Apparatus for ventilating and aspirating

• US 5,368,017 A
• Filed: 03/09/1992
• Issued: 11/29/1994
• Est. Priority Date: 04/01/1991
• Status: Expired due to Fees

• Current Assignee: Sorenson Media, Inc. (Nielsen Holdings plc)
• Original Assignee: Sorenson Laboratories, Inc.
• Inventors: Jeffs, Joseph H., Sorenson, James L., Mackert, Stephen C., Kaufman, David W., Reynolds, Valdon G.
• Primary Examiner(s): Burr, Edgar S.
• Assistant Examiner(s): Lewis, Aaron J.
• Application Number:
  US07/848,030
• Time in Patent Office: 995 Days
• Field of Search: 128/200.26, 128/207.14, 128/207.15, 128/207.16, 128/912, 128/DIG. 26, 604/171, 604/159, 604/160, 604/163, 383/64, 383/63, 383/100
• US Class Current: 128/200.26
• CPC Class Codes: A61M 1/7411 by changing the size of a vent in combination with changing the cross-section of the line A61M1/7413
• CPC Class Codes: A61M 16/0463 combined with suction tubes, catheters or the like; Outside connections
• CPC Class Codes: A61M 16/0825 with ball-sockets
• CPC Class Codes: A61M 16/0858 Pressure sampling ports
• CPC Class Codes: A61M 2205/32 with radio-opaque indicia
• CPC Class Codes: A61M 2205/584 having a color code
• CPC Class Codes: A61M 25/0111 Aseptic insertion devices
• CPC Class Codes: Y10S 128/912 Connections and closures for tubes delivering fluids to or from the body

Abstract

A ventilating and aspirating apparatus for delivering respiratory gases to the trachea and the congested lungs and breathing passageways of a patient includes a flexible catheter tube extendable into and withdrawable from the patient'"'"'s trachea. The catheter is housed within a pliable sheath extending from a manifold that is attachable to an endotracheal tube. The sheath has a slit defined by backing members formed along elongate opposed edges. A releasable, air tight "ziplock" seal is effected at the slit by a bead on one backing member and a groove to sealingly receive the bead on the other backing member. A "ziplock" actuator is structured as a slider member which travels along the bead and groove, and includes converging ends to hold the bead in the groove and a conduit member extending centrally through the slider member to interconnect an end of the catheter tube inside the sheath through a vacuum valve carried by the slider member outside the sheath to a vacuum source. The vacuum valve is operable by the same hand of a user that may be used to move the slider member.

Claims

1. A protective shield apparatus for allowing communication between a user located on a first side of a barrier and an implement for use with said protective shield, said implement located on a second side of said barrier across at least one channel dynamically locatable anywhere along a defined course of potential channel location through said barrier, said protective shield apparatus comprising:

anchoring means for allowing insertion of a portion of said implement therethrough;

a pliant barrier means defining a substantially discrete space;

at least one releasably sealable slit formed through said barrier means, said slit defining a course of travel along said barrier means, said slit having one portion thereof releasably connected to another portion thereof thereby providing physical sealing of said slit to prevent substantial airflow through said slit; and

connector means for allowing communication across said at least one channel between a user and said implement for use with said protective shield apparatus, said connector means including structure disposed through said at least one slit and being otherwise structured and arranged for slidable movement along said course, whereby to open a portion of said slit adjacent said connector means progressively in the direction of movement of said connector means while concurrently closing said slit following said connector means in the direction of movement.

2. The protective shield apparatus of claim 1 further including:

vacuum pressure source positioned for access by a user;

wherein said implement comprises a flexible catheter tube being extendable into and withdrawable from the trachea of a patient, said catheter tube having a longitudinal catheter axis, a catheter lumen and a distal end structured to permit secretions from a patient to enter said catheter lumen;

wherein said pliant barrier means comprises a pliant sheath formed of a substantially continuous sidewall and having a longitudinal sheath axis, said pliant sheath receiving and coaxially surrounding said catheter tube, said pliant sheath having a closed proximal end and an open distal end through which said catheter tube is slidable;

said connector means comprises a vacuum valve having an inlet connected to the lumen of said catheter tube, an outlet constituting means for connection to said vacuum pressure source, and a valve actuator for selectively communicating the lumen of said catheter tube with said vacuum pressure source; and

wherein said anchoring means comprises a manifold connected to the distal end of said pliant sheath and having a center passage in open communication with the interior of said pliant sheath, said manifold including a first end, a second end, and opening means for establishing a fluid connection between said center passage and a patient ventilation and exhalation apparatus and being structured to permit slidable passage of said catheter tube through said center passage.

