AU2013239345A1

AU2013239345A1 - Endotracheal tube introducer

Info

Publication number: AU2013239345A1
Application number: AU2013239345A
Authority: AU
Inventors: Alistair BOYCE
Original assignee: Individual
Current assignee: Individual
Priority date: 2012-03-28
Filing date: 2013-03-28
Publication date: 2015-11-12
Also published as: WO2013142915A1

Abstract

An endotracheal tube introducer (1) comprises a flexible elongate tubular body (2) extending between an insertion end (3) terminating at an insertion tip (5) and a manipulation end (4) with a camera (6) disposed at or adjacent the insertion tip (5) and positioned to receive images in a field of view from an area in front of the insertion tip (5). A light source (7) is disposed at or adjacent the insertion tip (5) and positioned to emit light to illuminate the field of view. An introducer connector (8) mounted at the manipulation end of the introducer (1) where the introducer connector (8) has electrical contacts (22, 23) accessible from the manipulation end (4) and connected to camera and light electrical wiring (11) extending within the body (2). Further, a monitor connector (12) configured to releasibly attach to the introducer connector (8) such that contacts of the monitor connector electrically connect with corresponding introducer connector contacts (9) and the monitor connector (12) connects to a monitor controller configured to control the camera 6 and the light source (7) and to receive images from the camera (6). An endotracheal tube is slidable from the manipulation end (4) over the introducer connector (8) towards the insertion end (3) when the monitor connector (12) is disconnected from the introducer connector (8).

Description

WO 2013/142915 PCT/AU2013/000330 1 ENDOTRACHEAL TUBE INTRODUCED Field of the Invention The present invention relates to endotracheal tubes and, in particular to an 5 endotracheal tube introducer. The invention has been developed primarily for use by anaesthetists in clinical or surgical environments and will be described hereinafter with reference to this application. However, it will be appreciated that the invention is not limited to this 10 particular field of use and can be used outside of clinical or surgical environments. Background of the Invention Many surgical operations require a patient to be placed into unconsciousness using a general anaesthetic. In order to administer the anaesthetic, an endotracheal tube 15 ("E'TT') is inserted into the trachea of the patient, called intubation, and the patient is ventilated by air delivered via the ETT and controlled by an anaesthetist, The anaesthetists intubate the airways of a patient to provide air which the patient would not otherwise be able to breathe on their own whilst under the anaesthetic. 20 It is typical for the surgical patient to be in a supine position when anaesthetised. This is advantageous since axial alignment of the patient's oral, pharyngeal and tracheal axes best occurs in this position and the anaesthetist manoeuvres the patient to ensure the best alignment. In order to successfully insert a tube into the trachea, the epiglottis is required to be moved clear of the trachea. 25 The ETT has a relatively large diameter so that it can be practically difficult and dangerous to insert without assistance. This is performed with an introducer which essentially is a flexible shaft or rod that can be bent to an approximate desired shape and over which the ETT'can be slid. These introducers are often known as "bougies". 30 The shaft is able flex to accommodate the shape of the anatomy during insertion, this being especially important in patients having an anatomy making intubation difficult, or in obese and other patients where the path may be narrowed or deformed.

