), comprising a pipe-or tube-shaped element for passing the cannula through a throat or trachea incision into the trachea of a patient whose upper airways are blocked, so as to supply said patient with air through the cannula (100). A shield (21, 22) is attached to the cannula (100) which rests against the neck of the patient and in so doing determines the position of the cannula or of the end of the cannula (100) in the trachea of the patient. To create a tracheotomy cannula (100) having the above features which can be easily adjusted to fit the anatomical characteristics of a patient and requires no special effort regarding the stock-keeping and adjustment of tracheotomy cannulas (100), the invention provides for the shield (21, 22) to be fixably attached to the cannula (100) in various positions in the longitudinal direction of the cannula (100).

Description

The present invention concerns a tracheotomy cannula comprising an element in the form of a tube or a hose that passes through an incision in the neck and the trachea within the trachea of a patient in a tracheostomy tube. if the upper respiratory tract of the patient is blocked, in order to provide the patient with breathing air through the cannula, and with a protective plate that is mounted to the cannula and the contact against the patient's neck defines the position of the cannula or end of the cannula in the patient's trachea. Cannulas for tracheotomy of the type used, on the one hand in surgery, that is, during operations, for example in the region of the upper respiratory tract, but on the other hand also in intensive care medicine and finally also for patients whose tract Upper respiratory tract is permanently blocked due to illness or accident and they breathe through this cannula. Particularly, when cannulas of the type that are intended for prolonged use, that is, for example, in intensive care medicine or for a patient who has to breathe continuously with this cannula, a certain degree of comfort in use is of great importance. significance from the patient's point of view, so that, for example, a feeling of pressure, pressure points or friction and pain in the wound is avoided. The position of the protective plate in the tracheostomy cannula is a significant aspect in that regard insofar as the protective plate serves to define the final position of the tracheostomy cannula in its condition when inserted into the trachea. In that respect, a lower portion of the tracheostomy cannula initially extends substantially perpendicularly along the trachea and then in a relatively smooth curve through 90 ° outward through the incision in the trachea and the incision on the patient's neck. It will be appreciated that the anatomical factors involved in the case of the respective patients concerned may be very different, in particular therefore, the diameter of the trachea and the distance of the trachea from the surface of the skin of the neck, as well as the position of the incisions in the neck and trachea. In order to take into account the various anatomical factors involved, there are already cannulas for tracheotomy of the widest variation in dimensions and sizes. In this particular aspect, the diameter of the cannulas for tracheotomy vary, but within certain limits there are also variations in their length and in their radius of curvature in the curve that forms the transition from the vertical portion that projects inside the trachea. to the portion projecting out from the patient's neck. The protective plate is worn in the region of that curve or at the end of the curve, in which case the tracheostomy cannula is basically inserted into the neck and trachea of a patient to the point where the protective plate is supported against the patient. neck of the patient. However, if the tracheostomy cannula is selected as adequate for a patient substantially on the basis of its outer diameter, this does not mean that the other anatomical factors of the patient are also in accordance with the dimensions established by the position of the patient. protective plate.

