GB2043449A

GB2043449A - Nasogastric catheter

Info

Publication number: GB2043449A
Application number: GB7905799A
Authority: GB
Original assignee: Betancourt V M
Current assignee: Betancourt V M
Priority date: 1979-02-19
Filing date: 1979-02-19
Publication date: 1980-10-08

Abstract

The invention is concerned with a nasogastric catheter comprising a tube 1 of relatively flexible material defining a main duct extending from one end of the tube to the other end thereof, and first and second inflatable vessels G2, G3 which are mounted at the exterior of the tube and through which the tube extends. The vessels are preferably situated approximately three- quarters of the way along the tube, and are, in any event, spaced from one another along the tube. First and second subsidiary conduits 2, 3 extend along the tube from a portion thereof which is to remain outside a patient when the catheter is in use and communicate with the first and second vessels G2, G3, respectively, but are isolated from said main duct. The tube is formed with at least one lateral perforation P' between the first and second vessels and at least one and preferably a plurality of lateral perforations P after the second vessel (i.e. between said vessel and that end of the tube which is to be inserted into the patient's stomach), the lateral perforations establishing communication between the main duct and the exterior of the tube. <IMAGE>

Description

SPECIFICATION Nasogastric catheter This invention relates to nasogastric catheters (which can be used for humans or animals).

It is known to introduce a nasogastric catheter into a patient's stomach cavity by way of his esophagus for the purpose of withdrawing the contents of the stomach by suction in order to control irrepressible vomiting, and for the purpose of feeding a patient who cannot be fed through the mouth. Nasogastric catheters used at present, such as the Levin catheter, comprise a relatively flexible tube that is simply introduced until it reaches the stomach cavity in order to supply liquid food to a patient who cannot be fed through the mouth.

Catheters of this type have the disadvantage that the patient, either consciously or unconsciously, makes peristaltic contractions or movements of the stomach and the esophagus that may cause the stomach contents to pass up the esophagus and enter the trachea, thereby flowing to the lungs of the patient.

This the reason why the condition of the patient frequently worsens due to complications with pneumonia produced by the effusion of food in the respiratory system, death often being the consequence of such conditions. Known catheters also involve the suffering of appreciable discomfort by thepatient and the danger of asphyxia attendant upon irrepressible vomiting.

According to the present invention there is provided a nasogastric catheter comprising a tube of relatively flexible material defining a main duct extending from one end of the tube to the other end thereof, first and second inflatable vessels which are mounted at the exterior of said tube and through which said tube extends, said vessels being spaced from one another along said tube, and first and second subsidiary conduits extending along the tube from a portion thereof which is to remain outside a patient when the catheter is in use and communicating with the first and second vessels, respectively, but being isolated from said main duct, said tube being formed with at least one lateral perforation between the first and second vessels and at least one (preferably a plurality) lateral perforation between the second vessel and that end of the tube which is to be inserted into the patient's stomach, the lateral perforations establishing communication between said main duct and the exterior of the tube. Preferably, said vessels are situated approximately threequarters of the way along the tube. In any event, and bearing in mind that the catheter of the present invention can be used in veterinary or human medicine, said vessels must be situated at a distance from that end of the catheter which is to be inserted into the patient's stomach such that said vessels can remain in the stomach when the catheter has been introduced.

The main duct and the subsidiary conduits may terminate at said one end of the catheter in respective tubular sections, which may be provided with spouts or valves for attaching e.g. syringes or feeding devices in order to supply liquid medicaments or food to the patient and to inflate the two vessels.

Preferably, one or both of said subsidiary conduits extends within the tube for at least part of the length of said conduit(s).

The tubular sections of the subsidiary conduits, where they are separated from the main tube, may be at different levels from the tubular section of the main tube, or they may be given different colours, or their spouts may be of different colours in order to identify from the outside the conduit to which each tubular section pertains and use it accordingly either for feeding, or for inflating the first and second vessels at the lower end of the catheter, as needed.

