Patent Application
20060100483
The present invention relates generally to hand-held viewing endoscopes for assisting in endotracheal intubation procedures.
Endotracheal intubation is a common medical procedure by which a flexible plastic endotracheal breathing tube is inserted into a patient's trachea for providing oxygen or anesthetic gases to the lungs. Usually, the endotracheal tube is introduced into the patient's trachea after the patient has been sedated or has become unconscious, with initial placement of the endotracheal breathing tube often performed under emergency conditions. Therefore, it is desirable to have an apparatus that facilitates the accurate placement, as quickly as possible, of the endotracheal tube within the trachea of a patient.
Various devices have been used to aid in the placement of endotracheal tubes within the trachea of a patient, including viewing endoscopes. Viewing endoscopes use a slender, elongated stylus having viewing and lighting conduits that cooperate with a hub, eyepiece and light source to permit viewing within the trachea during the placement of the endotracheal tube. The lighting conduit of the endoscope carries light from the light source, typically located in a handle secured to the hub at a proximal end of the stylus, to the distal end of the stylus to illuminate a viewing area. The viewing conduit carries the illuminated image from the distal end of the stylus to the eyepiece, again typically located on the hub at the proximal end of the stylus. The stylus may comprise an elongated tubular member or lumen made of malleable material that can be bent or shaped to guide the endotracheal tube into the trachea of a patient.
With the viewing eyepiece and the handle containing or communicating with a light source attached to the hub, the malleable stylus is inserted into the endotracheal tube and the stylus and the endotracheal tube are thereafter inserted into the trachea of a patient while the practitioner views the illuminated interior of the trachea through the eyepiece. The endotracheal tube must be inserted past the patient's teeth and tongue and further past the epiglottis and vocal cords into the trachea. After the endotracheal tube is advanced past the vocal cords and into the patient's trachea, the distal end of the tube should be approximately 2 to 4 centimeters (about 1 to 2 inches) in front of the bifurcation of the trachea in order to ventilate both of the patient's lungs equally. The stylus is then removed from the endotracheal tube, and the endotracheal tube is connected to a supply conduit which then supplies oxygen or another other gas to the lungs of the patient.
The location of the endotracheal tube in relation to the stylus is vital to the proper placement of the endotracheal tube in front of the bifurcation of the trachea of the patient. To ensure that the distal end of the endotracheal tube is properly placed within the trachea during the viewing endoscopic procedure, the distal ends of the endotracheal tube and stylus should be approximately co-terminus in relation to one another prior to their insertion into a patient. To maintain the co-terminus relationship between the distal ends of the endotracheal tube and stylus, adapter stops have been utilized to affix the proximal end of the endotracheal tube to the stylus of the endoscope.
Adapter stops of prior art endoscopes generally comprise a housing distinct from the hub of the endoscope that defines a bore adapted to accept an insertion of the stylus there-through. With the stylus inserted through the bore of the housing, the housing can be moved adjustably along the stylus's length. A locking device is typically associated with the housing to temporarily affix the housing to the stylus in a predetermined location. The housing of the adapter stop also defines an access opening configured for attachment to the proximal end of the endotracheal tube, with the access opening generally co-axial with the bore. The access opening is typically in fluid communication with an inlet for connection to an oxygen or anesthetic gas source.
The stylus of the endoscope is inserted through the bore of the adapter stop and through the endotracheal tube, with the proximal end of the endotracheal tube thereafter attached to the access opening of the adapter stop. A gas source is then attached to the inlet of the adapter stop to provide oxygen or another gas to the patient during intubation. The adapter stop and attached endotracheal tube are then adjustably moved along the length of the stylus until the distal ends of the stylus and tube are about co-terminus with one another. The locking mechanism of the adapter stop is then actuated to affix the proximal end of the endotracheal tube to the stylus, thereby maintaining the co-terminus relationship between the distal ends of the stylus and tube. After the co-terminus relationship is established between the distal ends of the stylus and tube, both are inserted into the trachea of the patient.
Several disadvantages, however, are associated with prior art endoscopes using distinct adapter stops. Because the adapter stop is distinct from the hub, it comprises a separate component of the endoscope that must be handled by practitioners during intubation procedures. During an emergency procedure where time is of the essence, practitioners often forego use of the adapter stop due to the precious time consumed in connecting it to the endotracheal tube and stylus. In absence of the adapter stop, practitioners must then hold the endotracheal tube in relation to the stylus to maintain the co-terminus relation of their distal ends. Such practices by medical practitioners may jeopardize the crucial relationship required between the stylus and endotracheal tube for the proper placement of the endotracheal tube within a patient. Such practices may also jeopardize the provision of a gas source to the patient during intubation procedures because the component having the gas inlet to the endotracheal tube has been eliminated.
Furthermore, because the adapter stop is a separate component of the endoscope, it may dropped or misplaced by practitioners during the harried intubation procedures often occurring in emergency care. Such misplacement may result in improper use of the viewing endoscope by practitioners while intubating patients, or it may result in a breach of the sterility of the system if the adapter stop is recovered after misplacement.
In addition to the disadvantages associated with adapter stops relating to emergency intubation procedures, disadvantages also exist relating to ease of use of the endoscope. Because the endotracheal tube is attached to the adapter stop while placing the tube within the patient, the tube must be separated from the adapter stop after proper placement of the tube within a patient and prior to withdrawing the stylus of the endoscope from the endotracheal tube. The removal of the endotracheal tube from the stop is often cumbersome when the adapter stop is located on the stylus in a location spaced from the hub. The attachment or adjustment of the gas source at the inlet of the adapter stop may be cumbersome as well if the stop and hub are displaced a considerable distance from one another.
