U.S. patent number 3,915,171 [Application Number 05/476,934] was granted by the patent office on 1975-10-28 for gastrostomy tube.
Invention is credited to Dennis William Shermeta.
United States Patent |
3,915,171 |
Shermeta |
October 28, 1975 |
Gastrostomy tube
Abstract
A gastrostomy tube for insertion into the stomach and for
retention as a consequence of bearing engagement against the inside
stomach wall and the outside abdominal wall. A conduit carries a
stiffly flexible retention bulb which can be collapsed by a stylet
for insertion through a stab wound through the stomach. In the
stomach the bulb resumes its normal shape when the stylet is
withdrawn and then can be pulled against the stomach wall. A second
retention bulb is inflatable and spaced apart from the first
retention bulb to engage the outer abdominal wall when it is
inflated.
Inventors: |
Shermeta; Dennis William
(Baltimore, MD) |
Family
ID: |
23893850 |
Appl.
No.: |
05/476,934 |
Filed: |
June 6, 1974 |
Current U.S.
Class: |
604/101.05;
D24/112; 607/84; 604/919; 604/910; 604/918; 604/104 |
Current CPC
Class: |
A61J
15/0065 (20130101); A61M 25/1009 (20130101); A61J
15/0015 (20130101); A61M 25/1011 (20130101); A61J
15/0038 (20130101); A61M 25/04 (20130101); A61M
2025/0233 (20130101); A61J 15/0042 (20130101); A61M
25/005 (20130101) |
Current International
Class: |
A61J
15/00 (20060101); A61M 25/00 (20060101); A61M
25/10 (20060101); A61M 25/04 (20060101); A61M
25/02 (20060101); A61M 025/00 () |
Field of
Search: |
;128/1,341,343,344,348-351,DIG.25,240-246,283,347 |
References Cited
[Referenced By]
U.S. Patent Documents
Primary Examiner: Gaudet; Richard A.
Assistant Examiner: Opitz; Rick
Attorney, Agent or Firm: Mon; Donald D.
Claims
I claim:
1. A gastrostomy tube comprising: a tubular conduit to be passed
through the abdominal wall and through the wall of the stomach,
said conduit having an axis of fluid flow and an axial bore, and a
first end and a second end spaced apart from one another along said
axis; first closure means spaced from the second end adapted to
close the conduit to the flow of fluid or to leave it open thereto,
whereby when the conduit passes through said wall and the conduit
is open, fluid can be supplied to or removed from the stomach
through said bore, and when the conduit is closed, fluid can be
retained in the stomach; a first retention bulb attached to the
conduit adjacent to said second end and having a greater lateral
dimension than the conduit so as to bear against the wall of the
stomach and resist the pull-out of the conduit from the stomach,
the first retention bulb being stiffly flexible whereby to tend to
retain its shape, the first retention bulb comprising a first face
section facing toward said first end of the conduit, a second face
section facing away from said first end, a medial section
interconnecting the said two face sections, the first face section
being connected to said conduit and the second face section being
attached to the conduit only through the medial section and the
first face section, the wall thickness of the two face sections
being relatively less than that of at least a portion of the medial
section, whereby the medial section forms a spring-like structure
which tends to restore the first retention bulb to its undistorted
shape, an internal chamber being formed within said sections, an
aperture through said first retention bulb other than through the
first face section communicating with said internal chamber to
provide fluid communication through the chamber between the stomach
and the bore, the first face section including an outer smooth and
continuous surface of revolution lying substantially normal to the
said axis; a second retention bulb attached to and surrounding said
conduit at a location axially spaced apart from the first retention
bulb, said second retention bulb being made of flexible
fluid-impermeable material whereby it is inflatable by fluid under
pressure to form a peripheral ring which has a greater lateral
dimension than the conduit and which tends to retain its shape
around the conduit and to bear against the outside of the abdominal
wall whereby to retain said walls between the two retention bulbs
and to attach the gastrostomy tube thereto and to form a
fluid-tight seal; fluid passage means entering the second retention
bulb to supply fluid under pressure to inflate the same; and second
closure means in said fluid passage means adapted to close the
fluid passage means or to leave it open to the flow of fluid,
whereby fluid under pressure can be injected through the fluid
passage into the second retention bulb to inflate said second
retention bulb and the second closure means can be closed to
maintain the inflation.
