CN101146564A - 管放置装置 - Google Patents

管放置装置 Download PDF

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CN101146564A
CN101146564A CNA2006800089343A CN200680008934A CN101146564A CN 101146564 A CN101146564 A CN 101146564A CN A2006800089343 A CNA2006800089343 A CN A2006800089343A CN 200680008934 A CN200680008934 A CN 200680008934A CN 101146564 A CN101146564 A CN 101146564A
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M·米森
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    • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
    • A61M16/04—Tracheal tubes
    • A61M16/0465—Tracheostomy tubes; Devices for performing a tracheostomy; Accessories therefor, e.g. masks, filters
    • A61M16/0472—Devices for performing a tracheostomy
    • A—HUMAN NECESSITIES
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    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
    • A61M16/04—Tracheal tubes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
    • A61M16/04—Tracheal tubes
    • A61M16/0465—Tracheostomy tubes; Devices for performing a tracheostomy; Accessories therefor, e.g. masks, filters
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
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    • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
    • A61M16/04—Tracheal tubes
    • A61M16/0488—Mouthpieces; Means for guiding, securing or introducing the tubes
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A61M25/01—Introducing, guiding, advancing, emplacing or holding catheters
    • A61M25/06—Body-piercing guide needles or the like
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
    • A61B90/03—Automatic limiting or abutting means, e.g. for safety
    • A61B2090/033—Abutting means, stops, e.g. abutting on tissue or skin
    • A61B2090/036—Abutting means, stops, e.g. abutting on tissue or skin abutting on tissue or skin
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
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    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M16/00—Devices for influencing the respiratory system of patients by gas treatment, e.g. mouth-to-mouth respiration; Tracheal tubes
    • A61M16/04—Tracheal tubes
    • A61M16/0434—Cuffs
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M25/00—Catheters; Hollow probes
    • A61M2025/0008—Catheters; Hollow probes having visible markings on its surface, i.e. visible to the naked eye, for any purpose, e.g. insertion depth markers, rotational markers or identification of type
    • A—HUMAN NECESSITIES
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    • A61M2205/00—General characteristics of the apparatus
    • A61M2205/58—Means for facilitating use, e.g. by people with impaired vision
    • A61M2205/583—Means for facilitating use, e.g. by people with impaired vision by visual feedback
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61M—DEVICES FOR INTRODUCING MEDIA INTO, OR ONTO, THE BODY; DEVICES FOR TRANSDUCING BODY MEDIA OR FOR TAKING MEDIA FROM THE BODY; DEVICES FOR PRODUCING OR ENDING SLEEP OR STUPOR
    • A61M2205/00—General characteristics of the apparatus
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Abstract

一种用于***气管造口术管的气管造口术器具(1)，其包括沿长度具有彩色条纹(13)且与位于机械端的注射器(14)连接的针(10)，注射器(14)用于探测气管(3)何时被穿透；探测的深度可以通过与皮肤表面(5)对齐的彩色条纹(13)而指示。气管造口术管的轴(20)的机械端具有许多与针(10)上的条纹(13)相应的彩色条纹(26)。凸缘(24)可以沿着管(2)移动，并且其相对与皮肤表面(5)对齐的针(10)上条纹(13)相应的彩色条纹(26)的位置而锁定。

