« PrécédentContinuer »
United States Patent 
 Patent Number: 5,057,091  Date of Patent: Oct. 15, 1991
 ENTERAL FEEDING TUBE WITH A
FLEXIBLE BOLUS AND FEEDING BOLUS
 Inventor: Erik Andersen, Vernon Hills, 111.
 Assignee: Corpak, Inc., Wheeling, 111.
 Appl. No.: 387,866
 Filed: Jul. 31, 1989
 Int. CI.5 A61M 31/00
 U.S. CI 604/270
 Field of Search 604/270, 275, 280, 283;
 References Cited
U.S. PATENT DOCUMENTS
1,899,781 2/1933 Twiss .
3,189,031 6/1965 Andersen 604/270
3,395,710 8/1968 Stratton et al 604/270
4,410,320 10/1983 Dykstra et al 604/270
4,490,143 12/1984 Quinn et al 604/270
4,594,074 6/1986 Andersen et al 604/270
4,610,673 9/1986 Russo 604/270
4,613,323 9/1986 Norton 604/270
4,654,036 3/1987 Tolkoff 604/270
4,778,455 10/1988 Kousai et al 604/270
4,781,704 11/1988 Potter 604/270
Primary Examiner—John D. Yasko
Assistant Examiner—Anthony Gutowski
Attorney, Agent, or Firm—Wallenstein, Wagner &
An enteral feeding tube adapted for transpyloric passage and duodenal intubation of a distal end of the feeding tube in a patient capable of peristaltic contractions of the stomach wall. A flexible bolus is located at the distal end of the feeding tube, which has a feeding bolus and connected thereto by a linking means. The flexible bolus is of such length, diameter and deformability to initiate peristaltic movement of the stomach wall. The linking means is of outer dimensions smaller than the outer dimensions of the flexible bolus and the feeding tube, and is of a length, diameter and deformability selected to initiate and maintain peristaltic contractions in the stomach walls around and behind the flexible bolus. The continued peristaltic contractions act upon the flexible bolus and linking means, thereby drawing the feeding bolus and distal end of the feeding tube through the pylorus to achieve duodenal intubation.
7 Claims, 2 Drawing Sheets
U.S. Patent Oct. is, 1991 sheet 1 of 2 5,057,091
ENTERAL FEEDING TUBE WITH A FLEXIBLE
BOLUS AND FEEDING BOLUS
TECHNICAL FIELD OF THE INVENTION 5
The present invention generally relates to the field of enteral therapy, and, in particular, to an improved enteral feeding tube to achieve transpyloric passage and, thereby, duodenal intubation.
BACKGROUND OF THE INVENTION
Enteral therapy is a method of nutritional support achieved typically through pre-pyloric intubation of a nasoenteric feeding tube. Tracheobronchial aspiration, which may lead to esophageal regurgitation, has been ^ recognized as a risk of intragastric or pre-pyloric tube feeding. Post-pyloric intubation of the enteral feeding tube has been identified as a means of reducing the risk of tracheobronchial aspiration and esophageal regurgitation. To effect post-pyloric or duodenal intubation, it 20 is necessary to obtain transpyloric passage of the distal end of the feeding tube. This may be achieved by endoscopy, fluoroscopy or x-ray techniques for uncooperative or comatose patients, or those patients having impaired peristaltic movement within the gastrointestinal 25 tract. Preferably, however, transpyloric passage is most safely achieved by use of peristaltic movement of the stomach walls to cause the distal end of the feeding tube to migrate through the pylorus.
A recent study has suggested that there is no advan- 30 tage in distally weighted feeding tubes as opposed to unweighted feeding tubes in achieving transpyloric passage and duodenal intubation. Levenson, R. et al., Do Weighted Nasoenteric Feeding Tubes Facilitate Duodenal Intubations?, Journal of Parenteral and En- 35 teral Nutrition, vol. 12, pp. 135-137 (1988). However, not only does this study use an unusually large, and therefore, stiff 10 Fr. tube, it also acknowledges that the effect of various weighted bolus designs on duodenal intubations was not evaluated. It is an object of the 40 present invention to develop a distally weighted feeding tube which maximizes use of peristaltic contractions to obtain a high incidence of successful transpyloric passage.
