EP1331912B1 - Adapter for a percutaneous endoscopic gastrostomy (peg) probe - Google Patents

Abstract

An adapter is connected to a probe tube of a PEG probe that is already in place, the probe tube being cut off above the abdominal wall of the patient. The adapter comprises an outer retaining element, which is supported on the abdominal wall, and comprises structure for fastening the proximal end of the PEG probe, and structure for connecting a delivery line to the flow channel. A shut-off element having a rotatable or displaceable closing body is provided for closing the PEG probe. The adapter is characterized by its universal use, simple handleability and small overall height.

Description

The invention relates to an adapter for the subsequent shortening of a PEG probe which has already been placed for artificial nutrition.

To place a PEG probe, an endoscope or gastroscope is inserted into the patient's stomach and the stomach is deployed by air insufflation. Subsequently, a cannula is advanced through the abdominal wall and the stomach wall into the stomach lumen. Through the cannula, a guide thread is introduced into the stomach lumen, detected with the endoscope or gastroscope and pulled out again through the esophagus and mouth of the patient. With the aid of the guide thread laid in this way, the probe is then guided to the inside of the stomach and from there via the cannula to the outside. This procedure is also known as percutaneous endoscopically controlled gastrostomy (PEG).

The known PEG probes, which are generally used, have at their distal end an inner retaining member with which the probe tube is supported on the stomach inner wall. The probe tube is sized to extend far out of the abdominal wall. At its proximal end, the tube has a connection part in order to be able to connect the transfer system for supplying nutrient solution. To close the probe tube, a conventional hose clamp or integrated closure cap is often provided.

In practice, the well-known PEG probes have proven to be troublesome. However, the relatively distant probe tube is perceived as disturbing by the active patient.

US-A-5,549,657 describes a PEG probe having an adapter for connection to a transfer system. The adapter is closed by a Y-slot valve which opens when connecting the transfer system. To open the valve, the connector of the transfer system has a projecting cannula which is inserted into the adapter. The disadvantage, however, is that the known PEG probe with the conventional Oberleitsystemen having a Luer-lock connector, is not directly compatible. In addition, there is a risk that the slit valve does not completely seal and loses its functionality too quickly.

US 5,527,280 describes an enteral nutrition probe having multiple lumens. The probe has an adapter with several connectors, each of which can be closed with plugs.

DE 41 45 661 A1 discloses a device for percutaneous enteral long-term nutrition. The flow channel also of this probe is closed with a stopper. A shut-off with rotatable or displaceable closure body is not provided here. DE 690 16 263 T2 describes a feeding probe, which again has a closable with a plug adapter.

A PEG probe with a fitting that is part of the probe tube is described in US-A-5,836,924. The connecting piece of the PEG probe has a rotatable closure body for the flow channel.

The invention has for its object to provide a universally applicable, easy-to-use and secure to be closed adapter with a low height, which allows the subsequent shortening of the probe tube an already placed PEG probe.

The solution of this object is achieved according to the invention with the features of claim 1 and 10.

The adapter according to the invention allows the shortening of the probe tube of an already placed PEG tube, without the need for probe exchange while still intact catheter tube, the adapter is connected to the only a short distance above the abdominal wall cut catheter tube.

To close the adapter, a shut-off device with a rotatable or displaceable closure body is provided. The obturator is advantageous in that the transfer system does not need to have a special connector that opens the adapter when connecting. Therefore, basically all application systems of enteral nutrition (according to EN 1615) can be connected.

The abutting the abdominal wall outer retaining member of the adapter should be made of a cuddly, elastic material, eg. As silicone rubber with particularly good biocompatibility properties, while the remaining parts of the adapter made of dimensionally stable materials, eg. As thermoplastics, should be made to give the adapter the required stability.

The attachment of the adapter to the PEG probe is carried out with two sleeve-shaped clamping parts, which can be screwed together with clamping of the proximal end of the fixed probe tube. The first sleeve-shaped clamping part is connected to the outer retaining member zwechmäßigerweise one piece, but may also be used loosely in the retaining member.

In the first clamping part, an elastic clamping ring is preferably used, while in the second clamping part, a conical hollow pin is arranged concentrically. Before screwing the two clamping parts of the probe tube is passed through the first clamping part and pushed onto the hollow pin of the second clamping part. When screwing the first and second clamping part of the clamping ring exerts a radial contact force on the hose, so that it is jammed on the hollow pin. Thus, a sufficient tensile and compressive strength of the compound can be achieved without the hose is damaged at the nip.

