Aspirating Tubes

Categories: INSTRUMENTARIUM
Sources: A Manual Of Peroral Endoscopy And Laryngeal Surgery

Independent aspirating tubes involve delay in

their use as compared to aspirating canals in the wall of the

endoscopic tube; but there are special cases in which an independent

tube is invaluable. Three forms are used by the author. The velvet

eye cannot traumatize the mucosa (Fig. 9). To hold a foreign body by

suction, a squarely cut off end is necessary. For use through the

tracheotomic wound without a bronchoscope a malleable tube (Fig. 10)

is better.



[FIG. 9.--The author's protected-aperture endoscopic aspirating tube

for aspiration of pharyngeal secretions during direct laryngoscopy and

endotracheobronchial secretions at bronchoscopy, also for draining

retropharyngeal abscesses. The laryngoscopes are obtainable with

drainage canals, but for most purposes the independent aspirating tube

shown above is more satisfactory. The tubes are made in 20 30, 40, and

60 cm. lengths. An aperture on both sides prevents drawing in the

mucosa. It can be used for insufflation of ether if desired. An

aspirating tube of the same design, but having a squarely cut off end,

is sometimes useful for removing secretions lying close to a foreign

body; for removing papillomata; and even for withdrawing foreign

bodies of a soft surface consistency. It is not often that the foreign

bodies can be thus withdrawn through the glottis, but closely fitting

foreign bodies can at least be withdrawn to a higher level at which

ample forceps spaces will permit application of forceps. Such

aspirating tubes, however, are not so safe to use as the protected,

double aperture tubes.]



[FIG. 10.--The author's malleable tracheotomic aspirating tube for

removal of secretions, exudates, crusts, etc., from the

tracheobronchial tree through the tracheotomic wound without a

bronchoscope. The tube is made of copper so that it can be bent to any

curve, and the copper wire stylet prevents kinking. The stylet is

removed before using the tube for aspiration.]



[28] Aspirators.--The various electric aspirators so universally

used in throat operations should be utilized to withdraw secretions in

the tubes fitted with drainage canals. They, however, have the

disadvantages of not being easily transported, and of occasionally

being out of order. The hand aspirator shown in Fig. 11 is, therefore,

a necessary part of the instrumental equipment. It never fails to

work, is portable, and affords both positive and negative pressures.

The positive pressure is sometimes useful in clearing the drainage

canal of any particles of food, tissue, clots, or secretion which may

obstruct it; and it also serves to fill the stomach or esophagus with

air when the ballooning procedure is used. The mechanical aspirator

(Fig. 12) is highly efficient and is the one used in the Bronchoscopic

Clinic. The positive pressure will quickly clear obstructed drainage

canals, and may be used while the esophagoscope is in situ, by simply

detaching the minus pressure tube and attaching the plus pressure. In

the lungs, however, high plus pressures are so dangerous that the

pressure valve must be lowered.



[Fig. 11--Portable aspirator for endoscopy with additional tube

connected with the plus pressure side for use in case of occlusion of

the drainage canal. This aspirator has the advantage of great power

with portability. Where portability is not required the electrically

operated aspirator is better.]



[FIG. 12.--Robinson mechanical aspirator adapted for bronchoscopic and

esophagoscopic aspiration by the author. The positive pressure is used

for clearing obstructed drainage canals and tubes.]



[FIG. 13.--Apparatus for insufflation of ether or chloroform during

bronchoscopy, for those who may desire to use general anesthesia. The

mechanical methods of intratracheal insufflation anesthesia

subsequently developed by Meltzer and Auer, Elsberg, Geo. P. Muller

and others have rightly superseded this apparatus for all general

surgical purposes.]