Anaesthetic and respiratory equipment — Tracheal tubes and connectors

Matériel d'anesthésie et de réanimation respiratoire — Sondes trachéales et raccords

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Status
Withdrawn
Publication Date
29-Sep-1999
Withdrawal Date
29-Sep-1999
Current Stage
9599 - Withdrawal of International Standard
Start Date
20-Sep-2012
Completion Date
20-Sep-2012
Ref Project

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Effective Date
15-Apr-2008

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ISO 5361:1999 - Anaesthetic and respiratory equipment -- Tracheal tubes and connectors
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INTERNATIONAL ISO
STANDARD 5361
First edition
1999-09-15
Corrected and reprinted
1999-12-15
Anaesthetic and respiratory equipment —
Tracheal tubes and connectors
Matériel d'anesthésie et de réanimation respiratoire — Sondes trachéales et
raccords
Reference number
ISO 5361:1999(E)
---------------------- Page: 1 ----------------------
ISO 5361:1999(E)
Contents
Page

1 Scope ........................................................................................................................................................................1

2 Normative references ..............................................................................................................................................1

3 Terms and definitions .............................................................................................................................................1

4 General requirements for tracheal tubes and tracheal tube connectors ...........................................................3

4.1 Size designation....................................................................................................................................................3

4.2 Dimensions............................................................................................................................................................3

4.3 Materials ................................................................................................................................................................9

4.4 Bevel ......................................................................................................................................................................9

4.5 Cuff.......................................................................................................................................................................10

4.6 Inflating tubes for cuffs......................................................................................................................................10

4.7 Curvature of tube................................................................................................................................................10

5 Additional requirements for tracheal tubes with a Murphy eye........................................................................12

5.1 Size of the Murphy eye.......................................................................................................................................12

5.2 Location of the Murphy eye ...............................................................................................................................12

6 Requirements for tracheal tubes with tracheal tube connector supplied sterile............................................13

6.1 Sterility assurance..............................................................................................................................................13

6.2 Packaging for tracheal tubes and tracheal tube connectors supplied sterile..............................................13

7 Marking ...................................................................................................................................................................13

7.1 Use of symbols ...................................................................................................................................................13

7.2 Tracheal tubes.....................................................................................................................................................14

7.3 Tracheal tube connectors ..................................................................................................................................15

Annex A (normative) Determination of cuff resting diameter...............................................................................16

© ISO 1999

All rights reserved. Unless otherwise specified, no part of this publication may be reproduced or utilized in any form or by any means, electronic

or mechanical, including photocopying and microfilm, without permission in writing from the publisher.

International Organization for Standardization
Case postale 56 • CH-1211 Genève 20 • Switzerland
Internet iso@iso.ch
Printed in Switzerland
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© ISO
ISO 5361:1999(E)

Annex B (normative) Test method for tube collapse............................................................................................. 17

Annex C (normative) Test method for cuff herniation........................................................................................... 20

Annex D (informative) Guidance on materials and design ................................................................................... 22

Bibliography.............................................................................................................................................................. 23

iii
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© ISO
ISO 5361:1999(E)
Foreword

ISO (the International Organization for Standardization) is a worldwide federation of national standards bodies (ISO

member bodies). The work of preparing International Standards is normally carried out through ISO technical

committees. Each member body interested in a subject for which a technical committee has been established has

the right to be represented on that committee. International organizations, governmental and non-governmental, in

liaison with ISO, also take part in the work. ISO collaborates closely with the International Electrotechnical

Commission (IEC) on all matters of electrotechnical standardization.

International Standards are drafted in accordance with the rules given in the ISO/IEC Directives, Part 3.

Draft International Standards adopted by the technical committees are circulated to the member bodies for voting.

Publication as an International Standard requires approval by at least 75 % of the member bodies casting a vote.

International Standard ISO 5361 was prepared by Technical Committee ISO/TC 121, Anaesthetic and respiratory

equipment, Subcommittee SC 2, Tracheal tubes and other equipment.