WO 2013/142915 PCT/AU2013/000330 2 The diameter of the introducer is relatively significantly smaller than the ETT diameter and provides the anaesthetist with some field of vision thereabouts. When the introducer has been slid into place through the glottis, the ETT can be slid along the outside of or over the introducer from the outside of the mouth and the introducer 5 is then pulled out from within the ETT which is left in place. A laryngoscope is a well-known device for assisting in the process of intubation. A laryngoscope includes a handle and a blade, one common type being a "Mackintosh blade". An eye piece is disposed in the laryngoscope blade which allows the 10 anaesthetist to look in a substantially straight line direction at the epiglottis or trachea entrance when the laryngoscope is in place. This allows the anaesthetist to more accurately know when the tracheal tube can be inserted. The laryngoscopes were improved by including a light source at or adjacent to the 15 blade tip to provide lighting and improve the view through the eye-piece. More recently, cameras have been fitted at or adjacent the end of the blades to provide real time images of the position of the end of the blade. Once the epiglottis is shown to have been moved and access to the trachea is clear, the introducer is inserted along a groove or channel in the blade through the oral cavity past the blade tip of the 20 laryngoscope and over into the trachea. As above, the ETT is then fed over the introducer/bougie until the tube is in position in the trachea and able to provide air to the airway and the introducer is removed. For the health of the patient, it is important not to attempt to insert the ETT or 25 introducer out of position with the trachea and intubate the oesophagus. If the .intubating ETT diameter is not correctly selected by the anaesthetist prior to insertion of the introducer it can be retained in place and the incorrect tube slid off and a new more appropriately sized tube slid down over the introducer prior to its removal when the ETT is in place. In general use, however, a laryngoscope can damage teeth and 30 mucosal surfaces and this is a function of the insertion of the laryngoscope blade into the oral cavity and moving the jaw and tongue. There are presently two major types of video laryngoscope, The first has a flexible scope shaft with a light source and camera/lens disposed at the tip of the shaft. This is WO 2013/142915 PCT/AU2013/000330 3 attached to a handle with a monitor for viewing by the anaesthetist. An ETT is disposed over the scope shaft prior to it being inserted into the patients oral cavity. The tongue is moved by the blade and the epiglottis moved clear of the trachea. As with the introducer rod above, the tip of the scope shaft is disposed over the trachea in 5 this arrangement and the ETT about the scope shaft is slid off into the trachea while the scope is removed. This type of laryngoscope suffers from the disadvantage that if the incorrect tracheal tube size is initially selected, the entire laryngoscope is required to be removed from 10 the patient, the incorrect sized tracheal tube slipped off from the tip of the shaft and the appropriate sized tracheal tube put back on and the laryngoscope reinserted. This is obviously disadvantageous as it will necessitate the reapplication of the laryngoscope in the patient which may undesirably cause damage and may facilitate infection. Further, by the very nature of the laryngoscopes and blades that are known, 15 it is not always possible to get a clear view of the epiglottis so that whilst this video laryngoscope provides advantages over the simple laryngoscope with eye-piece, this is not ideal. The second type of laryngoscope is the Pentax airways scope (AWS-S100). The 20 Pentax laryngoscope is similar to the first type of laryngoscope except that the shaft and tip of the scope are fed into a Mackintosh blade with a scope window at a handle end. The one side of the blade includes a groove to retain a tracheal tube or introducer. Once in place and visual confirmation of the glottis is achieved after moving the epiglottis the tracheal tube or the introducer are slid down the retaining 25 groove in the Macintosh blade, This may not have the problem of the first type because the tube slides in parallel with the blade of the laryngoscope, however, in practice it may be that the whole device would need to be removed if the incorrectly sized tracheal tube is initially selected. That is, the blade of the Pentax scope would need to be removed to allow a new tracheal tube to be fed down the groove. 30 To address the deficiencies of the above, an introducer having a. battery source and wireless video transmission means is disclosed in W0201l/128610. This publication describes that the cables extending from the viewing devices to the monitor of prior known devices can hinder free movement of the viewing device and that the prior WO 2013/142915 PCT/AU2013/000330 4 devices require uncoupling of the cables before this can be done interrupting the displayed image. Whilst superficially appearing a most useful device, this suffers from various disadvantages. The integration of wireless transmission equipment and batteries into an introducer limits the flexibility of the device since it is only a narrow 5 rod some 5mm across. This narrow diameter also provides the difficulty of how to economically miniaturise the components to actually fit such a diameter, for example, batteries and contacts. The disclosure also makes reference to there being some form of switch which is 10 preferably sealed within the device. Unfortunately the device needs to be discarded in the event the switch malfunctions, the batteries fail or some damage occurs to the outer surface thinned to fit the components and not exceed the existing introducer diameter which is fixed by human anatomy, for example. 15 Genesis of the Invention The genesis of the invention is a desire to overcome or substantially ameliorate one or more of the disadvantages of the prior art, or to.provide a useful alternative. Summary of the Invention 20 According to a first aspect of the present invention there is provided an endotracheal tube introducer comprising: a flexible elongate tubular body extending between an insertion end terminating at an insertion tip and a manipulation end; a camera disposed at or adjacent said insertion tip and positioned to receive 25 images in a field of view from an area in front of said insertion tip; a light source disposed at or adjacent said insertion tip and positioned to emit light to illuminate said field of view; an introducer connector mounted at said manipulation end of said introducer, said introducer connector having electrical contacts accessible from said manipulation 30 end and connected to camera and light electrical wiring extending within said body; and a monitor connector configured to releasibly attach to said introducer connector such that contacts of said monitor connector electrically connect with corresponding introducer connector contacts and said monitor connector connects to a WO 2013/142915 PCT/AU2013/000330 5 monitor controller configured to control said camera and said light source and to receive images from said camera and wherein an endotracheal tube is slidable from said manipulation end over said introducer connector towards said insertion tip end when said monitor connector is disconnected from said introducer connector. 5 According to another aspect of the invention there is provided an endotracheal tube introducer system comprising: an endotracheal tube introducer having: a flexible elongate tubular body extending between an insertion end 10 terminating at an insertion tip and a manipulation end; a camera disposed at or adjacent said introducer insertion tip and positioned to receive images in a field of view from an area in front of said insertion tip; a light source disposed at or adjacent said introducer insertion tip and 15 positioned to emit light to illuminate said field of view; and an introducer connector mounted at said manipulation end of said introducer, said introducer connector having electrical contacts accessible from said manipulation end and connected to camera and light electrical wiring extending within said body; 20 a monitor connector configured to releasibly attach to said introducer connector such that contacts of said monitor connector electrically connect with corresponding introducer conmector contacts; a monitor controller configured to be connected to said monitor connector to control said camera and said light source and to receive images from said camera and 25 wherein an endotracheal tube is slidable from said manipulation end over said introducer connector towards said insertion tip end when said monitor connector is disconnected from said introducer connector and a display monitor associated with the monitor controller and configured to display images from said camera field of view. 30 Preferably, the introducer includes a conduit disposed within said introducer body and extending from said manipulation end and accessible therefrom to said insertion end and accessible therefrom, said conduit configured to pass air or other materials therealong from the manipulation end to the insertion end.

