Endotracheal Tube and Nasogastric Tube Attachment Device

Abstract

An endotracheal tube and gastrointestinal tube attachment device for positively securing an endotracheal tube and a gastrointestinal tube to a patient and allowing selective lateral positioning and locking of the gastrointestinal tube without removing the device or tube from the patient is disclosed. The device includes an elongated strip of flexible material adapted to be adhesively attached to an upper lip region of a patient and a tube holder which is slideably mounted upon the strip. The tube holder has an arm extending in a direction perpendicular to and away from the strip and a securement strap is provided for positively securing the endotracheal tube along the length of the arm. The strip includes a fastener for fastening the gastrointestinal tube.

Claims

1. A device for securing an endotracheal tube and a nasogastric tube to a patient comprising: an elongated strip of flexible material shaped to fit on a region adjacent to and along one lip of a patient, said strip having inner and outer surfaces and a pair of opposite ends, said strip including a nasogastric tube fastener for releasably attaching the nasogastric tube to the strip; and a tube holder slidably connected to the strip and having an arm extending in a direction generally perpendicular to said strip, the tube holder including a endotracheal tube fastener for releasably attaching the endotracheal tube along the arm, allowing lateral sliding of the holder along a length of the strip, and the tube holder having a lock for positively locking the holder in a selected position along the length of the strip.

2. A method of securing an endotracheal tube and a nasogastric tube to a patient comprising: attaching an elongated strip of flexible material to a region adjacent to and along one lip of a patient, said strip having inner and outer surfaces and a pair of opposite ends, said strip including a nasogastric tube fastener for releasably attaching the nasogastric tube to the strip; slidably connecting a tube holder to the strip, the tube holder having an arm extending in a direction generally perpendicular to said strip, the tube holder including a endotracheal tube fastener for releasably attaching the endotracheal tube along the arm, allowing lateral sliding of the holder along a length of the strip, and the tube holder having a lock for positively locking the holder in a selected position along the length of the strip; attaching the endrotracheal tube to the endotracheal tube fastener; and attaching the nasogastic tube to the nasogastric tube fastener.

Description

BRIEF DESCRIPTION OF THE DRAWINGS

[0010] FIG. 1 is a perspective view of the endotracheal tube attachment device embodying this invention.

[0011] FIG. 2 is an enlarged cross-sectional view of one embodiment of the positioning means of the present invention.

[0012] FIG. 3 is a top plan view of one embodiment of the positioning and locking mechanisms of the present invention.

[0013] FIG. 4 is a top plan view of another embodiment of the positioning and locking mechanisms of the present invention.

[0014] FIG. 5 is a perspective view of the endotracheal tube attachment device of this invention fixedly securing an endotracheal tube to a patient.

[0015] FIG. 6 is a perspective view of one embodiment of the endotracheal tube fastener for attaching the endotracheal tube to the tube holder.

[0016] FIG. 7 is an enlarged cross-sectional view taken along line 7-7 of FIG. 5.

[0017] FIG. 8 is an embodiment of the strip showing the nasogastric tube fastener.

[0018] FIG. 9 is an embodiment of the strip showing the nasogastric tube fastener.

DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS

[0019] In FIG. 1, the numeral 10 generally designates an endotracheal tube attachment device having an elongated strip 11 of flexible material with inner and outer surfaces 12 and 13 and a pair of opposite ends 14 and 15. Strip 11 is preferably made of tough, flexible plastic material (e.g., polyethylene) and is shaped to fit on a region adjacent to and along one lip of the patient. Although strip 11 can be positioned along either of the patient's lips, it is believed preferable to position strip 11 along the patient's upper lip as illustrated in FIG. 5 due to the fact that if strip 11 were positioned along the lower lip, movement of the lower jaw might have adverse effects on the positioning of the endotracheal tube. Strip 11 is illustrated in FIG. 1 as having a linear and generally planar configuration in an unflexed or untensioned state and FIG. 5 illustrates strip 11 as being flexibly shaped to conform with the arcuate contour of a patient's upper lip. Although strip 11 is shown as being linear or planar when unflexed, it may, if desired, be preformed to have an arcuate configuration for easier positioning on the patient.