This first edition cancels and replaces previous editions of ISO 5361-1:1988, ISO 5361-2:1993, ISO 5361-3:1984,

ISO 5361-5:1984 and ISO 7228:1993, which have been technically revised. The requirements of ISO 5361-4:1987,

Tracheal tubes — Part 4: Cole type, have not been included in this revision because Cole type tubes are

specialized tubes, and as such, are excluded from the scope of this International Standard.

Annexes A, B and C form a normative part of this International Standard.
Annex D is for information only.
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© ISO
ISO 5361:1999(E)
Introduction

This International Standard specifies the dimensions, basic properties and method of size designation of the most

commonly used types of tracheal tube made of plastics materials and/or rubber. Tubes with walls reinforced with

metal or nylon, tubes with shoulders, tapering tubes and the many other types of tube devised for specialized

applications are not specifically covered, although most may be classified by their inside diameter as required by

this International Standard.

While the inside diameter has been specified for size reference, this International Standard requires that the outside

diameter also be marked, since this information is of clinical importance.

Clinical considerations have also dictated the apparently excessive specified length of tubes because long tubes,

sometimes of relatively narrow diameter, may be urgently required and therefore should be readily available.

Provision has also been included for pre-cut tracheal tubes.

Cuffed tracheal tubes can be characterized by a combination of the tube inside and outside diameters and by the

cuff resting diameter.

For tubes intended for re-use, information on the cuff resting diameter is required to be marked on the package or

insert but not on the tube itself. This is because re-use may alter the elastic properties, and thereby the diameter, of

the cuff.

The relationship between the cuff and tracheal diameters dictates the intracuff pressure required to provide a seal.

Excessive pressure on the tracheal wall may obstruct capillary blood flow.

Tracheal tubes, when in position, are intended to conform as closely as possible to human anatomy.

A range of cuff designs is available to meet particular clinical requirements. This International Standard requires that

the resting diameter of the cuff be marked on the unit package, as this information allows the clinician to match the

product to the application.

Herniation in relation to cuffs is a term widely understood in clinical anaesthetic practice. It is used to describe a cuff

which protrudes excessively at its patient end so that it partially or completely occludes the orifice at the bevel.

Herniation may be due to a variety of causes, singly or in combination: these may include over-inflation of the cuff,

traction of the tube when the cuff is inflated or deterioration of the material of the cuff.

It should be noted that although certain requirements for cuffs apply to tubes of sizes 2,0 to 4,5, cuffs are

infrequently used on these smaller sizes of tube.

Flammability of tracheal tubes, for example if flammable anaesthetics, electrosurgical units or lasers are used, is a

well-recognized hazard that is addressed by appropriate clinical management, outside the scope of this

International Standard.

It is a requirement that tracheal tubes include length mark(s) in centimetres, measured from the patient end. It is

recognized, however, that additional marks, easier to see during intubation, may assist the clinician in positioning

the tracheal tube within the trachea. There is currently, however, no clear consensus on the optimum style and

positioning of these marks and whether the positioning should differ with size of tube. Further clinical data is

required in order to support inclusion of recommendations for these marks in a future revision of this International

Standard.
1) See ISO/TR 11991.
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INTERNATIONAL STANDARD © ISO ISO 5361:1999(E)
Anaesthetic and respiratory equipment — Tracheal tubes
and connectors
1 Scope

This International Standard specifies requirements for the dimensions, basic properties and method of size

designation of the most commonly used types of oro-tracheal and naso-tracheal tube made of plastics materials

and/or rubber (plain and cuffed), and requirements for tracheal tube connectors.
Specialized tubes are excluded from the scope of this International Standard.
2 Normative references

The following normative documents contain provisions which, through reference in this text, constitute provisions of

this International Standard. For dated references, subsequent amendments to, or revisions of, any of these

publications do not apply. However, parties to agreements based on this International Standard are encouraged to

investigate the possibility of applying the most recent editions of the normative documents indicated below. For

undated references, the latest edition of the normative document referred to applies. Members of ISO and IEC

maintain registers of currently valid International Standards.
ISO 594-1,

Conical fittings with a 6 % (Luer) taper for syringes, needles and certain other medical equipment —

Part 1: General requirements.

ISO 5356-1, Anaesthetic and respiratory equipment — Conical connectors — Part 1: Cones and sockets.