WO 2013/142915 PCT/AU2013/000330 6 In other preferred embodiments, the introducer includes a fibre or wire disposed within said body adjacent a body sidewall and radially off-set from a body longitudinal axis, said wire or fibre longitudinally extending from or adjacent from 5 said insertion tip to, adjacent to or beyond said manipulation end, said fibre or wire being anchored to said body at or adjacent said insertion tip and said other end being tensionable or compressible. It can therefore been seen there is provided an inexpensive introducer that will allow 10 an ETT to be replaced without the need for the introducer to be removed and re inserted. The introducer provides a simple external connection means to allow control and power supply of the introducer components without the need for their integration which also aids maintaining flexibility of the introducer. Further, in preferred embodiments the introducer can advantageously include one or more embedded wires 15 or fibres extending from an anchor at or adjacent the insertion tip and extending longitudinally along the body so that the tension or compression of the wire or fibre (preferably from the manipulation end) causes movement of the tip. Brief Description of the Drawings 20 A preferred embodiment of the invention will now be described, by way of example only, with reference to the accompanying drawings in which; Fig. I is a schematic diagram of an introducer according to a first preferred embodiment; Fig. 2 is a schematic diagram of a system incorporating the introducer of Fig. 25 1; Fig. 3 is a schematic diagram of an introducer according to a second preferred embodiment; Fig. 4 is a schematic cut-away side view of part of a system incorporating an introducer according to a third preferred embodiment; 30 Fig. 5 is a cut-away view through a monitor connector of the system of Fig. 4; Fig. 6 is a close up cut-away side view of the manipulation end of the introducer in the system of Fig. 4; and Fig. 7 is a schematic cut-away side view of an introducer according to a fourth preferred embodiment.