In a preferred embodiment, the adapter for connecting the transfer hose on a Luer-Lock Anschiußteil, which is characterized by a small size and a safe Konnexion.

The closure body of the obturator may be a rotatably mounted cylinder body which is closed at one end, open at the other end and provided with a transverse bore. When the closure body opens the obturator, liquid can flow from the flow channel of the adapter through the transverse bore into the cylinder body. This closure body makes possible an arrangement of the Luer-Lock connection part transversely to the flow channel, whereby a particularly low height of the adapter is achieved and a lateral connection of the transfer hose is possible.

But the Verschlvißkörper can also be a closure piece, which is inserted axially into the flow channel. This embodiment is advantageous if the Luer-lock connector is to be arranged in the longitudinal direction of the flow channel, that is, the transfer hose is not connected laterally.

To facilitate handling, the closure piece can be moved by rotating the outer housing body of the adapter. The transformation of the Rotational movement in a translational movement is preferably carried out by means of a guideway.

Since the obturator closes the adapter tight, can be dispensed with in principle on an additional cap. However, this is an advantage, as it protects the Luer-Lock connector part of the adapter.

The retaining member is preferably formed as a disk-shaped body, so that the adapter has the lowest possible height.

In an alternative embodiment, the fastening means, the shut-off and the connection means of the adapter form a unit which is suitable for use in the retaining member. It can be provided depending on the hose length different locking positions. Since the retention member does not interfere with assembly, attachment of the adapter to the probe tube is facilitated.

For performing the probe tube, an opening is provided in the retaining member. If the probe tube is passed through the opening of the retaining member and deflected by 90 °, a particularly flat profile can be achieved. Thus, the retaining member can take a short piece of tubing as a reserve, so that the hose does not have to be cut off immediately above the abdominal wall.

For the hose, a guide is advantageously provided in the retaining member, which fixes the hose and reduces the risk of buckling at the bending point. But the fixation of the hose can also be done solely by the fact that the unit consisting of the fastening means, the shut-off and the connection means positively seated in the retaining member.

In the following, various embodiments of the invention will be explained in more detail with reference to the drawings.

Show it:

Fig. 1

a side view of a first embodiment of the adapter connected to a PEG probe,

Fig. 2

the adapter of Fig. 1 removed from the PEG probe,

Fig. 3

the top of the adapter of Fig. 2 in a sectional view,

Fig. 4

A second embodiment of the adapter connected to the PEG probe,

Fig. 5

the removed from the PEG probe adapter of Fig. 4, and

Fig. 6

the upper part of the adapter of Fig. 4 in a partially sectioned view.

Fig. 7

a third embodiment of the adapter connected to the PEG probe in a partially cutaway view,

Fig. 8

a view of the adapter from the direction of the arrow VIII of Fig. 7,

Fig. 9

a section through the retaining member of the adapter of Fig. 8 along the line IX - IX,

Fig. 10

another embodiment of the adapter, and

Fig. 11

a fixing element for the probe tube.

Figures 1 to 3 show a first embodiment of the adapter 1 for the probe tube 2 of a PEG probe 3. The probe tube 2 of the PEG probe 3 has at its distal end a plate-shaped inner retaining member 4, with which the tube on the stomach inner wall supported. The outer retaining member 5, with which the PEG probe is supported on the abdominal wall, is part of the adapter.

The retaining member 5 of the adapter is a circular disc of a cuddly, biocompatible material having a central opening 6 for passing the probe tube 2. On the side facing away from the patient, the retaining member 5 has a provided with an external thread 7 first sleeve-shaped clamping member 8, in the an elastic clamping ring 9 is inserted, through which the probe tube 2 is guided. In a provided with a corresponding internal thread 10 second sleeve-shaped clamping member 11, a conical hollow pin 12 is concentrically arranged, on which the probe tube 2 is pushed. To clamp the probe tube, the first and second clamping part 8, 11 are screwed together, whereby the elastic clamping ring 9 exerts a radial clamping force on the tube.

To the second clamping member 11, the housing body 43 of a obturator 13 connects, in which transverse to the longitudinal axis of the flow channel 14, a hollow cylindrical shut-off body 15 is rotatably mounted, which is open at one end 16, closed at the other end and provided with a central transverse bore 17 is. The cylinder body 15 can be rotated by means of a set screw 18, which is integral with the cylinder body. Before the open end 16 of the cylinder body 43, a positive Luer-lock connector 19 is attached to the housing body 43. On the housing body 43, a flexible tab 20 is attached laterally, to which a closure cap 21 is attached for closing the Luer-lock connector 19.