3. The protective shield apparatus of claim 2 wherein the manifold includes first port means for selectively introducing a lavage solution into the center passage to irrigate the exterior and interior of said catheter tube during and following retraction of the catheter tube into said pliant sheath.

4. The protective shield apparatus of claim 2 wherein the manifold includes a first swivel structure axially rotatably mounted to the first end of said manifold, the first swivel structure having an interior in open communication with said center passage and an "O"-ring seal structure disposed so as to be capable of substantially sealing the interior of said sheath from the center passage and wiping the exterior of said catheter tube during retraction of the catheter tube into the sheath.

5. The protective shield apparatus of claim 4 wherein the manifold further includes a second swivel structure axially rotatably mounted to the second end of said manifold opposite the first end on which the first swivel structure is mounted, the second swivel structure having an interior in open communication with said center passage.

6. The protective shield apparatus of claim 4 wherein said distal end of said flexible catheter tube includes at least one radially disposed perforation which in conjunction with negative pressure therethrough from said vacuum pressure source facilitates the breaking up of human secretions and other liquids of relatively high viscosity in the course of evacuation of said secretions and liquids.

7. The protective shield apparatus of claim 2 wherein at least one of said pliant sheath and catheter carries externally visually perceived longitudinal indicia denoting the extent of advancement of said catheter tube into the trachea of a patient.

8. The protective shield apparatus of claim 4 wherein at least one of said first swivel structure and catheter carries externally visually perceived indicia denoting the radial positioning of said catheter tube.

9. The protective shield apparatus of claim 2 wherein said pliant sheath comprises a first pad positioned at the proximal end whereby the pliant sheath may be anchored as said catheter tube is advanced into the trachea of a patient and whereby the direction of said catheter tube being extendable into and withdrawable from the trachea of a patient may be influenced.

10. The protective shield apparatus of claim 9 wherein said pliant sheath further comprises a second pad positioned at the distal end whereby the pliant sheath may be anchored as said catheter tube is retracted from the trachea of a patient.

11. The protective shield apparatus of claim 10 wherein said first pad includes a visually perceived first indicator of the function of the first pad and wherein said second pad includes a visually perceived second indicator of the function of the second pad.

12. The protective shield apparatus of claim 10 wherein said first indicator is color coding with relief and print inscriptions and wherein said second indicator is color coding with relief and print inscriptions.

13. The protective shield apparatus of claim 2 wherein said manifold includes second port means for monitoring conditions within said center passages.

14. The protective shield apparatus of claim 2 wherein said opening means of said manifold comprises a first conduit structure configured to allow relatively low dead air space therein, extending radially from said manifold and in communication with said center passage for selective communication of ventilating gases between a therapeutic ventilator and a patient.

15. The protective shield apparatus of claim 14 wherein said opening means further comprises a second conduit structure configured to allow relatively low dead air space therein, extending radially from said manifold and in fluid communication with said center passage for selective communication of ventilating gases between a therapeutic ventilator and a patient.

16. The protective shield apparatus of claim 15 wherein a plug for use in said first or second conduit structure is placed within said first or second conduit structure whereby fluid communication with said center passage through said conduit structure is prevented and dead air space in said first or second conduit structure is substantially avoided.

17. The protective shield apparatus of claim 2 wherein said pliant sheath provides a sterility preserving casing about said catheter tube and a limitation to migration of contaminants from a patient through said sheath to a user.

18. The protective shield apparatus of claim 1 wherein said communication between a user and an implement includes direct physical contact.

19. The protective shield apparatus of claim 18 wherein said communication between a user and an implement includes fluid communication.

20. The protective shield of claim 1 including closing means for releasably closing said slit along its entire length, said closing means comprising a bead formed along a first edge of said slit and a groove formed along a second edge of said slit to tightly receive said bead, thereby to prevent air flow through said slit.