2. A gastrostomy tube according to claim 1 in which a spring
extends axially along the conduit to reinforce it and resist its
collapse.
3. A gastrostomy tube according to claim 1 in which a central
recess is formed in the undistorted first retention bulb to center
a stylet inserted into the chamber through the conduit.
4. A gastrostomy tube according to claim 3 in which the first
retention bulb is formed as a body of revolution around said axis,
which body is continuous except for said aperture.
Description
BACKGROUND OF THE INVENTION
This invention relates to a gastrostomy tube which is passed
through the wall of the abdomen and of the stomach, and is attached
thereto to provide a conduit having a bore for supplying and
removing fluids from the stomach.
Gastrostomy tubes are utilized to supply and to remove fluids from
the stomach, when for some reason the stomach cannot be supplied or
relieved through the normal channels. An example of such a
condition is the consequence of severe traumatic injury to or
destruction of the windpipe. Then it is necessary to feed the
patient or to relieve excess gas by other means. It is an object of
this invention to provide a gastrostomy tube which can be inserted
into a stab wound where it will, without further trauma, make a
full peripheral gas seal with the walls of the stomach and abdomen,
and retain itself by clamping action against the walls. The conduit
is readily and quickly put in place. Its retention means is
sufficiently strong that it is unlikely to be pulled out by any
forces normally to be expected on it.
A gastrostomy tube according to this invention comprises a tubular
conduit to be passed through the wall of the abdomen and of the
stomach. The conduit has an axis of fluid flow, an axial bore, and
a first end and a second end spaced apart from one another along
the axis. First closure means is spaced from the second end and is
adapted to close the conduit to the flow of fluid or to leave it
open thereto, whereby when the conduit passes through said wall and
the conduit is open, fluid can be supplied to or removed from the
stomach through the bore. When the conduit is closed, fluid can be
retained in the stomach.
A first retention bulb is attached to the conduit adjacent to the
second end, and it has a greater lateral dimension than the
conduit, so as to bear against the inside wall of the stomach and
resist pull-out of the conduit from the stomach. A second retention
bulb is attached to and surrounds the conduit at a location axially
spaced apart from the first retention bulb. The second retention
bulb is made of flexible fluid-impermeable material, whereby it is
inflatable by fluid under pressure to form a peripheral ring which
has a greater lateral dimension than the conduit and which tends to
retain its shape around the conduit and to bear against the outside
of the abdomen, whereby to retain the walls between the two
retention bulbs, thereby to attach the gastrostomy tube thereto and
to form a fluid-tight seal with them.
Fluid passage means enters the second retention bulb to supply
fluid under pressure to inflate the same, and second closure means
in the fluid passage means is adapted to close the fluid passage
means or to leave it open to the flow of fluid, whereby fluid under
pressure can be injected through the fluid passage into the second
retention bulb to inflate it, and the second closure means can be
closed to maintain the said inflation.
According to a preferred but optional feature of the invention, the
first retention bulb is stiffly flexible, whereby to tend to retain
its shape.
The above and other features of this invention will be fully
understood from the following detailed description and the
accompanying drawings.
BRIEF DESCRIPTION OF THE DRAWINGS
FIG. 1 is an axial cross-section showing the presently preferred
embodiment of the invention;
FIG. 2 is a partial showing of the device of FIG. 1 in its
installed condition;
FIG. 3 is a left-hand end view of FIG. 1;
FIG. 4 is a cross-section taken at line 4--4 of FIG. 1;
FIG. 5 shows the device of FIG. 1 being installed; and
FIG. 6 is a side view, principally in axial cutaway cross-section,
showing another embodiment of the invention.