Description

管放置装置
本发明涉及一种包括管和细长穿透器具的管放置装置，该器具适合于穿透管将要放置的体腔。
在各种外科情况下，需要在体腔内制造通道以使管的一端能够***体腔内。例如，在一些气管造口术过程中，通道最初是采用中空的针穿过颈部组织到达气管，随后采用一个或者多个扩张器扩大通道，从而气管造口术的管能够***进去。在一些情况下，比如患者非常的胖，具有过多厚度的组织覆盖在气管上，评估组织的厚度非常困难，以至具有固定凸缘的传统管可能不适合。通常情况下，优选的方式是采用能够沿着管轴长度方向移动具有凸缘的管，从而凸缘根据患者的体形能够适当定位，该种管的问题在于：当管***之后，必须操作凸缘并给凸缘定位，这样可能导致患者外伤。
本发明的目的在于提供可选择的管放置装置及其方法。
根据本发明的一个方面在于，提供以上详述类型的管放置装置，其特征是器具沿其长度方向上设有可见标志，通过该标志，器具***的长度能够很容易确定下来，管相应地设有与器具上相同特征的可见标志，管上具有相对于标志沿着所述管的长度方向上可以移动并且可以锁定的凸缘，因此通过观察器具上标志显示的穿透长度可以将凸缘适当定位。
器具和管上的可见标志优选地为沿着器具和管周围延伸的条纹(bands)，标志优选地为彩色的且相互间不同。器具可以包括具有切削尖端的针。器具可以包括设备，例如注射器，用于指示器具尖端何时穿透体腔。管可以是气管造口术管，而器具可以适合于经过颈部组织穿透气管。
本发明的第二个方面在于，提供用于根据本发明的上述一个方面的装置里的管。
本发明的第三个方面在于，提供用于根据本发明的上述一个方面的装置里的器具。
本发明的第四个方面在于，提供一种在体腔内放置管的方法，其步骤包括：采用器具穿透身体组织，探测器具何时穿透体腔，沿着器具观察标志来决定哪个标志与皮肤表面对齐，沿着管移动凸缘，直到凸缘与和器具上的标志相应的管上的标志对齐为止，保持凸缘在管上的位置，然后沿着由器具建立的通道***管直到管上的凸缘和皮肤表面接触为止。
本发明的第五个方面在于，提供用于根据本发明的上述第四个方面的方法中的装置。
用于放置气管造口术管的装置及其方法，将以举例说明并参考附图的方式描述，附图中：
图1显示针器具***气管的截面图；
图2是气管造口术管的透视图；
图3是显示***气管的管的截面图。
首先参考图1和图2，装置包括针器具1和气管造口术管2。用于最初穿透气管的针器具1包括前端具有切削尖端11且后端具有插座(hub)12的坚硬的、中空的钢针10。沿着长度方向上，针10具有的可见标志13，其形式是环绕针的圆周延伸并相继排列的四个不同彩色的条纹。针可以携带外部套管，在这种情况下标志可以设置在套管上。标志为彩色条纹不是必需的，因为它们可以是数字或者字母，但是对于特定的直径相对小的针，彩色条纹应是最显著的。条纹13沿着与可能遇到的颈部组织厚度的变化幅度相应的针10长度的那部分而定位。针器具1还包括前端连接插座12的注射器14。注射器14用于探测针10的尖端11何时穿透气管3。可用于阻力丧失(out-of-resistance)技术，即使用者施加较轻的压力给注射器活塞15，而针穿过颈部组织4***。尖端11与颈部组织4接触以防止泄气，因此活塞15不相对于圆筒16移动，当针10的尖端11清除组织4进入气管3时，可能泄气从而允许活塞15向前移动，这个对使用者来说是很显然的。对气管3的进入可通过相对于圆筒16抽回活塞15以确信在气管内吸气来确认。用于穿透气管的其它形式的器具可类似地进行可视标记。
只要尖端11进入气管3，使用者就可以注意到与皮肤表面5对齐的条纹13的颜色。注射器14于是断开与插座12的连接，留下针10在位置上。导丝(图未示)于是沿着针10的孔而滑动，从而一端进入气管3。针10沿着导丝向后滑出患者，留下导丝在该位置。在针携带套管的地方，在穿透后移除针以留下套管在适当的位置，而且导丝将沿着套管***。扩张器(图未示)或者是一系列渐增尺寸的扩张器于是沿着导丝滑动，以扩大穿过颈部组织4的通道，到达大小能够充分容纳气管造口术管2。
管2包括带有密封气囊21的管状轴20，密封气囊21接近于前面即患者端22。管2的后面，即机械端，设有一般是15mm的联接件23。管2还包括颈部凸缘(flange)24，该种颈部凸缘24能够沿着轴20而滑动并且能够在任何所需要的位置上锁定。通过机构(图未示)凸缘24被锁定在位置上，这种机构可以是下面所述的任何传统形式，例如US5,026,352、US4,249,529、US4,449,527、US4,498,903、US4,530,354、US4,530,354、US4,649,913、US4,683,882、US4,774,944、WO80/02645、WO84/03217、US4278081和GB0503081.2。在管的后面，即机械端，具有直挺部分25，凸缘24能够沿着直挺部分25定位，而这部分长度的一部分具有与针上相同特征的可见标志，形式为相继设置的一系列四个不同彩色的条纹26，以提供相同色彩条纹的图案并以与针10上条纹13相同的顺序设置。在***管2之前，使用者根据与皮肤表面5对齐的针10上的条纹13，将凸缘24相对于彩色条纹26而定位，于是将凸缘24锁定在轴20的适当位置上，管2于是在引导器(图未示)上以通常的方式***，引导器沿着导丝滑动且随后被移除以留下管在如图3所示的气管3的位置上。
当管2为适应解剖学的变化已经几乎完全***进去时，可能需要微调凸缘24的位置。同时针器具1提供颈部组织4的厚度指示，而并非给出任何气管尺寸变化的指示，这样就会影响管2应该***多远。本发明的布局方式仍然可以使凸缘24相对精确地优先定位，并减少管在患者体内需要操作的次数，这样可以相当大程度的减少患者的外伤以及不适。
本发明不限于气管造口术管，也可以用于放置在身体里的其它管。