38. The protective shield apparatus of claim 1, wherein said protective shield apparatus comprises an improved ventilating and aspirating apparatus for delivering respiratory gases to the trachea of a patient and aspirating congested lugs and breathing passageways of a patient, said ventilating and aspirating apparatus further comprising:

said implement comprising a flexible catheter tube having a catheter lumen and a longitudinal catheter axis, said catheter tube being extendable into and withdrawable from a patient'"'"'s trachea and having a distal end structured to permit secretions to enter said catheter lumen;

a vacuum valve with an inlet connected to the lumen of said catheter tube, an outlet constituting means for connection to a vacuum source, and an actuator for selectively communicating the lumen of said catheter tube with the vacuum source;

said pliant barrier means comprising a pliant sheath formed of a substantially continuous sidewall and having a longitudinal sheath axis, said sheath receiving and coaxially surrounding said catheter tube, having an open distal end through which said catheter tube is slidable and a releasably closed slit formed in a portion of said sidewall, said slit being defined by opposed edges of a discontinuous portion of said sidewall;

a manifold connected to the distal end of said sheath having a center passage in open communication with the interior of said sheath, said manifold including means for establishing a fluid connection between said center passage and a patient ventilation and exhalation apparatus and being structured to permit slidable passage of said catheter tube through said center passage; and

said connector means for connecting said catheter tube inside the sheath to the vacuum valve outside the sheath, said connector means including structure disposed through said slit and being otherwise structured and arranged for movement parallel said sheath axis, whereby to open a portion of said slit adjacent said connector means progressively in a direction of travel of said connector means while concurrently closing said slit following said connector means in said direction of travel.

39. The improved ventilating and aspirating apparatus of claim 38 including closing means for releasably closing said slit along its entire length, said closing means comprising a bead formed along a first edge of said slit and a groove formed along a second edge of said slit to tightly receive said bead, thereby to prevent air flow through said slit.

40. An improved ventilating and aspirating apparatus as in claim 39 wherein the connector means includes a slider member having legs straddling a portion of said closing means and a web interconnecting said legs, said legs converging at their respective opposite ends, whereby said ends function to hold the bead in the groove, and said legs diverging at a central portion of said slider member;

a divider member between said legs at said central portion and shaped to separate the bead from the groove at said central portion; and

a conduit means extending through said divider member and having a first end connected to the catheter tube inside the sheath and a second end projecting through the web of the slider member.

41. An improved ventilating and aspirating apparatus as in claim 40 wherein the divider member is a portion of an insert member, inserted into the slider member from within the sheath and further including stepped walls for engaging the material of the sheath when said insert member is wedged into the slider member, between the spaced legs.

42. An improved ventilating and aspirating apparatus as in claim 41 for delivering respiratory gases to the trachea of a patient and aspirating congested lungs and breathing passageways wherein the vacuum valve is carried by the slider member and includes a valve body secured to the slider member and a passageway in said valve body connected to the catheter tube;

and further including;

a conduit connector opening into said passageway;

a valve actuator to open the valve;

means biasing the valve actuator to a valve-closed position;

means preventing flow from the catheter tube to the conduit connector when the valve is in a valve-closed position; and

means connecting the catheter tube to the conduit connector for flow therebetween upon movement of said valve actuator to a valve-open position.

43. An improved ventilating and aspirating apparatus as in claim 42 for delivering respiratory gases to the trachea of a patient and aspirating congested lungs and breathing passageways, wherein:

the valve actuator includes a valve stem extending therefrom into the valve body, said valve stem having a passage therethrough for flow from the catheter tube to the conduit connector; and

the means biasing the valve actuator comprises a resilient pushbutton portion of the valve actuator.

44. An improved ventilating said aspirating apparatus as in claim 43, for delivering respiratory gases to the trachea of a patient, and aspirating congested lungs and breathing passageways, wherein the valve actuator includes a flexible tube extending through the valve body, and wherein the means biasing the valve actuator biases the valve actuator to compress the flexible tubing to prevent flow therethrough.

45. An improved ventilating and aspirating apparatus as in claim 44, for delivering respiratory gases to the trachea of a patient and aspirating congested lungs and breathing passageways, wherein:

the valve actuator compresses a plunger slidable into a sidewall of the valve body and said plunger having a hole therethrough inside the valve body;

the biasing means compresses a spring positioned between an opposite sidewall of the valve body and the plunger; and

the flexible tubing extends through the hole in the plunger to secure the plunger in the valve body.

46. An improved ventilating and aspirating apparatus as in claim 45, for delivering respiratory gases to the trachea of a patient and aspirating congested passageways, further including means to lock the plunger in a valve-open position.