Therefore, this may certainly be the case, that the distance of the patient's trachea towards the surface of the neck is greater or smaller than the distance of the protective plate of the tracheostomy cannula from the vertical portion of the cannula. tracheotomy or the theoretical prolongation of it. In that case, the patient will feel an uncomfortable pleasure or tension forces if the cannula stops - Tracheotomy is inserted until the protective plate is supported against the surface of the neck. It must be recognized that in principle it is also possible to have tracheostomy cannulas stored not only of different diameters, but also with different distances of protected plates relative to the vertical portion, but this makes the storage and also the selection and adaptation of a respective tracheotomy cannula for a patient a relatively complicated and expensive process. Taking the cutting-edge technology as its basic starting point, the object of the present invention is to provide a tracheostomy cannula that has characteristics established in the opening part of this specification, which can be adapted in a simple way to the factors anatomical which are obtained in relation to a patient, and that do not cause greater expense in terms of storage and adaptation of the cannulas for tracheotomy. This object is obtained in that the protective plate of the tracheostomy cannula is mounted to the cannula which can be fixed in several positions in the longitudinal direction of the cannula. In this case, the tracheostomy cannula only needs to be selected with respect to a correct diameter and then inserted through the incisions in the patient's neck and trachea inside the neck and the trachea thereof. This may possibly have an effect under the monitoring control of the X-rays. Then, when the cannula has assumed the position that is both adequate with respect to its functional capacity as well as anatomically correct, insofar as no point expels pressure or Tension forces on the surrounding tissue, the protective plate that first retracts into as far as possible, is fixed on the tracheostomy cannula in a position in which it rests against the patient's neck without, in that case, the cannula is further pushed or pulled out of the incision in the neck. In the preferred embodiment, provided for the protective plate, there is a clamping device which comes in a snap-free engagement of the clamp with the outside of the cannula. This clamping device has the advantage that it can be ensured to follow steps to the tracheostomy cannula and that additionally none of the devices, profiling portions or holding or stopping places have to be provided on the cannula itself, instead, the cannula can be a substantially soft tube in which the clamping device is moved into suitable positions and then clamped quickly on the outer surface of the cannula. In that regard, a preferred embodiment of the invention is one in which the clamping device, while not actively actuated, is prefatigated within the clamping clip. This means that the protective plate that was secured in the clamping device retains the position, once adopted, in the cannula for tracheotomy, and is movable on the cannula only at the moment of actuation of the same, that is, at the moment to release the pre-stressed engagement of the clamp.

A particularly preferred embodiment of this invention is one in which the clamping device comprises at least two retaining portions, each having a substantially circular opening through which the tracheostomy cannula is passed, where the two retaining portions that surround the cannula can be displaced relative to one another in a direction perpendicular to the axes of the openings or perpendicular to the axis of the cannula. This means that, when the two openings, for example, are brought into alignment with each other, they can receive the cannula together quickly and can be displaced on the external surface of the cannula, while after the relative displacement perpendicular to the axis the cannula or perpendicularly to the axis of the openings, those openings still partially overlap each other and the overlapped region quickly clamps the cannula. According to an embodiment of the invention, it is provided that at least two of the retaining portions having openings move with pivoting about a third axis which also extends parallel to the axis of two openings but which is not coincident with one of those axes. When the two portions move relative to each other about that third axis, the overlapped cross section of the two openings change again so that the desired clamping effect is produced in the manner in which it is possible. In another alternative configuration, the retaining portion is substantially displaceable linearly relative to the other, more specifically, once again perpendicular to the axis of the respective openings or relative to the axis of the cannula. A particularly preferred embodiment of the invention is one in which the clamping device comprises three portions, where two of the finely connected portions together (alternatively these can also be integrally joined together) and together form a box having two openings mutually aligned so that a tracheotomy cannula passes through, and where a third substantially planar portion is provided which fits within the box and which also has an opening for passing a tracheotomy cannula therethrough, which can at least partially be brought into an overlap relationship with the two mutually aligned openings of the first portion and the second portion, so that the tracheostomy cannula can be hooked through the three openings, where the third flat portion is prefatigated in the box in such a way that its opening moves to a position that is eccentr ica in relation to the other two openings, where the tracheostomy cannula is clamped in the overlapped portion of the three openings. The two portions forming the box can for example each have a spring edge and they can be adjusted together while the third, substantially flat portion fits between them or in one of the box portions. The two portions of the box can also be connected integrally together, for example through an inflectional hinge. The configuration of multiple parts of the box serves in particular to accommodate the third flat portion securely within the box formed of two other portions without having the ability to move out of the box. In order to produce the pre-triggered eccentric action, the flat portion preferably has a spring arc which is supported against the inner wall of the box formed by the first portion and the second portion. The spring arch