[0020] Ends 14 and 15 of strip 11 are provided with apertures 14a and 15a for attachment to head-encircling band means for securing the strip on the patient's head. Any type of band means may be employed to encircle the patient's head and connect ends 14 and 15, but the flexible, soft cloth band 16 shown in FIG. 1 has been found to be particularly effective for this purpose. Band 16 has an enlarged portion 17 that comfortably fits against the back of a patient's head and holds the band in place. Elongated strap portions 18 and 19 extend from enlarged portion 17 and can be threaded through respective apertures 14a and 15a, then reversed and attached to themselves by clamps (not shown) or, preferably, by using fabric loop and hook-type retainers commonly known and sold under the trademark Velcro. Where Velcro is employed, flexible plastic end straps 18a and 19a with plastic (nylon) hooks 20 can be attached to the ends of strap portions 18 and 19 for attaching to the soft loop cloth 21 of straps 18 and 19.

[0021] Inner (bodyside) surface 12 of strip 11 is provided with adhesive pad means for comfortably attaching strip 11 along the patient's lip. The pad means preferably takes the form of pad 22 having a narrow elongated portion 22a and a pair of opposite, enlarged end portions 22b and 22c. Narrow elongated portion 22a is secured by a thin layer of adhesive 23, such as a liquid cyanoacrylate adhesive, to inner surface 12 of strip 11 and enlarged portions 22b and 22c are positioned adjacent ends 14 and 15 so that the junction of the head band and strap ends will not cause discomfort to the patient. In a preferred construction, pad 22 is composed of a first layer 24 of a resilient, flexible, fine-celled thermoplastic foam, such as polyolefin or polyurethane foam, and a second layer 25 of soft, deformable skin barrier material having both wet and dry tack properties. It is believed that skin barrier materials that employ fluid-absorbing, hydrocolloid-containing adhesives with both wet and dry tack are preferable, and particularly effective skin barrier materials are disclosed in U.S. Pat. No. 4,496,357, the complete disclosure of which is incorporated herein by reference. However, if desired, layer 24 may be formed of materials other than foam, such as a film of flexible polyurethane or other polymeric film having similar properties, and layer 25 may instead be formed of a suitable pressure-sensitive adhesive (e.g., a medical grade acrylic adhesive). Regardless of the particular composition of adhesive layer 25, a removable silicone-coated release sheet 26 is provided to cover the adhesive prior to use.

[0022] An endotracheal tube holder, generally designated at 27, is slideably mounted upon strip 11 and has an arm 28 that extends in a direction perpendicular to strip 11 away from the outer surface 13 of that strip. The Endotracheal tube holder 27 can be provided on arm 28 for securing an endotracheal tube thereto in a parallel direction. The tube holder 27 includes an endotracheal tube fastener. In a preferred form, the endotracheal tube fastener comprises a soft, elongated strap 29 of elastomeric material, preferably a copolymer of etheylene and vinyl acetate, and an enlarged retaining portion 29a is formed on one end of the strap. As most clearly seen in FIG. 7, arm 28 is provided with a slot 30 for receiving strap 29, and slot 30 has a pair of recessed ends 30a and 30b for receiving retaining portion 29a and securely fixing that end of the strap to the arm. A free length 29b of strap 29 then extends in the direction transverse to arm 28 and may be formed into a tube-retaining loop for encircling and securing an endotracheal tube 31 along arm 28. An adhesive pad 32 formed of a suitable pressure-sensitive adhesive is provided on an inner surface 29c of strap 29 to further restrain tube 31 from rotational or longitudinal movement when it is secured against arm 28 by strap 29 (FIG. 6), and a removable silicone coated release layer 33 may be provided on pad 32 prior to use (FIG. 1). A plurality of sharp, nub-like prongs 34 may also be provided on a bottom 28a of arm 28 for frictionally engaging endotracheal tube 31 and further restraining the tube from movement.