The inflatable vessels can be independently inflated, and may have equal or different volumes. The purpose of the vessels is to seal the entrance of the stomach cavity and to prevent the catheter from adhering to the walls of the esophagus or of the stomach cavity and having its perforation(s) obstructed by such contact.

When the objective is the suction of the stomach contents, the first vessel is inflated to its maximum capacity and the catheter is slightly drawn upwards until it touches and seals the entrance of the stomach cavity, and subsequently the second vessel may be inflated to the maximum capacity to prevent the catheter from adhering to the walls of the stomach cavity and permit the suction of the stomach contents through the lateral perforation(s) of the main tube.

When a patient is being fed and the entrance of the stomach cavity is sealed by the second vessel that has been inflated to its maximum capacity, the latter will prevent the stomach contents from passing to the esophagus and thus from flowing to the lungs.

Under these conditions, if the first vessel is inflated to a lesser degree than the second, the result is that the walls of the esophagus will not adhere to the perforation(s) between the two vessels whereby it becomes possible to extract the buccopharyngeal secretions that in these conditions accumulate within the esophagus. After a predetermined period of time the feeding is suspended and the suction is effected through the main tube to extract the secretions accumulated in the pharynx through the perforation(s) between the two vessels, the feeding being resumed when it is deemed necessary.

To further illustrate and describe the invention reference will now be made, by way of example, to the accompanying drawings, in which: Figure 1 shows a lateral longitudinal view of a nasogastric catheter in accordance with the invention; Figures IA, IB, and 1C illustrate details of the catheter of Fig. 1, Figures 2, 3 and 4 illustrate use of the nasogastric catheter of Fig. 1 for the purpose of extracting a patient's stomach contents; Figures 5, 6, 7 and 8 illustrate use of the catheter of Fig. 1 for controlling irrepressible vomiting, either while the patient is being fed or during extraction of the stomach contents; and Figures 9, 10 and ii illustrate use of the catheter of Fig. 1 for feeding a patient who cannot be fed through the mouth.

The illustrated nasogastric catheter comprises a main tube 1 of relatively flexible material, i.e. material which is flexible but is nevertheless strong enough to enable the catheter to be introduced via the nasal conduit without being easily flexed. Thus, for example, the material may be rubber. The main tube 1 is open at its two ends and extends through two inflatable globes G2 and G3 which are positioned near the lower end of the catheter, approximately three-quarters of the way along the catheter. The main tube 1 has a zone T1 between the globes G2 and G3, and a zone T2 between the globe G3 and the lower end of the tube, the bag G2 being slightly above the globe. The wall of the tube 1 is formed with lateral perforations P' and P in the zones T1 and T2.First and second subsidiary conduits 2 and 3 extend within the wall of the tube 1 from the upper end of the tube 1 and open into the globes G2 and G3, respectively. The conduits 2 and 3 are independent of each other and integral with the external surrounding wall of the main tube 1, the upper ends of the conduits 2 and 3 being branched off from the main tube and having tubular sections 2' and 3' respectively. The conduits 2 and 3 enable the globes G2 and G3 to be inflated independently of each other.

The main tube 1 and the tubular sections 2' and 3' of the conduits 2 and 3 are provided with valves or spouts B1, B2 and B3, respectively, for the attachment of suction syringes or special devices for supplying food or medicines through the main tube and for inflating the globes G2 and G3. The use of a specific embodiment of the invention will now be described:1. Suction of the Gastric Content Procedure (Adults).

(a) After applying local anesthesia to the nasal fossa and lubricating the catheter, the latter is introduced in the nasal fossa, up to the opening of conduit 2 (Fig. 1). Thus, the catheter is introduced a distance of 108 cms. (42.5 inches) and approximately 58 cms. (23.5 inches of the catheter will be disposed in the gastric cavity (Fig. 2).

(b) Suction is applied to the conduit 3 in order to be sure the catheter is inside the gastric cavity.