To shorten the probe tube 2 of the already installed PEG tube 3, the tube above the abdominal wall is cut straight, the projecting tube end is guided by the retaining member 5 with the first clamping piece 8 and pushed onto the hollow pin 12 of the second clamping piece 11. Subsequently, both clamping pieces are screwed together.

The transfer hose of the transfer system, not shown, has a negative luer lock connector. To connect the transfer hose the protective cap 21 is removed from the positive Luer-lock connector 19 and the two luer-lock connectors of the adapter and the hose are connected together.

Figures 4 to 6 show a second embodiment of the adapter, which differs from the embodiment according to Figures 1 to 3 by the obturator. The parts of the embodiment according to the figures 4 to 6, which correspond to the parts of the embodiment according to the figures 1 to 3, are provided with the same reference numerals.

The adapter again has a retaining member 5 with a first sleeve-shaped clamping part 8 and a second sleeve-shaped clamping part 11auf. In the first clamping part 8, an elastic clamping ring 9 is again used to clamp the pushed onto the hollow pin 12 of the second clamping part probe tube 2 when screwing the two clamping parts.

The second clamping member 11 is in this embodiment in a lower hollow cylindrical body 22, in which an upper hollow cylindrical body 23 is guided longitudinally displaceable. In the lower cylinder body 22, a cylindrical closure member 24 is arranged concentrically. At the open end of the upper cylinder body 23 connects in the longitudinal direction of the flow channel 14, the positive Luer-lock connector 19 at.

On the underside of the Luer-lock connector 19, an annular projection 25 is provided, from which a sleeve-shaped body 26 extends downwardly, which has a guide track 27 for extending from the lower cylinder body 22 radially outward guide pin 28.

To close the PEG probe 3, the upper part of the adapter 1 is rotated, so that the upper and lower cylinder body 22, 23 are pushed together and the cylindrical closure member 24 in the lumen of the upper cylinder body sealing introduced. To better grip the adapter, its annular projection 25 may be provided with a knurling or the like.

Figures 7 to 9 show a third embodiment of the adapter, which differs from the embodiment according to the figures 4 to 6 by the retaining member 5 and the means for fixing the probe tube 2. The corresponding parts are again provided with the same reference numerals.

The retaining member 27 is a plate-shaped element which is placed with its flat underside on the abdominal wall. It has an opening 30 for the passage of the probe tube. On its upper side define two parallel webs 31, 32 a subsequent to the opening 30 guide channel 33 for the hose 2. In the embodiment according to the figures 7 to 9 form the means for fixing the probe tube, the obturator and the means for connecting the Überleitungsschlauchs a unit 34 which is inserted into the retaining member 27 fits. The attachment of the hose to the adapter is not done by screwing two clamping parts, as in the embodiments of Figures 1 to 6. Instead of the two clamping parts, the adapter according to the figures 7 to 9 at its hose end a profiled insert 35 with a conical hollow pin 36 for pushing on the hose. The insert 35 can be inserted into a correspondingly profiled recess 37 of the retaining member, which adjoins the guide channel. The profililierte recess 37 has a cylindrical portion 38 which receives the pushed onto the hollow pin piece of tubing by clamping.

The probe tube 2 is guided for connection of the adapter through the opening 30, cut to the correct length and pushed onto the conical hollow pin 36 of the insert 35. Subsequently, the probe tube is bent by 90 ° and inserted into the guide channel 33, and the adapter is inserted with the insert 35 in the recess of the retaining member. there the hose piece sitting on the hollow pin is clamped. The guidance of the hose in the area of the deflection and in the attachment area reduces the risk of buckling. Moreover, the hose connection is relieved because the hose is clamped fixed. Further support provides the positive connection between the insert of the adapter and the profiled recess of the retaining member.

In the profiled recess and a plurality of detent positions may be provided for inserting the insert to compensate for different lengths of the probe tube can.

The areas of the retention member 27 with direct skin and tissue contact consist of a cuddly, biocompatible material, eg. As silicone rubber, whereas the remaining parts of the retaining member made of a harder materials, eg. B. thermoplastic materials are made.

Fig. 10 shows another embodiment of the adapter, which differs from the embodiment according to the figures 7 to 9 characterized in that not the obturator according to the embodiments 4 to 6, but the obturator according to the figures 1 to 3 is used. Corresponding parts are again provided with the same reference numerals.