[0023] The endotracheal tube fastener can be provided on arm 28 for securely engaging a segment of strap 29 along its free length 29b and maintaining the strap in tension to restrain a tube encircled by it. The endotracheal tube fastener may take the form of an elongated, cantilevered clamping member 35 that is hingedly attached at 36 to endotracheal tube holder 27 as most clearly seen in FIG. 6. Clamping member 35 can be pivoted and raised about hinged portion 36 to allow free length 29b of strap 29 to be folded over the top 28b of arm 28, and then clamping member 35 can be lowered and locked in place against arm 28 to maintain strap 29 in tension about tube 31. To crimp strap 29 and ensure that it does not slip out from between arm 28 and clamping member 35, clamping member 35 is preferably provided with a longitudinal rib 35a and arm 28 is provided with a longitudinal channel 37 for receiving rib 35a.

[0024] A latch can be provided to lock clamping member 35 against arm 28 with strap 29 interposed therebetween. The latch may take the form of a flexible, resilient latching member 38 that is flexible about its attachment point 39 to arm 28. A clip or hook portion 40 is provided on member 38 so that when clamping member 35 is lowered, latching member 38 will be pushed outwardly and pivot about attachment point 39 to allow clamping member 35 to tightly engage strap 29. Clip portion 40 then securely engages top 35b of clamping member 35 and locks clamping member 35 in place. When it is desired to release tube 31, a person may simply pull clip portion 40 of latching member 38 away from the tube holder until clip 40 is retracted beyond the end of clamping member 35, and clamping member 35 can then be raised to release strap 29. Such a construction allows for easy longitudinal adjustment of the endotracheal tube by releasing strap 29, and then resecuring the endotracheal tube, after such adjustment, to the holder with strap 29. The ability to easily adjust the tube in the longitudinal direction is greatly advantageous as endotracheal tubes are often adjusted in the longitudinal direction shortly after initial placement if chest x-rays reveal that the tube is not in its optimal position.

[0025] Positioning means are provided for connecting endotracheal tube holder 27 to strip 11 and allowing selective lateral positioning of the tube holder 27 and endotracheal tube along strip 11. Such positioning means preferably takes the form of track means disposed on outer surface 13 of strip 11 and shuttle means disposed on endotracheal tube holder 27 for engaging the track means and allowing lateral sliding of the shuttle and tube holder along the track means. In one embodiment, the track means takes the form of rail 42 of a generally T-shaped cross-sectional configuration and including a first member 43 extending perpendicularly from outer surface 13 and a second cross-member 44 parallel to strip 11, as most clearly shown in FIGS. 1 and 2. The shuttle means may then take the form of retainer 45 having a generally C-shaped configuration. Retainer 45 has a pair of opposing arms 46 and 47 that fit relatively tightly between outer surface 13 of strip 11 and an inner face 44a of cross-member 44 to stabilize retainer 45 on rail 42 but without impeding lateral movement of retainer 45 along the longitudinal length of rail 42. Although retainer 45 and rail 42 have been described in considerable detail, it will be understood that different types of shuttle and track means may be employed as long as the shuttle means allows lateral sliding of endotracheal tube holder 27 along strip 11 and enables the tube to be repositioned from one side of a person's mouth to the other. It will also be understood that stop members (not shown) may be provided on the ends of rail 42 to prevent retainer 45 from sliding off the track.

[0026] The positioning means allows lateral positioning of endotracheal tube holder 27 and endotracheal tube 31 into any of a multiplicity of selected positions along strip 11, and locking means are provided for positively locking the tube holder and tube in the selected position of adjustment. The locking means includes restraining means disposed on strip 11 and engaging means disposed on endotracheal tube holder 27 operable to selectively and positively engage or disengage the restraining means and respectively lock the tube holder in the selected position or allow lateral sliding of the tube holder along strip 11. A preferred form of engaging means is most clearly shown in FIG. 3 and comprises a pair of lever arms 48 and 49 that are positioned generally perpendicular to strip 11. Endotracheal tube holder 27 can include a central member 50 and an end member 51 for mounting of the lever arms. Lever arms 48 and 49 include distal end portions 48a and 49a that are positioned to engage the restraining means on strip 11 when the arms are in an unflexed condition, intermediate portions 48b and 49b that are respectively connected by flexible webs 52 and 53 to central member 50, and proximal end portions 48c and 49c that when squeezed towards each other in a flexed condition cause the lever arms to pivot about their intermediate portions which results in distal end portions 48a and 49a becoming disengaged from the restraining means on strip 11 (shown by broken lines in FIG. 3). End member 51 is provided to contact proximal end portions 48c and 49c when the lever arms are flexed and serves as a stop to limit their pivotal movement so that a user only needs to apply as much force as necessary to disengage distal end portions 48a and 49b from the restraining means. In a preferred form, the restraining means comprises a longitudinal series of transversely-extending ratchet teeth 54 disposed along outer face 42a of rail 42.