WO 2013/142915 PCT/AU2013/000330 7 Detailed Description Referring to the drawings generally, there is shown an endotracheal tube introducer 1. The introducer I is in the form of a solid tube or rod formed from PVC plastics 5 material. The introducer 1 is extruded to a predetermined length preferably between 600mm and 900mm long. The diameter of the introducer I is approximately 5mm and this can be selected as desired. It will be appreciated that the introducer I is longer than a desired endotracheal tube that is to be slid thereover once positioned in place. Although made from PVC, the introducer I can be made of any preferred 10 material provided it is flexible and cylindrical. Further, the introducer 1 need not be solid. The introducer I extends between the insertion end 3 and a manipulation end 4. The introducer 1 terminates at the insertion end 3 at an insertion tip 5. The introducer I is 15 able to be handled by a practitioner at the manipulation end 4. Although not illustrated, the introducer 1 may be bent off axis by a predetermined amount on or about the manipulation end to assist with handling and use by the practitioner. Within the introducer body 2 there is disposed a camera 6 at the insertion tip 5 of the 20 introducer 1. The camera 6 is positioned to receive images in the field of view that extends in an area in front of the insertion tip 5. Also disposed within the introducer body 2 is a light source 7. This is also disposed at the insertion tip 5. The light source 7 is an LED positioned to emit light from the insertion tip 5. This light is intended to illuminate a direction ahead of the introducer I as it is moved toward the glottis. This 25 light is detected by the camera 6 and provides vision for the practitioner or other people. In the embodiment shown, the light source 7 and the camera 6 are hernetically sealed within the introducer I and sit right at the insertion tip 5. A window may be formed 30 from the front of the camera 6 and the light source 7 disposed at the insertion tip 5 to minimise image distortion. Although not clearly illustrated, the camera 6 and the light source 7 are integrally formed on a single circuit board. The camera 6 is preferably a high resolution video camera and this can be provided as desired.