47. An improved ventilating and aspirating apparatus as in claim 46 including means to lock the plunger in a valve-closed position.

48. The improved ventilating and aspirating apparatus of claim 38 including closing means for releasably closing said slit along its entire length, said closing means comprising a backing member formed along each said edge of said slit, a bead formed along a first said backing member and a groove formed along a second said backing member to tightly receive said bead, thereby to prevent air flow through said slit.

49. An improved ventilating and aspirating apparatus as in claim 48 wherein the connector means includes a slider member having legs straddling a portion of said means for releasably closing said slit and a web interconnecting said legs, and said legs and web converging at opposite ends thereof, whereby the ends of said legs hold said slit closed and diverge at a central portion thereof;

a divider member between the legs at a central portion thereof and shaped to open the slit at said central portion; and

a conduit means extending through said divider means for releasably closing said slit and having one end connected to the catheter tube inside the sheath and its other end projecting through the web of the slider member to be connected to a suction source.

50. An improved ventilating and aspirating apparatus as in claim 49 wherein the divider member is a portion of an insert member, inserted into the slider member from within the sheath said further including stepped walls for engaging the backing members and the sheath material of the sheath whets said insert member is wedged into the slider member, between the spaced legs.

51. An improved ventilating and aspirating apparatus as in claim 50 for delivering respiratory gases to the trachea of a patient and aspirating congested lungs and breathing passageways wherein the vacuum valve is carried by the slider member and includes a valve body secured to the slider member and a passageway in said valve body connected to the catheter tube;

and further including;

a conduit connector opening into said passageway;

a valve actuator to open the valve;

means biasing the valve actuator to a valve-closed position;

means preventing flow from the catheter tube to the conduit connector when the valve is in a valve-closed position; and

means connecting the catheter tribe to the conduit connector for flow therebetween upon movement of said valve actuator to a valve-open position.

52. An improved ventilating and aspirating apparatus for delivering respiratory gases to the trachea of a patient and aspirating congested lungs and breathing passageways as in claim 51, wherein:

the valve actuator includes a valve stem extending therefrom into the valve body, said valve stem having a passage therethrough for flow from the catheter tube to the conduit connector; and

the means biasing the valve actuator comprises a resilient pushbutton portion of the valve actuator.

53. An improved ventilating and aspirating apparatus in claim 52, for delivering respiratory gases to the trachea of a patient, and aspirating congested lungs and breathing passageways as, wherein the valve actuator includes a flexible tube extending through the valve body, and wherein the means biasing the valve actuator biases the valve actuator to compress the flexible tubing to prevent flow therethrough.

54. An improved ventilating and aspirating apparatus as in claim 53, for delivering respiratory gases to the trachea of a patient and aspirating congested lungs and breathing passageways, wherein:

the valve actuator compresses a plunger slidable into a sidewall of the valve body and said plunger having a hole therethrough inside the valve body;

the biasing means compresses a spring positioned between an opposite sidewall of the valve body and the plunger; and

the flexible tubing extends through the hole in the plunger to secure the plunger in the valve body.

55. An improved ventilating and aspirating apparatus as in claim 54, for delivering respiratory gases to the trachea of a patient and aspirating congested passageways, further including means to lock the plunger in a valve-open position.

56. An improved ventilating and aspirating apparatus as in claim 55 including means to lock the plunger in a valve-closed position.

57. An improved ventilating and aspirating apparatus as in claim 49 wherein the manifold includes a first swivel structure axially rotatably mounted to one end of said manifold, the first swivel structure having an interior in open communication with said center passage and an "O"-ring seal structure disposed so as to be capable of substantially sealing the interior of said sheath from the center passage and wiping the exterior of said catheter tube during retraction of the catheter tube into the sheath.

58. An improved ventilating and aspirating apparatus as in claim 57 wherein the manifold further includes a second swivel structure axially rotatably mounted to the end of said manifold opposite the end on which the first swivel structure is mounted, the second swivel structure having an interior in open communication with said center passage.

59. An improved ventilating and aspirating apparatus as in claim 57 wherein said distal end of said flexible catheter tube includes at least one radially disposed perforation which in conjunction with negative pressure therethrough from said vacuum pressure source facilitates the breaking up of human secretions and other liquids of relatively high viscosity in the course of evacuation of said secretions and liquids.