[0027] In another embodiment of the restraining means (FIG. 4), the ratchet teeth may be eliminated and the lever arms can engage outer face 42a of rail 42 which is smooth, but resilient, and adapted to frictionally engage distal end portions 48a and 49a by means of a wedging action, and lock endotracheal tube holder 27 in a selected position of an infinite number of such positions when the lever arms are in unflexed condition. In such a construction, lever arms 48 and 49 preferably have a relatively rigid mounting so that distal ends 48a and 49a provide a tight wedging action against the outer surface of the rail. In the illustration given in FIG. 4, such a rigid mounting is provided by attaching lever arms 48 and 49 to endotracheal tube holder 27 with short semi-flexible webs 52 and 53 which allow the lever arms to be flexed a sufficient distance to disengage their distal ends from track 42 while still providing sufficient stiffness to positively lock the tube holder in place when the lever arms are unflexed.

[0028] The endotracheal tube attachment device 10 of this invention can applied with the endotracheal tube 31 already positioned in the patient's mouth and trachea. Preferably, a bite block device is already prepositioned about the tube to prevent the patient from clamping the tube between his or her teeth. Such a bite block device is well known and compatible with the attachment device of this invention. The person applying the device then removes release layer 26 from adhesive pad 22 and applies and positions strip 11 adjacent to and along the lip, preferably the patient's upper lip. Band 16 is secured about the patient's head to secure strip 11 in place. The applier actuates lever arms 48 and 49 to allow lateral sliding of endotracheal tube holder 27 into position so that arm 28 is positioned adjacent and parallel to tube 31, at which point lever arms 48 and 49 are released to positively lock tube holder 27 in position. Release layer 33 is then removed from adhesive 32 and the free length 29b of strap 29 is formed into a tube-retaining loop about tube 31. A segment of strap 29 is locked between clamping member 35 and channel 37 by lowering clamping member 35 below clip 40 which engages the top of clamping member 35 and securely locks strap 29 about tube 31. Once so positioned, strap 29, adhesive 32, and prongs 34 all act to prevent rotational and longitudinal movement of tube 31. Endotracheal tube holder 27 and tube 31 can then be laterally repositioned as desired by actuating lever arms 48 and 49 to allow lateral sliding of the tube holder along the length of strip 11. One of the primary advantages of such a construction is that the tube can easily be repositioned and positively locked without requiring release of tube 31 from the endotracheal tube holder 27. This is advantageous because if it were required to release tube 31, tube 31 might possibly shift longitudinally in the patient's trachea, requiring respositioning of the tube and possibly x-ray verification of the tube's placement which is time-consuming, expensive and potentially harmful.

[0029] As shown in FIGS. 8 and 9, the strip 11 can be provided with a gastrointestinal tube fastener 60 for fastening a gastrointestinal tube 62 to the strip 11. The gastrointestinal fastener 60 can be in the form of two clamps or arms sized to releasably fasten the gastrointestinal tube 62 to the strip 11. These clamps or arms are sized and positioned to accept a range of sized nasogastric tubes from 10-18 French (Fr). These clamps or arms will position the nasogastric tubes away from the oral cavity area, potentially reducing the chance of entanglement or dislodgement. The clamps or arms will assist in managing the nasogastric tube securement as well as offer a landing area to apply tape to the device. The avoidance of using tape directly on the skin will aid in potentially reducing skin irritation, skin breakdown and skin infection. If desired, an oralgastic tube can be used in place of the nasogastric tube and fastened to the strip 11 using the fastener 60.

[0030] While in the foregoing, embodiments of the invention have been disclosed in considerable detail for purposes of illustration, it will be understood by those skilled in the art that many of these details may be varied without departing from the spirit and scope of the invention.