WO 2013/142915 PCT/AU2013/000330 8 Electrical wires (schematically shown as dashed lines) are disposed within the introducer body 2. These are connected to the camera 6 and the light source 7 and extend within the body 2 from the camera 6 and light 7 substantially to the manipulation end 4. The electrical wiring provides power to the light source 7 and a 5 camera 6 and also receives signals from the camera 6 and provides control signals thereto. An introducer connector 8 is disposed at the manipulation end 4 of the introducer 1. The introducer connector 8 includes electrical contacts 9 accessible from the outside 10 of the introducer body 1 at the manipulation end 4. Internal contacts 10 are connected to the electrical wiring and those contacts 10 are also hermetically sealed within the introducer body 2. The internal contacts 10 are integrally formed through the body of the introducer connector 8 and terminate at the external electrical contacts 9. The external electrical contacts 9 are accessible from outside the introducer body 2 at the 15 manipulation end 4. A monitor connector 12 is configured to releasably attach to the introducer connector 8. The monitor connector 12 includes electrical contacts (not illustrated) to electrically connect with corresponding extemal contacts 9 of the introducer 20 connector 8. That is, the monitor connector 12 connects to the electrical wiring extending to the camera 6 and the light source 7 for communication therewith. Electrical wiring extends from the monitor connector 12 to a monitor controller 13, shown in a schematic view of a system 20 employing introducer 1 in Fig. 2. The 25 monitor controller 13 is configured to operate the camera 6 and the light source 7. The monitor controller 13 in the preferred embodiment also receives and displays the images provided by the camera 6 on a video display 14. The monitor connector 12 and the introducer connector 8 releasably engage with each 30 other in a mechanical arrangement that most preferably is able to be disconnected by the practitioner with one hand. In use, the patient to receive the endotracheal tube (not illustrated) is laid in a supine position and positioned to receive the introducer I through the oral cavity and into the WO 2013/142915 PCT/AU2013/000330 9 glottis. Before insertion, the monitor connector 12 is connected to the introducer connector 8. This provides power to the camera 6 and the light 7 and allows images from the camera 6 to be displayed on the video display 14. The insertion end 3 is inserted through the oral cavity down the throat into the glottis, and it will be 5 appreciated that a Macintosh blade or the like can be used to assist in clearing the tongue and epi-glottis. Once the insertion end 3 of the introducer I is disposed through the glottis, the monitor connector 12 is disconnected and an endotracheal tube slid over the 10 introducer 1 from the manipulation end 4. It will be appreciated that the introducer connector 8 has substantially the same diameter as the introducer body 2 so as not to impede movement of the endotracheal tube thereover. It will be further appreciated that the introducer connector 8 at the manipulation end 4 can be shaped on an outer circumference to act as a handle when connected to the monitor connector 12. 15 Once the endotracheal tube is then slid over the introducer body 2 through the glottis and into the trachea to allow ventilation thereof through the endotracheal tube, the monitor connector 12 may be reconnected to the introducer connector 8 once the endotracheal tube has been received past the manipulation end 4 of the introducer 20 body 2. The introducer I is then withdrawn leaving the endotracheal tube in place. The endotracheal tube is then connected to an oxygen or air source for the patient. It will be appreciated that the introducer 1 may be a single use device which is disposed of after use. In the alternative, it may be able to be cleaned and sterilised or 25 autoclaved for reuse in a subsequent patient, It can be seen that the introducer 1 is relatively cheaply produced when compared to prior art wireless introducers whilst offering substantially all the same benefits. Furthermore, it will be appreciated that the introducer 1 of the preferred embodiment 30 is particularly advantageous over the Pentax airway scope, for example, of the prior art. The introducer 1 lacks the physical dimension or bulk that the Pentax scope possesses which allows improved access when a patient's mouth cannot be opened beyond a limited amount. Also, the intubation process is simplified over that art since WO 2013/142915 PCT/AU2013/000330 10 the total bulk is lessened so as not to add to the bulk of the endotracheal tube as it is passed over the introduced 1. In the preferred embodiment, the wires in the monitor connector 12 extend a 5 predetermined distance and terminate at a USB or other type of connector to be plugged in to the monitor controller 13 as.desired to operate the camera 6 and the light source 7 to display images. It will be appreciated that in alternative embodiments of the invention, not illustrated, 10 various modifications can be provided. For example, a wired connection between the monitor connector 12 and the monitor controller 13 can be replaced with a wireless link. In such an embodiment, a wireless transceiver is disposed within the monitor connector 12 or is connected to it. Once connected, power and control signals are provided to the camera 6 and the light source 7 by the wireless connector 12 and the 15 wireless transceiver sends signals indicative to the camera images to the monitor controller 13 having a corresponding wireless transceiver which also communicates with the wireless transceiver disposed in the monitor connector 12. In this way, the wires are removed between the monitor 13 and the monitor connector 20 12. The monitor connector 12 is connected and disconnected as is the case with wires when an endotracheal tube is slid over the introducer 1. Further, wireless equipment and a battery source is disposed in monitor connector 12 rather than in introducer body 2. 25 It will be also appreciated that the monitor controller 13 can be computing device. Such a computing device may be a dedicated device such as shown in the preferred embodiment or alternatively may be a personal computer, a laptop or portable computer, a tablet computer or a modem cellular telephone with smartphone capabilities. So far as the introducer 1 is only used for a relatively short period of 30 time to navigate a path through the glottis, significant computing device power supplies are not required. It will also be appreciated that the light source 7 may be longitudinally off-set away from the insertion tip 5 to prevent directly emitted light being received by the camera WO 2013/142915 PCT/AU2013/000330 11 6. In an alternative to this or in combination, the camera 6 may be physically shielded from the light source 7 within the introducer body 2. Whilst a mechanical arrangement is provided to releasably connect the introducer 5 connector 8 and the monitor connector 12, it will be appreciated that these may connect in an interference fit or a magnetic arrangement. Most preferably, the connectors are self-aligning so that they can only be connected in one configuration which is encouraged through movement of the monitor connector 12 relative to the introducer connector 8. 10 It will also be appreciated that the light source 7 may be replaced with one or more optical fibres if desired. Likewise the camera 6 can be replace by an optical fibre camera which extends from the insertion tip 5 to the introducer connector 8 and which couples optically to corresponding connections in the monitor connector 12. The use 15 of optical fibres may further simplify the introducer I and may also reduce the cost of production. In other preferred embodiments, the introducer body 2 can include a conduit extending from the manipulation end 4 to the insertion tip 5 to provide a channel 20 therethrough. To assist a practitioner in using the introducer 1, they may desire to place releasably attachable weights at one or more points on the outside of the introducer body 2. These weights allow the introducer body 2 to behave more as desired by a practitioner. Similarly, a stiffening wire may be longitudinally disposed within the introducer body 2 and extending along part or all of the introducer body 2. 25 Referring to Fig. 3, there is shown a second preferred embodiment of the introducer 1. In this embodiment, a wire or fibre 16 is embedded in the body 2. The wire or fibre 16 is anchored at one end 17 at or adjacent the insertion tip 5 within the body 2. 30 In the preferred embodiment, the wire 16 extends within the body 2 substantially parallel to a body longitudinal axis 18 and is radially off-set therefrom. The wire or fibre 16 extends through the body 2 at the manipulation end 4 to allow it to be placed under tension by a user of the introducer 1.