60. An improved ventilating and aspirating apparatus as in claim 57 wherein said first swivel structure comprises externally visually perceived indicia denoting the radial positioning of said catheter tube.

61. An improved ventilating and aspirating apparatus as in claim 49 wherein said manifold comprises a first conduit structure extending radially from the manifold and in fluid communication with said center passage for selective communication of ventilating gases between a therapeutic ventilator and a patient.

62. An improved ventilating and aspirating apparatus as in claim 61 wherein said manifold further comprises a second conduit structure extending radially from said manifold and in fluid communication with said center passage for selective communication of ventilating gases between a therapeutic ventilator and a patient.

63. An improved ventilating and aspirating apparatus as in claim 62 wherein selectively either and both of said conduit structure has placed therein a plug for use in said first or second conduit structure whereby fluid communication with said center passage is prevented and dead air space in said first or second conduit structure is substantially voided.

64. An improved ventilating and aspirating apparatus as in claim 49 wherein the manifold includes first port means for selectively introducing a lavage solution in into the center passage to irrigate the exterior and integer of said catheter tube during and following retraction of the catheter robe into said pliant sheath.

65. An improved ventilating and aspirating apparatus as in claim 49 wherein said manifold includes second port means for monitoring conditions within said center passage, said conditions selectively including at least gas type, gas flow rate, pressure, temperature, humidity level and liquid type.

66. An improved ventilating and aspirating apparatus as in claim 49 wherein said pliant sheath provides a sterility preserving casing about said catheter tube and a limitation to migration of contaminants from a patient through said sheath to a user.

67. An improved ventilating and aspirating apparatus as in claim 49 wherein said pliant sheath comprises a first pad positioned at the proximal end whereby the pliant sheath may be anchored as said catheter tube is advanced into the trachea of a patient and whereby the direction of extension of said catheter tube into the trachea of a patient may be influenced.

68. An improved ventilating and aspirating apparatus as in claim 67 wherein said pliant sheath further comprises a second pad positioned at the distal end whereby the pliant sheath may be anchored as said catheter tube is retracted from the trachea of a patient.

21. A protective shield apparatus for allowing communication between a user located on a first side of a barrier and a catheter tube for use with said protective shield apparatus, said catheter tube located on a second side of said barrier across at least one channel dynamically locatable anywhere along a defined course of potential channel location through said barrier, comprising:

a pliant barrier means defining a substantially discrete space;

at least one releasably closed slit formed through said barrier means, said slit defining a course of travel along said barrier means;

connector means for allowing communication across said at least one channel between a user and said catheter tube for use with said protective shield apparatus, said connector means including structure disposed through said at least one slit and being otherwise structured and arranged for slidable movement along said course, whereby to open a portion of said slit adjacent said connector means progressively in the direction of movement of said connector means while concurrently closing said slit following said connector means in the direction of movement; and

closing means for releasably closing said slit along its entire length, said closing means comprising a backing member formed along each said edge of said slit, a bead formed along a first edge of said backing member and a groove formed along a second edge of said backing member to tightly receive said bead, thereby to prevent air flow through said slit.

22. The protective shield of claim 21 wherein the connector means includes a slider member having legs straddling a portion of said means for releasably closing said slot and a web interconnecting said legs, and said legs and web converging at opposite ends thereof, whereby the ends of said legs hold the slot closed and diverge at a central portion thereof;

a divider member between the legs at a central portion thereof and shaped to open the slot at said central portion; and

a conduit means extending through said divider means for releasably closing said slot and having one end connected to the catheter tube inside the sheath and its other end projecting through the web of the slider member to be connected to a suction source.

23. The protective shield of claim 22 wherein the divider member is a portion of an insert member, inserted into the slider member from within the sheath and further including stepped walls for engaging the backing members and the sheath material of the sheath when said insert member is wedged into the slider member, between the spaced legs.

24. The protective shield of claim 23 wherein the vacuum valve is carried by the slider member and includes a valve body secured to the slider member and a passageway in said valve body connected to the catheter tube;

and further including;

a conduit connector opening into said passageway;

a valve actuator to open the valve;

means biasing the valve actuator to a valve-closed position;

means preventing flow from the catheter tube to the conduit connector when the valve is in a valve-closed position; and

means connecting the catheter tube to the conduit connector for flow therebetween upon movement of said valve actuator to a valve-open position.