DETAILED DESCRIPTION OF THE DRAWINGS
FIG. 1 shows a gastrostomy tube 10 according to the invention which
includes a tubular conduit 11 having a central axially-extending
bore 12 passing from a first end 13 to a second end 14. A
reinforcement spring 15 in the form of a coil spring may be
imbedded in the wall of the conduit, or may surround the conduit,
or abut the inside wall thereof as preferred. Its purpose is to
resist the compressive collapse of, or the pinching closed of, the
tubular conduit. The conduit and bore extend along axis 16.
First closure means 20 comprises a plug 21 fitted in a seat 22 at
the first end of the tubular conduit. A strap 23 prevents the plug
from being separated from the conduit. The plug makes an
interference fit in the seat. It is removable to open the tubular
conduit to flow through the bore and can be closed to close the
bore and prevent fluid flow therethrough.
A first retention bulb 25 is attached to the tubular conduit
adjacent to the second end thereof. In its undistorted shape, bulb
25 has a greater lateral dimension than the conduit so as to resist
the pull-out of the conduit from the stomach. Bulb 25 includes a
neck 26 which is attached to the conduit immediately adjacent to a
first face section 27. The neck makes a peripheral fluid-sealing
attachment with the outer wall of the tubular conduit. The
retention bulb is a hollow body of revolution including an internal
chamber 28. The first face section faces toward the first end of
the tubular conduit and has a wall thickness 29. It is smooth,
annular, and imperforate, and its surface can bear against the
stomach wall to form a fluid seal. The surface substantially lies
in a plane normal to axis 16 and is a continuous surface of
revolution. A second face section 30 faces away from the said first
end and has a wall thickness 31. The two face sections are
interconnected by a medial section 32 which has a wall thickness
33. The second face section is connected to the tubular conduit
only through the medial section and the first face section. The
first face section is connected to the conduit at neck 26. The wall
thickness 33, at least at the central portion of the medial
section, is greater than the wall thicknesses 29 and 31. This
heavier wall thickness acts as a relatively strong spring when the
first retention bulb is stretched axially, and tends to act as a
spring-like structure to return the bulb to the illustrated shape.
It springily resists distortive forces, although its resistance can
be overcome. A plurality of openings 34 (sometimes called
"apertures") through the second face section fluidly interconnect
the outside of the first retention bulb to the bore (and the bore
to the inside of the stomach when the gastrostomy tube is
installed). The apertures are formed in the first retention bulb
other than in the first face section.
A second retention bulb 40 is attached to the conduit and surrounds
it at a location axially spaced apart from the first retention
bulb. The second retention bulb is made of flexible
fluid-impermeable material, whereby it is inflatable by fluid under
pressure to form a peripheral ring 41, as in FIG. 2. The ring when
inflated tends to retain its shape around the conduit and is
intended to bear against the outside of the abdominal wall. It is a
body of revolution, and its surface adjacent to the abdominal wall
is smooth and annular. The walls are retained between the two
retention bulbs, and two seals are formed.
Fluid passage means 45, in the form of a pipe 46, is attached along
its length to the tubular conduit and enters the second retention
bulb. Second closure means 47 is provided to admit and to confine
fluid in the second retention bulb. Means 47 includes a removable
plug 48 which makes an interference fit in a seat 49. A strap 50
prevents the plug from being separated from the passage means.
FIG. 6 illustrates another embodiment of the invention which
differs from that of FIG. 1 only in the nature of the first
retention bulb. For this reason, similar parts are given identical
numbers. In this embodiment, the first retention bulb is
inflatable, rather than merely inherently shape-retaining as a
consequence of the materials used to make it, and of its
dimensions.
In the device of FIG. 6, the tubular conduit is open directly to
the stomach when it is installed, instead of first discharging into
a chamber.