WO 2013/142915 PCT/AU2013/000330 12 As the wire or fibre 16 is tensioned, the anchored end 17 is caused to bend way from the body longitudinal axis towards the wire or fibre 16. This allows the introducer 1 to be moved about an obstacle or just in a preferred direction. Preferably,. the wire or fibre 16 is formed from an inert metal or alloy, or is formed from a plastics material. 5 Of course, any natural or synthetic fibre may be used as desired. Although Fig. 3 shows one wire or fibre 16, it will be appreciated any number of spaced apart wires or fibres 16 can be used. For example, a pair of wires or fibres 16 can be disposed on opposing sides of the body 2. In this way, the insertion end 3 can 10 be bent about the body longitudinal axis 18 towards one of the wires or fibres 16 when one of the wires or fibres 16 is tensioned. Likewise, a third, fourth or subsequent spaced apart wires or fibres 16 can be disposed in the body 2 off-set from the body longitudinal axis 18.- These wires or fibres 16 15 need not be symmetrically disposed about the body longitudinal axis 18. As shown in Fig. 3, the wire or fibre 16 extends from the body 2 at the manipulation end 4. The wire or fibre 16 extends a predetermined distance from the end 4 and terminates at a handle or arrangement 19 (eg loop, etc) to allow the practitioner to 20 clasp a wire or fibre 16 and tension it whilst holding the body 2 about the manipulation end 4. Turning to Fig. 4, there is shown a schematic cut-away side view of part of a system 20 incorporating an introducer 1 according to a third preferred embodiment. In this 25 embodiment, the monitor connector 12 used in the form of a cap that is received over the manipulation end 4 of the introducer 1. The monitor connector 12 includes a plurality of electrical wires 15 configured to power and control both the camera 6 and light source 7. 30 The monitor connector electrical wires 15 terminate within the monitor connector 12 at electrical contacts 22 and 23. The contacts from the lower group of wires 15 are denoted numeral 23 and the wires from the upper group of monitor connector electrical wires 15 terminate at contacts 22. It is noted that the contacts 22 and 23 are in the form of circumferentially disposed strips or bands that are longitudinally spaced WO 2013/142915 PCT/AU2013/000330 13 apart. This can be best seen in Fig. 5A which shows a cut-away view through the monitor connector 12 of the system 20. In Fig. 6 there is shown a close up cut-away side view of the manipulation end 4 of 5 the introducer 1 in the system 20. Here, the wires 11 extending from the camera 6 and light source 7 terminate at contacts 9 in the form of circumferentially disposed strips or bands that are longitudinally spaced apart. These form of the introducer connector 8. It will be appreciated that the contacts 9 have corresponding contact with contacts 22 or 23 for which contact is formed when the monitor connector 12 is disposed over 10 the manipulation end 4 of the introducer 1. In this way, the medical practitioner using the introducer I does not need to align the monitor connector 12 with the introducer connector 8 other than axially. The monitor connector 12 can be flared if desired to assist in alignment. The monitor connector 12 15 simply needs to be slid over the manipulation end 4. This can be particularly important when the practitioner is distracted or in emergency situations when they either do not have a free hand to align the monitor connector 12 or the ability to look and make a visual alignment. 20 The embodiment of Figs 4-6 shows the monitor contacts 22 and 23 corresponding to wiring for the camera 6 and light source 7 respectively being longitudinally spaced apart. This is best shown in Figs 5B & C schematically showing the contact 22 & 23 layout within the monitor connector 12. However, it will be appreciated that any arrangement of monitor contacts 22 and 23 can be provided for electrical engagement 25 with introducer contacts 9. For example, any earth or ground contacts may be placed towards an opening (not illustrated clearly) of the monitor connector 12 so that only live contacts are formed once the monitor connector 12 is substantially received the introducer manipulation 30 end 4 and corresponding contacts 9 are substantially in position. It will be further appreciated that the opening of the monitor connector 12 may have a slight taper for receiving the manipulation end 4 of the introducer 1 in a light interference fit. Also, the opening of the monitor connector 12 may include an WO 2013/142915 PCT/AU2013/000330 14 electrical switch 27 triggered by the manipulation end 4. The switch 27 is actuated upon insertion of the manipulation in 4 into the monitor connected 12 a sufficient distance. In this way, the contacts 22 and 23 can be configured not to be electrically active unless properly connected to the manipulation end 4 of the introducer 1. Of 5 course, such a switch may only be needed to actuate contacts 22 or 23 that provide electrical power to the camera 6 and light source 7. Referring now to Fig. 7, there is shown a schematic cut-away side view of an introducer I according to a fourth preferred embodiment. In this embodiment, the 10 light source 7 is in the form of one or more optical fibres or waveguides. The optic fibre light source 7 in this embodiment extends from the insertion tip 5 at the insertion end 3 within the introducer 1. The optic fibre light source 7 terminates at or adjacent the manipulation end 4. In such an embodiment, the monitor connector 12 does not include electrical wires 15 for powering the light source 7 but instead includes a 15 coupling 24 to an optical light source (not illustrated). In this way, the monitor connector 12 attaching to the manipulation end 4 causes optical coupling between a light source or light guide providing light via the monitor connector 12 and the light source 7 at the manipulation end 4. 20 In this embodiment, the camera 6 has been replaced by a bundle of optical fibres extending from the insertion tip 5 within the introducer I to the manipulation end 4. The optic fibre bundle 6 is coupled with a camera and wire 25 o- waveguide device 25 (leading to a camera, not illustrated) disposed within the monitor connector 12 in place of electrical wires 11. In such an embodiment, the introducer I may be able to 25 be created more economically and possibly as a disposable device since the optical coupling for the light source 7 and the optical fibre bundle 6 can be disposed within the monitor connector 12. Since the monitor connector 12 when in use is not disposed within the oral cavity of 30 the patient, re-use of the monitor connector with a replacement introducer I does not provide significant risk of contamination or infection. This is unlike the case where the introducer 1 itself is reused. It will be appreciated that although Fig. 7 shows an optical fibre bundle 6 and optic fibre light 7, the introducer I may have either or both bundle 6 and light 7 formed from optic fibres.