ISO 10993-1, Biological evaluation of medical devices — Part 1: Guidance on selection of tests.

ISO 11607, Packaging for terminally sterilized medical devices.

EN 556:1994, Sterilization of medical devices — Requirements for medical devices to be labelled "Sterile".

3 Terms and definitions

For the purposes of this International Standard, the following terms and definitions apply.

3.1
angle of bevel

acute angle between the plane of the bevel and the longitudinal axis of the tracheal tube at the patient end

[ISO 4135:1995]
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© ISO
ISO 5361:1999(E)
3.2
bevel
slanted portion at the patient end of the tracheal tube
[ISO 4135:1995]
3.3
cuff

inflatable balloon permanently attached around the tracheal tube near the patient end to provide an effective seal

between the tube and the trachea
3.4
inflating tube
tube through which the cuff is inflated
[ISO 4135:1995]
3.5
inflation lumen
lumen within the wall of the tracheal tube for inflating the cuff
3.6
machine end
that end of a tracheal tube which is intended to project from a patient
[ISO 4135:1995]
3.7
machine end

that portion of the tracheal tube connector intended to mate with the breathing system of an anaesthetic machine or

ventilator
3.8
Murphy eye

hole through the wall of a tracheal tube near the patient end and on the side opposite to the bevel

3.9
naso-tracheal tube
tracheal tube for insertion through the nose into the trachea
[ISO 4135:1995]
3.10
oro-tracheal tube
tracheal tube for insertion through the mouth into the trachea
[ISO 4135:1995]
3.11
patient end
that end of the tracheal tube which is intended to be inserted into the trachea
[ISO 4135:1995]
3.12
patient end

that end of the tracheal tube connector nearest to the patient, which is inserted into the tracheal tube.

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© ISO
ISO 5361:1999(E)
3.13
pilot balloon
balloon fitted to the inflating tube to indicate inflation of the cuff
[ISO 4135:1995]
3.14
tracheal tube

tube designed for insertion through the larynx into the trachea to convey gases and vapours to and from the trachea

[ISO 4135:1995]
3.15
tracheal tube connector
tubular component that fits directly into a tracheal tube
[ISO 4135: 1995]
3.16
tracheal tube of the ‘Magill’ type
tracheal tube with a radius of curvature (as specified in 4.7)
4 General requirements for tracheal tubes and tracheal tube connectors
4.1 Size designation

The size of tracheal tubes and tracheal tube connectors shall be designated by the nominal inside diameter,

expressed in millimetres, in accordance with Table 1 for tracheal tubes and Table 2 for tracheal tube connectors.

4.2 Dimensions
4.2.1 Tracheal tubes
The basic dimensions of tracheal tubes shall be in accordance with Table 1.
4.2.1.1

4.2.1.2 The actual inside diameter shall be the marked inside diameter subject to a tolerance of ± 0,15 mm for

sizes 6,0 and smaller, or subject to a tolerance of ± 0,20 mm for sizes 6,5 and larger.

4.2.1.3 The actual outside diameter (OD) shall be the marked outside diameter (OD) subject to a tolerance of

± 0,15 mm for sizes 6,0 and smaller, or subject to a tolerance of ± 0,20 mm for sizes 6,5 and larger [see 7.2.1.1 b)].

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© ISO
ISO 5361:1999(E)
Table 1 — Basic dimensions of tracheal tubes
Dimensions in millimetres
Maximum distance C from Minimum distance of point
Designated size the patient end of the tube to of separation of the inflating
Minimum length of tube
(nominal inside the machine end of the tube from the patient end of
[see Figure 1 a) and b), dimension A]
diameter) inflatable length of the cuff the tube
[see Figure 1 a) and b)] [see Figure 1 a) and b),
a, b
dimension S ]
a 1
Nasal or oral/nasal Oral
2,0 130 110 — —
2,5 140 110 — —
3,0 160 120 — —
3,5 180 130 — —
4,0 200 140 — —
4,5 220 150 — —
5,0 240 160 56 110
5,5 270 170 56 120
6,0 280 190 58 125
6,5 290 210 62 135
7,0 300 230 66 140
7,5 310 240 69 145
8,0 320 250 72 150
8,5 320 260 75 155
9,0 320 270 78 160
9,5 320 280 81 165
10,0 320 280 85 170
10,5 320 280 85 170
11,0 320 280 85 170

Manufacturers desiring to market packaged sterile oral pre-cut tubes with connectors inserted may be guided by the tube

lengths shown in the table. However, the user is cautioned that anatomical variations, conditions of use, length of tube

inserted or other factors may well result in the use of a tracheal tube either too long or too short for a given patient. The

necessity remains for expert clinical judgement in selecting the size and length of tracheal tubes.