25. A protective shield as in claim 24, wherein:

the valve actuator includes a valve stem extending therefrom into the valve body, said valve stem having a passage therethrough for flow from the catheter tube to the conduit connector; and

the means biasing the valve actuator comprises a resilient pushbutton portion of the valve actuator.

26. The protective shield of claim 25, wherein the valve actuator includes a flexible tube extending through the valve body, and wherein the means biasing the valve actuator biases the valve actuator to compress the flexible tubing to prevent flow therethrough.

27. The protective shield of claim 26, wherein:

the valve actuator compresses a plunger slidable into a sidewall of the valve body and said plunger having a hole therethrough inside the valve body;

the biasing means compresses a spring positioned between an opposite sidewall of the valve body and the plunger; and

the flexible tubing extends through the hole in the plunger to secure the plunger in the valve body.

28. The protective shield of claim 27, further including means to lock the plunger in a valve-open position.

29. The protective shield of claim 28, further including means to lock the plunger in a valve-closed position.

33. The protective shield of claim 24, wherein:

the valve actuator includes a valve stem extending therefrom into the valve body, said valve stem having a passage therethrough for flow from the catheter tube to the conduit connector; and

the means biasing the valve actuator comprises a resilient pushbutton portion of the valve actuator.

34. The protective shield of claim 25, wherein the valve actuator includes a flexible tube extending through the valve body, and wherein the means biasing the valve actuator biases the valve actuator to compress the flexible tubing to prevent flow therethrough.

35. The protective shield of claim 34, wherein:

the valve actuator compresses a plunger slidable into a sidewall of the valve body and said plunger having a hole therethrough inside the valve body;

the biasing means compresses a spring positioned between an opposite sidewall of the valve body and the plunger; and

the flexible tubing extends through the hole in the plunger to secure the plunger in the valve body.

36. The protective shield of claim 35, further including means to lock the plunger in a valve-open position.

37. The protective shield of claim 36, further including means to lock the plunger in a valve-closed position.

30. A protective shield apparatus for allowing communication between a user located on a first side of a barrier an catheter tube for use with said protective shield apparatus, said catheter tube located on a second side of said barrier across at least one channel dynamically locatable anywhere along a defined course of potential channel location through said barrier, comprising:

a pliant barrier means defining a substantially discrete space;

at least one releasably closed slit formed through said barrier means, said slit defining a course of travel along said barrier means;

closing means for releasably closing said slit along its entire length, said closing means comprising a bead formed along a first edge of said slit and a groove formed along a second edge of said slit to tightly receive said bead, thereby to prevent air flow through said slit; and

connector means for allowing communication across said at least one channel between a user and said catheter tube for use with said protective shield apparatus, said connector means including structure disposed through said at least one slit and being otherwise structured and arranged for slidable movement along said course, whereby to open a portion of said slit adjacent said connector means progressively in the direction of movement of said connector means while concurrently closing said slit following said connector means in the direction of movement, the connector means including a slider member having legs straddling a portion of said closing means and a web interconnecting said legs, said legs converging at their respective opposite ends, whereby ,said ends function to hold the bead in the groove, and said legs diverging at a central portion of said slider member;

a divider member between said legs at said central portion and shaped to separate the bead from the groove at said central portion; and

a conduit means extending through said divider member and having a first end connected to the catheter tube inside the sheath and a second end projecting through the web of the slider member.

31. The protective shield of claim 30 wherein the divider member is a portion of an insert member, inserted into the slider member from within the sheath and further including stepped walls for engaging the material of the sheath when said insert member is wedged into the slider member, between the spaced legs.

32. The protective shield of claim 31 wherein the vacuum valve is carried by the slider member and includes a valve body secured to the slider member and a passageway in said valve body connected to the catheter tube;

and further including;

a conduit connector opening into said passageway;

a valve actuator to open the valve;

means biasing the valve actuator to a valve-closed position;

means preventing flow from the catheter tube to the conduit connector when the valve is in a valve-closed position; and

means connecting the catheter tube to the conduit connector for flow therebetween upon movement of said valve actuator to a valve-open position.

69. An improved ventilating and aspirating apparatus as in claim 69 wherein said first pad includes a visually perceived first indicator of the function of the first pad and wherein said second pad includes a visually perceived second indicator of the function of the second pad.

70. An improved ventilating and aspirating apparatus as in claim 69 wherein said first indicator is color coding with relief and print inscriptions and wherein said second indicator is color coding with relief and print inscriptions.