may, for example, comprise an arc that curves along a circular arc and which is secured with a central part to one end of the flat portion or is integrally connected to it and has two side members that they project forward, which can bend elastically far away. It will be appreciated that the spring bow may also be a separate portion and may also be in the form of a spring element of another type. On the opposite side of the relationship to the bow of "spring, the planar portion preferably has an actuator element that extends outwardly through a free lateral opening in the box, such that the actuator element can be pressed inward from the outside of the box against the force exerted by the actuator. spring arc, where the three portions can be arranged relative to each other in such a way that, when the actuator element is pressed inward, the overlapped region of the three openings is increased and possibly all three openings can also be completely brought into a mutual alignment in such a way that in that condition the tracheostomy cannula whose outer diameter is slightly smaller than the inner diameter of the three openings can be easily moved in the three mutually aligned openings or conversely the clamping device can be easily moved in the cannula to tracheotomy. However, as soon as the actuating element is released, the spring arch drives the central opening of the two openings which are arranged in the plane portion arranged inside the box in an eccentric position in such a way that as a result the cannula For tracheotomy, clamp. Desirably the inner edge of the openings of the device has a serrated or serrated configuration such that the clamping device provides a firm fit in the tracheostomy cannula. As already mentioned, the protective plate of the tracheostomy cannula is secured to the clamping device so that the protective plate also moves with the clamping device. Desirably, the protective plate is mounted on the side of the clamping device, that is, towards the neck of the patient. An actuating device for releasing the clamping device, in order to be able to move it together with the protective plate along the tracheotomy cannula, is disposed correspondingly on the clamping device, on one side of the protective plate that It is remote from the patient's neck. In a preferred embodiment of the invention, the clamping device that is connected to the protective plate of the tracheostomy cannula has such a design that it can be released with the fingers of the hand and displaced in the tracheostomy cannula. That property can also be found in the embodiments described in greater detail hereinafter. More specifically, this is achieved on the one hand, as already mentioned, in that the clamping device is connected to the protective plate and on the other side in which the clamping device comprises at least two portions that are connected to the protective plate. resist strongly in relation to each other and that are pre-designed toward each other in a block direction such that they can be clamped quickly on the outer wall of the tracheostomy cannula and have such an interconnected configuration and fit together in such a manner that for example one of the portions of the clamping devices project with respect to the other portions so that the two portions can be held with the fingers of the hand and the projecting portion can be pushed back, the portions that are prefatigated among themselves are released. When the tracheotomy tube of this type is manipulated, it is often a matter of greater significance that any patient by itself or a doctor or nurse have a free hand, when moving the protective plate, in order to be able to hold or operate any other instrument, so it is a matter of great advantage if the clamping device can be operated with only one hand and can be moved along with the protective plate in the tracheostomy tube. In a preferred embodiment of the invention, the protective plate has an opening whose diameter is greater than the diameter of the tracheostomy cannula and is also larger than the diameter of the openings of the clamping device, and the protective plate is fitted with a preferably circular opening in a projection cylindrical clamping device, which is arranged substantially concentrically with respect to the abutting opening of the clamping device so that the tracheotomy cannula passes through it. The cylindrical projection driving the protective plate preferably has at its end a clamping flange projecting radially outwards. Furthermore, in the preferred embodiment of the invention, the protective plate comprises two separate wings moving in relation to each other and each having a respective ring portion having an opening and fitting over the cylindrical projection . In that case, the portions of the rings, on their mutually facing surfaces, preferably have a serrated or slotted configuration which prevents a relative rotation of the portions of the ring and thus the wings form the protective plate. It can be appreciated that relative rotary motion is still possible, by overcoming a corresponding resistance force, such that it is possible to substantially fixedly fix the wings in relatively different positions which are predetermined by the slotted or serrated configuration. In this arrangement, the portions of the rings are more or less prefatigated within a hooking of one another between the retaining flange of the cylindrical projection and the base of the cylindrical projection and the base of the cylindrical projection, ie the surface of the portion from which the cylindrical projection extends, and which in any case are retained together in such a way that they are rotatable relative to each other only when certain holding forces are overcome. In this respect, one of the wings can possibly also be secured to the clamping device or to the cylindrical projection in such a way that it is not rotatable with respect to the clamping device so that only the other wing is rotatable relative to the aforementioned wing. and that the clamping device and the aforementioned position of the wing are adjusted together with the clamping device at the desired location. Additional advantages, characteristics and possible uses of the invention will be apparent from the following description of a preferred embodiment and from the accompanying drawings in which: Figure 1 is a perspective view of a tracheostomy cannula with a movable protective plate, Figure 2, shows several views of a clamping device according to the invention, Figure 3 shows several views of the first portion of the box of a clamping device of Figure 2 , Figure 4 