WO 2013/142915 PCT/AU2013/000330 15 In any of the above described preferred embodiments, it will be appreciated that an optically transparent prophylactic may be used to receive the introducer 1 and provide a sealed environment. In some preferred embodiments, the prophylactic need not be 5 optically clear except at a tip end to which the insertion tip 5 of the introducer 1 is disposed adjacent to or contiguous with in use. For example, the prophylactic can be formed from any preferred material such as latex or vinyl. The foregoing describes only preferred embodiments of the present invention and 10 modifications, obvious to those skilled in the art, can be made thereto without departing from the scope of the present invention. The term "comprising" (and its grammatical variations) as used herein is used in the inclusive sense of "including" or "having" and not in the exclusive sense of 15 "consisting only of"

Claims

1. An endotracheal tube introducer comprising: a flexible elongate tubular body extending between an insertion end terminating at an insertion tip and a manipulation end; a camera disposed at or adjacent said insertion tip and positioned to receive images ina field of view from an area in front of said insertion tip; a light source disposed at or adjacent said insertion tip and positioned to emit light to illuminate said field of view; an introducer connector mounted at said manipulation end of said introducer, said introducer connector having electrical contacts accessible from said manipulation end and connected to camera and light electrical wiring extending within said body; and a monitor connector configured to releasibly attach to said introducer connector such that contacts of said monitor connector electrically connect with corresponding introducer connector contacts and said monitor connector connects to a monitor controller configured to control said camera and said light source and to receive images from said camera, wherein an endotracheal tube is slidable from said manipulation end over said introducer connector towards said insertion tip end when said monitor connector is disconnected from said introducer connector.

2. An introducer according to claim 1 including a wireless transceiver disposed within said monitor connector or connectable thereto to communicate wirelessly with said monitor controller.

3. An introducer according to claim 1 wherein said electrical contacts accessible at said manipulation end are connected to corresponding internal contacts disposed within said introducer body.

4. An introducer according to claim 3 wherein said electrical contacts at said manipulation end are integrally formed with said internal contacts disposed within said body.

5. An introducer according to claim I wherein said monitor controller is configured to display and/or record images from said camera.

6. An introducer as according to any one of claims I to 5 wherein said monitor controller is a computing device selected from the group consisting of: a WO 2013/142915 PCT/AU2013/000330 17 personal computer; a cellular telephone or smart phone; a laptop or portable computer; and a tablet computer.

7. An introducer according to any one of claims 1 to 6 including a handle integrally formed with said monitor connector forming an extension of said introducer manipulation end when said monitor & introducer connectors are attached.

8. An introducer according to any one of claims I to 7 wherein said light source is formed from at least one LED light element or at least one optical fibre.