SUMMARY OF THE INVENTION 45
According to the present invention, an enteral feeding tube has been developed which is especially adapted for achieving passive duodenal intubation through use of peristaltic movement of the stomach walls. In all 50 embodiments of the present invention, a bolus is joined to a distal end of an enteral feeding tube by a linking means comprised of a length of flexible material of a diameter smaller than either the bolus or the feeding tube. The feeding tube is inserted through the patient's 55 nasal passages and is guided through the patient's stomach by the use of a stylet. Upon reaching the pylorus after passing through the stomach, intubation is stopped. Preferably, natural peristaltic movements of the stomach walls are utilized to obtain passage of the 60 bolus through the pylorus. Where peristalsis does not occur, such as after gastric surgery, endoscopy or fluoroscopy techniques may be utilized to achieve transpyloric passage.
The bolus and the linking means connecting the bolus 65 to the distal end of the feeding tube are also of such length, diameter and deformability to permit the peristaltic action of the stomach to act upon the bolus and
linking means to draw them through the pylorus. Due to the fine diameter and high deformability characteristics of the linking means, it is believed that peristaltic action responds to the bolus in the same manner as a free-floating independent mass. That is, the linking means enhances peristalsis by initiating and permitting contractions to continue behind the bolus to draw the bolus through the pylorus. Continued peristaltic action results in passage of the distal end of the feeding tube into the duodenum through the pylorus, whereby the feeding tube is placed in a position to allow nutritional fluid to flow directly into the duodenum through one or more openings in the distal end of the feeding tube. It is well known in the art that such post-pyloric feeding lessens the incidence of tracheobronchial aspiration and esophageal regurgitation.
In the preferred embodiment of the present invention, the bolus is weighted with a non-toxic mass, and the inside surface of the bolus is coated with a radiopaque material to make the bolus better appear on a fluoroscope or on x-rays. This radiopaque coating results in an improved ability to track the bolus as it is moved through the patient's gastrointestinal tract to more easily determine whether transpyloric passage of the bolus and the feeding tube have been successfully achieved.
In another embodiment of the present invention, the bolus and linking means are both hollow. This permits insertion of a stylet through the feeding tube, linking means and bolus to eliminate any pre-pyloric looping of the bolus and linking means, and allows passage of nutritional fluid into the duodenum through the distal end of the bolus from the feeding tube. This also obviates the need for the distal end of the feeding tube to pass through the pylorus.
Other advantages and aspects of the invention will become apparent upon making reference to the specification, claims, and drawings to follow.
BRIEF DESCRIPTION OF DRAWINGS
FIG. 1 discloses in a perspective view one embodiment of a distal end bolus for a feeding tube for duodenal intubation;
FIG. 2 discloses a sectional view taken along line 2—2 of FIG. 1;
FIG. 3 discloses in a perspective view another embodiment of the present invention;
FIG. 4 is an illustration depicting one stage of duodenal intubation in which the bolus has achieved transpyloric passage;
FIG. 5 discloses the progressive deformation of the linking means by peristaltic movement of the stomach and pylorus; and,
FIG. 6 discloses in a perspective view a further embodiment of the present invention.
DETAILED DESCRIPTION OF THE
While this invention is susceptible of embodiment in many different forms, there is shown in the drawings and will be described in detail, a preferred embodiment of the invention. The present disclosure is to be considered only as an exemplification of the principles of the invention and is not intended to limit the broad aspect of the invention to the embodiment illustrated.
Referring now to the drawings, FIG. 1 discloses an embodiment of the present invention which comprises an enteral feeding tube 10 preferably having, at its distal