shows several views of the second portion of the clamping device box of Figure 2, Figure 5 shows the third flat portion of the clamping device of Figure 2, and Figure 6 shows various views of one or two wings forming the protective plate. With reference to Figure 1, there is shown a tracheostomy cannula 100 with a protective plate in the form of two wings 21, 22 which can be secured to a clamping device 200. The clamping device 200 moves together with the wings 21, 22, in the tracheostomy cannula in the longitudinal direction so that the protective plate 21, 22 can be adjusted in any desired position that is suitable for the patient. Additionally, the wings 21, 22 can also be moved with pivoting about the axis of the tracheostomy cannula 100, as indicated by the arrows A, B. Figures 2 to 5 show more details of the clamping device 200. Figures 2b and 2c show the clamping device 200 in two different side views moving through 90 ° relative to each other, while Figure 2c shows the clamping device in a view corresponding to the direction of view in Figure 2b from the bottom as indicated by the arrows laia, lia, but with a lower portion of the box 2 that has been omitted As can be seen from the reference of Figures 2b and 2c, the clamping device 200, substantially comprises two box portions 1, 2 which fit together, and a flat portion 3 which is inserted therebetween within box. The portion of the box 1 also has a cylindrical projection 6 with a retaining flange 7 so that the ring elements 23 which are described with reference to Figure 6 are received in the interspace 8 which is formed between the retaining flange 7. u the surface of the portion of the box 1, which abuts the cylindrical projection 6. Figure 2a shows a plan view of the flat portion 3 that is inserted inside the portion of the box 1. In its upper wall that is partially enclosed by the flat portion 3, in which the portion of the box 1 has a circular opening 11 approximately, while the flat portion 3 has a corresponding circular opening 13 of the same diameter as, however, in the illustrated position corresponding to the rest position of the clamping device 200, moves eccentrically with respect to the opening 11. The lower portion of the box 2 has a circular opening corresponding to tooth 12 which is aligned in the mounting position with the opening 11 in the upper portion of the box 1. The eccentric position of the opening 13 with respect to the opening 11, which can be seen in Figure 2a, is worn around of the elements of a spring arch 7 which is integrally disposed at one end of the flat portion 3 and which is supported with its two legs outward and forwardly extending against the inner wall of the portion of the case 1. Arranged therein. side of the flat portion 3, which is in opposite relation to the spring arch 7, is an actuating tab or an actuating projection 5 extending through a lateral opening 15 formed by an opening in the side wall of the portion of the case 1. When the actuating projection 5 is pressed into the opening 15, the spring arch 4 yields elastically and the two openings 11, 13 can be substantially brought into alignment. The lateral deflection of the flat portion 3 is provided on one side by the projection 5 which is a properly closed fit at the opening 15 and further still, also through the flat portion 3 which is received substantially tightly closed between the walls sides of the box portion 1. In the view shown in Figure 2a, therefore, the flat portion 3 can essentially perform only the linear lateral movements in the portion of the box 1, in which case the spring arch 4 is prefatigated to a greater or lesser degree.

When the projection 5 is not pushed in, the fatigue effect of the spring on the spring arch 4 causes the tracheostomy cannula to extend simultaneously through the openings 11, 13 and having an outer diameter slightly smaller than the openings 11, 13 are clamped through the toothed inner surfaces of the openings 11, 13, where the clamping device 20 is substantially immovably retained rapidly towards the wall of the tracheostomy cannula 100. FIGS. 5 shows in detail the individual parts of which the clamping device 200 is manufactured, each in several views. Figure 3 shows the upper portion of the box 1. This substantially comprises a shallow rectangular parallel pipe with rounded corners, of which a side wall has the aforementioned opening 15 for the driving projection 5 to pass through it. , and whose upper wall having the opening 11 is provided with a cylindrical projection 6, at a free end from which the retaining flange 7 extends radially outwardly. The cylindrical projection 6 extends concentrically with respect to the opening 11. As can be seen from the sectional view of Figure 3b, the side walls of the box portion 1 have a stepped configuration so that the stepped projection 17 correspondingly of the portion of the box 2 can be assembled in an adjustment relationship with the side walls of the portion of the box 1. Figure 3x is a view on the portion of the box 1 corresponding to the direction of the view from below on the portion of box 1 shown in Figure 2a. Figure 4a shows the lower portion of the box 2 in a view from the inside of the box, Figure 4b shows a vertical section through the center of the lower portion of the box 2 and Figure 4c shows a side view illustrating the stepped projection 16 whose outer diameter is matched to the inside diameter of the complementary projection 17 in the box portion 1 such that the two portions of the box can be pushed together or adjusted together with a firm fit, possibly a pressure adjustment , so that they can be held together in the shape of the box illustrated in Figure 2, with the flat portion accommodated there. Figure 4d shows a part of the edge of the opening 12, this also corresponds precisely to the details Y and X in Figures 3a and 5a. The serrated edge of the opening 12 provides a fixed immovable engagement of the clamping device on the tracheostomy cannula 100. Figure 5 shows the planar portion 3 that fits into the box formed of portions 1 and 2. The portion flat 3 has an opening 13 of the same diameter precisely as the openings 11 and 12 but is prefatigated by the spring arch 4 in the housing in eccentric relation with the openings 11 and 12. The shallow actuating projection 5 serves to carry the openings 11, 12 and 13 to a condition of mutual alignment, to the point where the spring arc 4 which rests with its ends against the inner wall of the box is pressed flat, away from its normally curved position. Figure 6 shows one of the two wings 12, 22 which together form the protective plate.