In FIG. 6, the first retention bulb is attached to and surrounds
the conduit. It is made of flexible fluid-impermeable material, and
with the conduit forms an annular fluid-tight region, whereby the
bulb is inflatable by fluid under pressure to form a peripheral
ring (similar to that of the second retention bulb as shown) which
tends to retain its shape around the conduit and to bear against
the inside of the stomach wall.
A second fluid passage means 56 comprises a pipe 57 making a fluid
communication with the first retention bulb. It includes third
closure means 60 for admitting fluid under pressure to inflate the
retention bulb and to retain it when the removable plug is placed
in its respective seat. For this purpose, there is provided a
removable plug 61, a seat 62 and a strap 63, as in the other
closure means 47.
In FIG. 1, a recess 65 is formed centrally in the second face
section. This is for the purpose of centering a stylet 66 (see FIG.
5) when the device is to be installed.
The process of installation of the device of FIG. 1 is shown in
FIG. 5 where there is illustrated in simplified notation the wall
67 of the stomach and the abdominal wall 68 with a stab wound 69
passing through the two of them. The stylet is passed through the
bore and is centered by the recess. When the stylet is axially
pressed relative to the tubular conduit, it stretches the first
retention bulb, distorting its sections as shown. As it happens,
this tends to form the first retention bulb into a group of small
collapsed leaflets grouped around the axis, which readily pass
through the stab wound. Then the stylet is withdrawn, and because
of the springy construction of the first retention bulb, it will
spring back toward its original shape, as shown in FIG. 2. A pull
exerted on the tubular conduit will draw it against the inside
stomach wall. The thickened portion of the medial section resists
too-easy pull-out of the tube.
Next, the second tubular bulb is inflated by removing the plug from
the second closure and inserting a syringe into seat 49. The
syringe will insert fluid 70 under pressure (either gas or a
liquid, such as sterile saline solution) into the second retention
bulb, so as to inflate it as shown. Accordingly, a tight fluid seal
will be formed between the walls 67 and 68 and both bulbs, which is
fluid-tight relative to both the inside of the stomach and the
abdominal cavity. The two walls are structurally embraced by the
two bulbs. Therefore, the gastrostomy tube is attached to the body
and prevents leakage from the stomach and from and into the
abdominal cavity. Plug 48 will be replaced in the closure means to
maintain the inflation. When it is removed, the fluid can escape,
and the second tubular bulb can collapse. To remove the device, the
stylet will again be inserted, and the first retention bulb
collapsed, as shown in FIG. 5, and the tube will be withdrawn while
the first retention bulb is collapsed. With the gastrostomy tube
installed, communication to the stomach may be made by opening the
first closure means to exhaust fluids or to supply them as
required.
The usage of FIG. 6 should be evident from the foregoing. In this
case, no endwise force is exerted on the first retention bulb. The
material of the first retention bulb will be sufficiently thin that
it will readily collapse to pass through the stab wound when
conduit 11 is passed through the stab wound. The installation is
made by inflating both retention bulbs in the same manner as the
second retention bulb was inflated in FIG. 2, and then the usage of
the device will be as described above. Removal of the device is
accomplished by pulling the plug 61 from its seat so that the first
retention bulb can be collapsed and the tube removed.
The device is preferably made entirely from medical grade silicone
rubber, because of the compatibility of this material with human
tissue and because of its elasticity and flexibility. The wall
thickness of the inflatable bulbs is sufficiently thin that it can
readily be stretched by fluid inserted therein, and the wall
thickness of both retention bulbs in FIG. 6 and the second
retention bulb in FIG. 1 may be on the order of 0.010 inch. The
wall thicknesses 29, 31 and 33 may be approximately .030, .020, and
.035 inch, respectively. The first retention bulb 25 will be of
sufficiently thick dimensions that it is inherently self-retaining
and is stiffly flexible.
This invention is not to be limited by the embodiments shown in the
drawings and described in the description, which are given by way
of example and not of limitation, but only in accordance with the
scope of the appended claims.
* * * * *