(c) The globe G2 is inflated with 15 c.c. of water (Fig. 3) supplied through the conduit 2.

(d) The catheter is withdrawn with care, until it stops, (Fig. 4). In this position the globe G2 blocks the esophagus where it opens into the stomach.

(e) The catheter is secured to the cutaneous tegument with Micropor, which will retain the globe G2 in its position blocking the esophagus.

(f) Suction is applied to the conduit 3 for the necessary time.

2. Incoercible Vomit Procedure (Adults).

(a) Carry out steps (a), (b), (c), (d) and (e) of the procedure for suction of the gastric content.

(b) The conduit 3 is connected to an empty food supply equipment.

3. Feeding Procedure (Adults).

(A) If the Catheter is in Phase of Suction (Fig.

4), i.e. in the course of step (f) of the procedure for suction of the gastric content.

(i) Without pathology in upper or lower respiratory tract (without abnormal reactions).

(a) The suction is removed and the conduit 3 connected to a food supply equipment.

(b) In the same position the passing of food is carried out through conduit 3 (Fig. 4).

(c) When the food is in the food supply equipment is finished the catheter must remain in the same position, until the next feeding. This is not inconvenient, since it takes 3 or 4 minutes to pass the food.

(d) Once every 12 hours, is necessary to do the following operation before the administration of food: ~The globe G2 is deflated by extracting the 15 c.c. of water: and the globe G3 is inflated with 15 c.c. of water (Fig. 5).

~The cathether is withdrawn with care, until it stops (Fig. 6). In this position the globe G3 blocks the esophagus where it opens into the stomach.

~The catheter is secured to the cutaneous tegument with Micropor, which will secure the globe G3 in its position blocking the esophagus.

~Suction (- 10 at - 20) is applied to the conduit 3 and serves to extract by way of the orifices P' the secretions (saliva, etc.) that have accumulated in the esophagus (the marks + represent the secretions) (Fig. 7).

The removal of secretions is facilitated if the globe G2 is partially inflated with 3 c.c. of water (Fig. 8) so that it is approximately 15 mm in diameter (the esophagus being from 25 to 28 mm in diameter), thus avoiding adhesion of the esophagus' walls to the catheter and consequent blocking of the passage of the accumulated secretions into the main tube 1 by way of the orifices P'.

~When the extraction of secretions is finished, the globe G3 is deflated by extracting the 15 c.c. of water, just as the globe G2 is deflated if it was partially inflated as described above (by extracting the 3 c.c. of water), and the catheter is inserted into the gastric cavity by a futher 5 inches (Fig. 2).

~The globe G2 is inflated with 15 c.c. of water (Fig. 3).

The cathether is withdrawn with care, until it stops (Fig. 4).

The catheter is secured to the cutaneous tegument, whereby the globe G2 is retained in this position.

(e) Repeat steps (b) and (c).

(ii) With pathology in upper or lower respira tory tract (with abundant secretions).

(a) Carry out steps (i)(a) and (i)(b).

(b) Carry out step (i)(d) with every inftroduction of food into the gastric cavity. (This is at the physician's discretion: if between two successive introductions of food, the secretions taken out by the suction, are 200 to 300 ml., it is necessary to repeat the suction before the next introduction of food. If the secretions are more than 300 ml., it is advisable to apply suction continually after the introduction of the food until the next introduction of food).

~When it is desired to secure the catheter, it may be secured to the cutaneous tegument.

(B) Catheter Being Used in Treatment of Inco ercible Vomiting.

(i) Without pathology in upper or lower respi ratory tract (without abnormal secretions).

(a) The empty food supply equipment is re moved and the conduit 3 is connected to a food supply equipment.

(b) Carry out steps (b), (c), (d) and (e) of procedure (A)(i).

(ii) With abundant secretions.

(b) Carry out steps (b) and (c) of procedure (A)(i).

(c) At each administration of food carry out step (d) of procedure (A)(i).