Claims (11)

1.一种管放置装置，包括：管(2)和细长穿透器具(1)，所述器具适于穿透所述管将要放入的体腔(3)，其特征在于：所述器具(1)沿其长度设有容易确定所述器具***长度的可见标志(13)，所述管(2)相应地设有与所述器具上相同特征的可见标志(26)，所述管(2)具有相对于所述可见标志(26)沿着所述管的长度可以移动并且可以锁定的凸缘(24)，使得通过观察表示穿透长度的所述器具上的所述可见标志(13)可以将所述凸缘适当定位。
2.根据权利要求1所述的装置，其特征在于，所述器具和所述管上的所述可见标志是环绕所述器具和管延伸的条纹(13、26)。
3.根据权利要求1或2所述的装置，其特征在于，所述可见标志(13、26)彼此不同地着色。
4.根据前述权利要求中任一项所述的装置，其特征在于，所述器具包括带有切削尖端(11)的针(10)。
5.根据前述权利要求中任一项所述的装置，其特征在于，所述器具包括用于指示所述器具的所述尖端(11)何时穿透所述体腔(3)的设备(14)。
6.根据权利要求5所述的装置，其特征在于，用于指示穿透的设备包括注射器(14)。
7.根据前述权利要求中任一项所述的装置，其特征在于，所述管为气管造口术管(2)，且所述器具(1)适于经过颈部组织(4)穿透所述气管(3)。
8.一种使用于根据前述权利要求中任一项所述装置内的管(2)。
9.一种使用于根据前述权利要求中任一项所述装置内的器具(1)。
10.一种在体腔(3)内放置管(2)的方法，其步骤包括：采用器具(1)穿透身体组织(4)；探测所述器具(1)何时穿透所述体腔(3)；沿着所述器具(1)观察标志(13)，以确定哪个标志与所述皮肤表面(5)对齐；沿着管(2)移动凸缘(24)，直到所述凸缘跟与所述器具上的所述标志(13)相应的所述管上的标志(26)对齐为止；保持所述凸缘(24)在所述管(2)上的位置，然后沿着由所述器具(1)建立的通道插所述管，直到所述管上的所述凸缘(24)与所述皮肤表面(5)接触为止。
11.一种使用于根据权利要求10所述方法中的装置。
CN2006800089343A 2005-03-19 2006-03-16 管放置装置 Expired - Fee Related CN101146564B (zh)

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PCT/GB2006/000956 WO2006100442A1 (en) 2005-03-19 2006-03-16 Tube placement apparatus

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JP2008532673A (ja) 2008-08-21
WO2006100442A1 (en) 2006-09-28
US20080168986A1 (en) 2008-07-17
CN101146564B (zh) 2010-10-06
EP1871450A1 (en) 2008-01-02
US9205213B2 (en) 2015-12-08
GB0505723D0 (en) 2005-04-27
EP1871450B1 (en) 2018-08-08

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