These two wings 21, 22 are identical in such a way that only one of these wings needs to be shown here. Figure ßa shows a rear view of the wing 21, 22, Figure ßb shows a view of the wing in a longitudinal section and Figure 6x shows a view from the front towards the wing. The wing 21, 22 is an elongated portion that approximately has a bone shape in plan view, with elongated ends and a thinner intermediate portion, although the wings 21 and 22 respectively are of a relatively flat and thin nature, as can be seen by reference in Figures 6b and 6d. The end is provided with a central opening 24 whose diameter corresponds to the outer diameter of the cylindrical projection 6 of the retaining portion 1 of the clamping device. That opening 24 is formed or surrounded by a ring element 23 of which one side is provided with a notched or slotted configuration 25 which can be best seen from Figure 6c. In this arrangement the crest of the teeth of the serrated configuration extends substantially radially. As can also be seen through the reference in Figure b, the portion of the ring 23 of the flange 21 or 22 is only half as thick as the connecting part of the flange 21, 22. In this case the toothed configuration or slot 25 is provided with the side of the ring element 23, which is on the left in Figure ßb. As can be easily imagined, two of these wings 21, 22, which, for example, face opposite directions can then be arranged one above the other with their respective ring elements in an equal relationship, in which case the toothed configurations 25 of the ring elements 23 face each other and engage with each other. Because the stepped transition of the ring element 23 to the surrounding part 26, which is twice the thickness of the flange 21, 22, the protective plate that is formed of the two flanges 21, 22, has a constant thickness throughout of this region. While the transition from the thicker part 26 of the wing towards the ring element 23 extends only over an angular region of about 90 to 100 °, the two wings 21, 22 that fit together in an equal relationship with their Ring elements 23 can also move with pivoting in relation to each other from their position in which the two wings face opposite positions, around the common axis of the elements of the ring, so that they can include with each one an angle of minimum of 100 ° and a maximum of 180 °. It can be seen that the wings 21, 22 can also easily be in this configuration as they can move with pivoting relative to each other on the larger desired angular region, for example from 0 ° to 180 °. The two ring elements 23 are fitted on the cylindrical projection ß of the portion of the box 1, in which case the elements of the ring are sufficiently widened (optionally 1 portion of the flange 7 can also be correspondingly deformable or compressible), with in order to be able to move on the flange portion. The flange portion 7 then retains the two elements of the ring together so that the serrated configurations 25 remain engaged with sufficient firmness to retain the two wings 21, 22 in a selected angular position, although the wings are also rotatable relative to each other, by applying a certain force, without involving a greater degree of difficulty, so that they assume the desired angular position in relation to each other. The other end of the wing 21 also has an opening which is identified by the reference 27 and which is provided to pass through this and is fitted with a safety band or lath (not shown here).

Claims (19)

1. CLAIMS 1. A tracheostomy cannula comprising a tube or hose-shaped element to pass through an incision in the neck and trachea within the trachea of a patient in case the patient's upper respiratory tract is blocked in order to provide the patient with breathing air through the cannula, and with a protective plate that is mounted to the cannula and whose contact against the patient's neck defines the position of the cannula or the end of the cannula in the trachea of the patient, characterized in that the protective plate is mounted to the cannula in a fixed manner in several positions in the longitudinal direction of the cannula.