The practitioner typically holds the endoscope by a handle secured to the hub and must remove one or more hands from the handle to detach the endotracheal tube from the adapter stop, or to attach or adjust the gas source at the adapter stop's inlet. In removing his or her hands from the handle of the endoscope during an intubation procedure, the practitioner may encounter difficulty gripping the endoscope and may possibly jeopardize the proper placement of the endotracheal tube within a patient.
With regard to the handle of the endoscope, it is noted that many endoscopes utilize a handle that also comprises the light source of the system. The handle, typically attached to the hub of the endoscope, may include a battery power source and a light bulb for cooperation with the lighting conduit of the system. Within the medical industry, standards have been developed in relation to the structure of such handles so that a given handle may be utilized with a variety of medical devices requiring a light source. For example, the International Organization for Standardization (ISO) has promulgated a standard, namely, ISO 7376, for anesthetic and respiratory equipment that specifies general requirements for laryngoscopes and critical dimensions for the handle and lamp of hook-on type laryngoscopes. This standard is widely accepted and used within the medical industry.
A need therefore exists in the art for an endoscope that eliminates an adapter stop that is separate and distinct from the hub of an endoscope, thereby eliminating both the possibility of misplacement of the component during emergency intubation procedures and cumbersome procedures relating to the endotracheal tube or gas source connected to the adapter stop. A need also exists in the art for an endoscope that utilizes a standardized handle incorporating a light source and a standardized connection to the hub, and which is constructed and arranged so that the practitioner can disengage the adapter stop from the hub by manipulation from the hand holding the handle to release the endotracheal tube from the stylus and permit withdrawal of the stylus to leave the endotracheal tube in place in the patient. The present invention meets these needs.
Numerous other advantages and features of the present invention will become readily apparent to those skilled in the art from the following detailed description of the preferred embodiment of the invention, the drawings, and the appended claims.
While this invention can be embodied in many different forms, there are shown in the drawings and described in detail, preferred embodiments of the invention. The present disclosure is an exemplification of the principals of the invention and is not intended to limit the invention to the embodiments illustrated.
Referring to
The viewing endoscope 10 facilitates the viewing by a medical practitioner of the interior of a patient's trachea during an endotracheal intubation procedure. A viewing of the interior or the patient's trachea during an intubation procedure allows the medical practitioner to properly locate a distal end of the endotracheal tube therein.
The hub 19 has a proximal end 24 and a distal end 26 and a mesial or middle portion 28. In a preferred embodiment of the invention, the hub 19 is made of corrosion-resistant metal, such a aluminum, stainless steel, or an inert plastic. Because of the material composition of the hub 19, it is receptive to sterilization procedures that may include elevated temperature levels.
A coupler 30 is located on the proximal end 24 of the hub 19 and is constructed and arranged to receive the eyepiece 12. A connector 32 is located on the mesial or middle portion of the hub 19 and is provided with hook portions 35 that define a slot 33 in the connector 32. The connector 32 is constructed and arranged to cooperate with a conventional hook-on fitting on the handle 14 so as to secure the hub 19 to the handle 14. Preferably, the hub 19, coupler 30 and connector 32 are integrally formed.
Stylus 34 is secured at one end within receiver 40 defined by a bore in the distal end 26 of the hub 19 in a suitable manner, for example, by a threaded connection or by compression fit. The stylus 34 is a flexible elongated member made from a suitable material, for example, inert rubber or a polymeric material. The stylus 34 is flexible so that it can be bent in various directions without retaining a memory. Such flexibility is desirable during intubation procedures to enable the practitioner to insert the stylus 34 through the mouth of the patient and into the trachea.
The connection of the eyepiece 12 to the hub 19 is facilitated by the coupler 30 (best shown in
A port 41 (best shown in
The endotracheal tube 20 includes a portion of substantially uniform cross section and has the adapter stop 44 at one end which is constructed and arranged to fit within the receiver 40 of the hub 19. Basically in use, the endotracheal tube 20 and the adapter stop 44 secured on the end thereof are slipped over the stylus 34 until the end of the stop 44 is received in the receiver 40. The engaged position of the adapter stop 44 in the hub 19 is a predetermined distance 50 (
As better shown in
With reference to
In use, the medical practitioner will place the endotracheal tube 20 on the stylus 34, with the stop 44 inserted into the receiver 40 in the hub 19. A gas source will be connected to the fitting 42 that has been inserted into the port 41. The stylus 34 and the endotracheal tube 20 are advanced through the mouth into the trachea of the patient. After proper positioning of the endotracheal tube 20 in the patient, the medical practitioner will disconnect the endotracheal tube 20 from the receiver 40 of the hub 19 by tactile contact, i.e., by pushing outwardly on the flange or flanges 22 on the adapter stop 44 by a finger on the hand holding the handle 14 of the viewing endoscope 10. The medical practitioner can then withdraw the stylus 34 from the endotracheal tube 20, leaving the endotracheal tube 20 properly positioned in the trachea of the patient.
While we have shown a presently preferred embodiment of the present invention, it will be apparent to persons skilled in the art that the invention may be otherwise embodied within the scope of the following claims.