(d) When the catheter is in the position shown in Fig. 4, the conduit 3 is connected to an empty food supply equipment, and the catheter remains in this position, connected to the empty food supply equipment until the next feeding.

(C) Catheter to be Introduced.

(b) Carry out steps, (b), (c), (d) and (e) of procedure (A)(i).

(c) If necessary, carry out the steps of procedure (A)(ii).

In the above description, (C), reference can be made to Figs. 9, 10 and 11 which show the position of the catheter actually during normal feeding via the catheter and show the inflation of globe G3 to prevent the catheter adhering to the walls of the stomach cavity.

The position of the catheter shown in Fig. 11 is that adopted before deflation of globes G2 and G3 and subsequent withdrawal of the catheter.

Note: If the catheter is to be removed, the globes are deflated before removal.

It will be appreciated that the invention is not limited to the particular construction that is described and illustrated, since variations may be made without departing from the scope of the invention.

The present invention also includes a method of (a) effecting suction of the stomach contents of an animal; or (b) feeding an animal; which method comprises utilising a catheter of the invention in a manner substantially as hereinbefore described. It should, however, be clearly understood that such method should not be construed as including within its scope a method of treatment of the human or animal body by surgery or therapy or of diagnosis practices on the human or animal body. We make no claim herein to the method when so-construed. Subject to the foregoing disclaimer, the following are the

Claims

1. A nasogastric catheter comprising a tube of relatively flexible material defining a main duct extending from one end of the tube to the other end thereof, first and second inflatable vessels which are mounted at the exterior of said tube and through which said tube extends, said vessels being spaced from one another along said tube, and first and second subsidiary conduits extending along the tube from a portion thereof which is to remain outside a patient when the catheter is in use and communicating with the first and second vessels, respectively, but being isolated from said main duct, said tube being formed with at least one lateral perforation between the first and second vessels and at least one lateral perforation between the second vessel and that end of the tube which is to be inserted into the patient's stomach, the lateral perforations establishing communication between said main duct and the exterior of the tube.

2. A catheter as claimed in claim 1, wherein said vessels are situated approxi mately three-quarters of the way along the tube.

3. A catheter as claimed in claim 1 or claim 2, wherein there are a plurality of lateral perforations between the second vessel and that end of the tube which is to be inserted into the patient's stomach.

4. A catheter as claimed in any one of claims 1 to 3, wherein said main duct and said subsidiary conduits each terminate in a respective tubular section at said portion of the tube which is to remain outside the patient.

5. A catheter as claimed in claim 4, wherein said tubular sections are provided with spouts or valves for attachment of other apparatus to the catheter.

6. A catheter as claimed in claim 4 or claim 5, wherein the tubular sections of the subsidiary conduits terminate at a different position along the catheter from the tubular section of the main duct.

7. A catheter as claimed in any one of claims 4 tso 6, wherein the tubular sections of the subsidiary conduits are coloured differently from the tubular section of the main duct.

8. A catheter as claimed in claim 5 or claim 6 when dependent upon claim 5, wherein the spouts or valves of the subsidiary conduits are coloured differently from the spout or valve of the main duct.

9. A catheter as claimed in any one of claims 1 to 8, wherein said vessels have equal volumes.

10. A catheter as claimed in any one of claims 1 to 8, wherein said vessels have different volumes.

11. A catheter as claimed in any one of claims 1 to 10, wherein one or both of said subsidiary conduits extends within the tube for at least part of the length of said conduit(s).

12. A nasogastric catheter substantially as hereinbefore described with reference to and as illustrated in the accompanying drawings.

13. A method of: (a) effecting suction of the stomach contents of an animal; or (b) feeding an animal; which method comprises utilising a catheter as claimed in any one of claims 1 to 12 in a manner substantially as hereinbefore described.

14. A method of: (a) effecting suction of the stomach contents of an animal; or (b) feeding an animal; which method comprises utilising a catheter as claimed in any one of claims 1 to 12 in a manner substantially as hereinbefore described with reference to the accompanying drawings.