2. 2. A cannula for tracheotomy according to claim 1, characterized in that the protective plate is mounted to a clamping device (19) that is hooked by clamping and can be released to the outside of the cannula.
3. 3. A cannula for tracheostomy according to claim 3, characterized in that the clamping device is pre-stretched within the engagement of the clamping in the cannula.
4. 4. A tracheostomy cannula according to Claim 2 or Claim characterized in that the clamping device comprises at least two retaining portions (1, 3) that at least partially surrounds the cannula in an annular configuration and that it moves in relation to each other perpendicular to its ring axes.
5. 5. A tracheostomy cannula according to claim 4 characterized in that the retention portions (1, 3) move with pivoting about a third axis that is parallel to the two axes of the ring but that are not coincident with one of the axes of the ring. H.H.
6. A cannula for tracheotomy according to claim 4, characterized in that one of the retaining portions (3) is linearly displaceable relative to the other (1).
7. A cannula for tracheostomy according to Claim 6 is characterized in that the clamping device comprises substantially three portions, where one of the portions (1, 2) is fixedly connected to the other and form a box having two openings mutually aligned so that a tracheostomy cannula passes through this, where the clamping device has a third, substantially planar portion (3) that also has an opening for the tracheostomy cannula to pass through, which it may be at least partially carried within the overlapped relationship with the two openings mutually aligned when the third flat portion is disposed within the box formed by a first portion and a second portion, where the third flat portion is prefatigated in such a way that so that its opening (13) is displaced eccentrically with respect to the two openings (11, 12) of the other po tions (1, 2), wherein the tracheostomy cannula is clamped in the region that overlaps the three openings.
8. 8. The tracheostomy cannula according to claim 7 characterized in that to produce the pre-fatigue eccentric effect of the third planar portion (3) has a spring arch that bears against the inner wall of the box formed by the first portion and the second portion (1, 2).
9. 9. A tracheostomy cannula according to claim 8, wherein an actuating element (5) extending in the side of the third planar portion (3) that is in opposite relation to the spring arch (4) is provided. out through the lateral opening left free in the box, in such a way that the actuator element (5) can be pressed inward from the outside of the box against the force of the spring bow (4), where the overlapped region of The three openings increases in size.
10. 10. A cannula for tracheotomy according to some of Claims 4 to 9 characterized in that the inner edge of at least a portion of the openings in the portions of the clamping device has a serrated configuration.
11. 11. A tracheostomy cannula according to any one of claims 1 to 10, characterized in that the protective plate of the tracheostomy cannula is secured to the clamping device.
12. 12. A tracheostomy cannula according to claim 11 characterized in that the protective plate (21), 22) has an opening whose diameter is greater than the diameter of the tracheostomy cannula and which is adjusted to a cylindrical projection in the clamping device, where the cylindrical projection (6) is oriented substantially concentrically with respect to at least one of the three openings of the clamping device.
13. 13. A cannula for tracheotomy according to claim 12 characterized in that at its free end the cylindrical projection (6) has a retention flange that projects radially outwards (7).
14. 14. A tracheostomy cannula according to any of claims 11 to 13, characterized in that the protective plate comprises two separate wings that are rotatable relative to one another around the cannula.
15. 15. A cannula for tracheotomy according to claim 14, characterized in that the wings (21, 22) that move relative to one another are adjusted with a respective ring portion (23, 24) in the cylindrical projection ( 6) of the clamping device.
16. 16. A cannula for tracheotomy according to claim 15, characterized in that on its mutually facing surfaces the portions of the ring (23, 24) have a slotted or serrated configuration that prevents relative rotational movement of the ring elements.
17. 17. A cannula for tracheostomy according to claim 15 or claim 16, characterized in that the portions of the ring (23, 24) are preattached in an engagement against each other between the flange (7) and the base of the projection. cylindrical (6).
18. 18. A tracheostomy cannula according to any one of Claims 14 to 17, characterized in that one of the wings is fixed without rotation to the clamping device.
19. 19. A cannula according to any of claims 11 to 18 characterized in that the cylindrical projection protection plate is relatively disposed on the side of the clamping device, which is towards the neck of the patient.