The retaining member 27 again has an opening 30 for the probe tube 2 and a subsequent thereto guide channel 33, in which the tube is inserted. The profiled insert 35 of the adapter with the conical hollow pin 36 is inserted into the entprechend profiled recess 37 of the retaining member fitting, wherein the probe tube 2 is clamped in the cylindrical portion 38 of the recess on the hollow pin. The recess is formed such that the adapter with the adjusting screw 18 and the Luer-lock connector 19 is laterally supported on the Rüchhalteglied 27.

11 shows a fixing element 40 for the probe tube 2 during the installation of the PEG probe. The fixing element is formed as a flat plate, which is cut in the longitudinal direction. The incision 41 has a smaller width than the probe tube, so that the tube with the fixing element is clamped fixable. The thickness of the fixing element corresponds to the desired distance between the abdominal wall and the outer retaining member 5 of the adapter. At the edge opposite to the incision, the fixing element has a projecting lug 42. To apply the PEG probe, the fixation element is placed on the abdominal wall and pushed laterally onto the probe tube until the stop 42 abuts against the retaining member, so that the tube is fixed by clamping. Subsequently, the probe tube is cut off and the retaining member is fixed to the probe tube. The fixing element serves as a spacer.

Claims (13)

1. An adapter for a PEG probe with an internal retaining element supported on the stomach wall at its distal end and an open proximal end, wherein the adapter comprises:

   a flow channel (14), an external retaining element (5) supported on the abdominal wall, means (15, 24) for closing the flow channel and means (19) for connecting a delivery tube to the flow channel, wherein the means for closing the flow channel is a shut-off element, which can be closed with a rotatable or displaceable closure body (15, 24), characterised in that the adapter further comprises means (8, 11) for fixing the proximal end of the PEG probe to the retaining element, and the means for fixing the PEG probe comprises a first sleeve-shaped clamping part (8), which is in one piece with the external retaining element (5), and a second sleeve-shaped clamping part (11), wherein the first and second clamping part can be screwed together thereby clamping the PEG probe.
2. The adapter according to claim 1, characterised in that the means for connecting the delivery tube is a Luer lock connector (19).
3. The adapter according to claim 2, characterised in that the Luer lock connector (19) can be closed with a closure cap (21).
4. The adapter according to claim 3, characterised in that an elastic clamping ring (9) is inserted into the first sleeve-shaped clamping part (8) and a conical hollow peg (12) is arranged concentrically in the second sleeve-shaped clamping part (11).
5. The adapter according to any one of claims 1 to 4, characterised in that the closure body is a cylindrical body (15) mounted capable of rotating about an axis at right angles to the flow channel (14), said cylindrical body being closed at one end, open at the other end (16) and provided with a transverse bore (17), the means (19) for fixing the PEG probe being arranged at the open end of the closure body.
6. The adapter according to any one of claims 1 to 5, characterised in that the closure body is a cylindrical closure piece (24), which can be pushed axially into the flow channel (14).
7. The adapter according to claim 6, characterised in that the cylindrical closure piece (24) is arranged concentrically in a first cylindrical body (22) which is in one piece with the retaining element (5), and a second cylindrical body (23) is inserted into the first cylindrical body, the first and second cylindrical bodies being displaceable towards one another by means of a guide (28, 29).
8. The adapter according to claim 7, characterised in that the Luer lock connector (19) is arranged on the second cylindrical body (23) in the longitudinal direction of the flow channel (14).
9. The adapter according to any one of claims 1 to 8, characterised in that the retaining element (5) is designed as a disc-shaped body.
10. An adapter for a PEG probe with an internal retaining element supported on the stomach wall at its distal end and an open proximal end, wherein the adapter comprises:

    a flow channel (14), an external retaining element (5) supported on the abdominal wall, means (15, 24) for closing the flow channel and means (18) for connecting a delivery tube to the flow channel, wherein the means for closing the flow channel is a shut-off element, which can be closed with a rotatable or displaceable closure body (15, 24), characterised in that the adapter further comprises means (8, 11) for fixing the proximal end of the PEG probe to the retaining element, and the retaining element (27) has an opening (30) for the passage of the PEG probe and a recess (37), the means for fixing the proximal end of the PEG probe, the shut-off element and the means for connecting the delivery tube forming a unit (34) which can be inserted into the recess.
11. The adapter according to claim 10, characterised in that the recess (37) comprises a cylindrical clamping portion (38).
12. The adapter according to claim 11, characterised in that the retaining element (27) comprises a guide channel (33), which follows on from the opening (30).
13. The adapter according to any one of claims 1 to 12, characterised by a fixing element (40) for the clamped fixing of the probe tube, said fixing element being configured as a small flat plate with a lateral indent (41).

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