9. An introducer according to any one of claims I to 8 wherein said camera and said light source are disposed within said body adjacent to or contiguous with a window disposed on said introducer tip such that said camera is longitudinally offset into said body from said light source.

10. An introducer according to any one of claims 1 to 9 wherein said camera is shielded from light directly emitted from said light source.

11. An introducer according to any one of claims 1 to 10 wherein said camera and said light source are integrally formed on a common circuit board and hermetically sealed within said introducer body at said insertion tip.

12. An introducer according to claim I wherein said camera and/or said light source are formed from one or more optical fibres extending from or adjacent said insertion tip to said manipulation end.

13. An introducer according to any one of claims 1 to 12 wherein said introducer and monitor connectors are self-aligning; and/or attach magnetically, mechanically or in an interference fit.

14. An introducer according to any one of claims I to 13 including one or more weights disposable about said introducer body, said weights being positionable along said body.

15. An introducer according to any one of claims I to 14 including a fibre or wire disposed within said body adjacent a body sidewall and radially off-set from a body longitudinal axis, said wire or fibre longitudinally extending from or adjacent from said insertion tip to, adjacent to or beyond said manipulation end, said fibre or wire being anchored to said body at or adjacent said insertion tip and said other end being tensionable or compressible.

16. An introducer according to claim 15 including: WO 2013/142915 PCT/AU2013/000330 18 a pair of spaced apart fibres or wires disposed on opposite sides of said body; or three or more spaced apart fibres or wires disposed radially symmetrically about said body longitudinal axis within said body.

17. An introducer according to any one of claims I to 16 wherein said monitor connector includes an opening having a plurality of spaced apart electrical contracts therein, said opening adapted to receive said manipulation end of said introducer such that said introducer connector contacts are disposed about said manipulation end and configured to contact said connector contacts when said insertion end is received in said opening.

18. An introducer according to claim 17 wherein said introducer connector contacts are longitudinally spaced apart and circumferentially disposed about said manipulation end and said monitor connector contacts are circumferentially disposed within said opening such that receipt of said manipulation end by said opening causes said introducer and monitor connector contacts to engage.

19. An introducer according to any one of claims .1 to 17 further including a prophylactic extending between an open end and a closed end, the prophylactic configured to receive said introducer therein such that said insertion tip is adjacent to or contiguous with said closed end of said prophylactic.

20. An endotracheal tube introducer system comprising: an endotracheal tube introducer having: a flexible elongate tubular body extending between an insertion end terminating at an insertion tip and a manipulation end; a camera disposed at or adjacent said introducer insertion tip and positioned to receive images in a field of view from an area in front of said insertion tip; a light source disposed at or adjacent said introducer insertion tip and positioned to emit light to illuminate said field of view; an introducer connector mounted at said manipulation end of said introducer, said introducer connector having electrical contacts accessible from said manipulation end and connected to camera and light electrical wiring extending within said body; WO 2013/142915 PCT/AU2013/000330 19 a monitor connector configured to releasibly attach to said introducer connector such that contacts of said monitor connector electrically connect with corresponding introducer connector contacts; a monitor controller configured to be connected to said monitor connector to control said camera and said light source and to receive images from said camera and wherein an endotracheal tube is slidable from said manipulation end over said introducer connector towards said insertion tip end when said monitor connector is disconnected from said introducer connector; and a display monitor associated with the monitor controller and configured to display images from said camera field of view.

21. An endotracheal tube introducer comprising: a flexible elongate tubular body extending between an insertion end terminating at an insertion tip and a manipulation end; an optical fibre bundle extending within said body from said insertion tip to said manipulation end, said optical fibre bundle positioned to receive images in a field of view from an area in front of said insertion tip; a fibre optic light source extending within said body from said insertion tip to said manipulation end, said fibre optic light source positioned to emit light to illuminate said field of view; an introducer connector mounted at said manipulation end of said introducer, said introducer connector having an optical coupling for said optical fibre bundle and said light source; and a monitor connector configured to releasibly attach to said introducer connector such that optical coupling disposed in said monitor connector optically couples said optic fibre bundle to a camera in said monitor connector and said optical fibre light source with a light source disposed within said monitor connector such that said monitor connector connects to a monitor controller configured to control said camera and said light source and to receive images from said camera, wherein an endotracheal tube is slidable from said manipulation end over said introducer connector towards said insertion tip end when said monitor connector is disconnected from said introducer connector.