These values are not specified for cuffed tracheal tubes of sizes 4,5 or smaller because cuffed tubes of these sizes are

infrequently used.
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© ISO
ISO 5361:1999(E)
Key
1 Patient end 5 Machine end
2 Angle of bevel (see 4.4) 6 Alternative integral pilot balloon/valve assembly
3 Radius of curvature (see 4.7) 7 Separating angle (see 4.6.2)
4 Inflating tube 8 Region for marking size [see 7.2.1.1 f)]
9 Inflatable length of cuff
See 4.6.6.
See Table 1.
Minimum value for S = A - S .
2 1
a) Typical cuffed tracheal tube (‘Magill’ type)
Figure 1 — Cuffed tracheal tubes
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© ISO
ISO 5361:1999(E)
Key
1 Patient end 5 Machine end
2 Angle of bevel (see 4.4) 6 Pilot balloon
3 Radius of curvature (see 4.7) 7 Separating angle (see 4.6.2)
4 Inflating tube 8 Region for marking size [see 7.2.1.1 f)]
9 Inflatable length of cuff
See 4.6.6.
See Table 1.
Minimum value for S = A - S .
2 1

b) Typical cuffed tracheal tube (“Magill” type), showing alternative design features

Figure 1 — Cuffed tracheal tubes
4.2.2 Tracheal tube connectors

4.2.2.1 The basic dimensions of tracheal tube connectors shall be in accordance with Table 2.

4.2.2.2 When a tracheal tube is supplied with a tracheal tube connector, the designated size of the connector shall

be not less than that of the tracheal tube with which it is provided.
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© ISO
ISO 5361:1999(E)

4.2.2.3 The minimum inside diameter of a curved or angled connector shall be not less than 80 % of the

designated size, and the corresponding cross-sectional area shall not be reduced by more than 10 %.

4.2.2.4 A suction port, if provided, shall be designed so that its closure does not obstruct or narrow the lumen of

the connector.

NOTE The connector may be straight, curved or angled. If curved or angled, the connector may incorporate a suction port.

4.2.2.5 The machine end of a tracheal tube connector shall be a male 15 mm conical connector complying with

ISO 5356-1. The inside diameter of the (conical) machine end shall be not less than that allowed by Table 2 for the

patient end. Any transition in the inside diameter shall be tapered to permit an adequate lead-in for smooth passage

of a suction catheter.

4.2.2.6 The basic dimensions of the patient end (see Figures 2 and 3) of the connector shall be in accordance with

Table 2.

4.2.2.7 The opening at the patient end shall have a plane at (90 ± 5)° to the long axis of the patient end of the

connector.

Table 2 — Tracheal tube connectors — Size range and basic dimensions of patient end

Dimensions in millimetres
Straight connectors — Curved connectors —
Designated size Inside diameter minimum dimension l minimum dimension l
1 2
a a
(nominal inside diameter) (effective length) (effective length)
d (± 0,15)
(Figure 2) (Figure 3)
2,0 2,0 9 —
2,5 2,5 9 —
3,0 3,0 9 —
3,5 3,5 11 —
4,0 4,0 11 —
4,5 4,5 12 —
5,0 5,0 12 —
5,5 5,5 13 10
6,0 6,0 13 10
6,5 6,5 16 10
7,0 7,0 16 10
7,5 7,5 16 10
8,0 8,0 16 10
8,5 8,5 16 10
9,0 9,0 16 10
9,5 9,5 16 10
10,0 10,0 16 10
10,5 10,5 16 10
11,0 11,0 16 10

The effective length of the patient end of a tracheal tube connector is that length available for insertion into the tracheal

tube.
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