WO2009141598A2

WO2009141598A2 - Medical apparatus

Info

Publication number: WO2009141598A2
Application number: PCT/GB2009/001247
Authority: WO
Inventors: Ifeoma Ebelechukwu Ikwueke
Original assignee: Ifeoma Ebelechukwu Ikwueke
Priority date: 2008-05-17
Filing date: 2009-05-18
Publication date: 2009-11-26
Also published as: GB2460091B; GB0808995D0; GB0817493D0; GB2459941A; WO2009141598A3; GB2459941B; GB2460091A

Abstract

Apparatus for the nasogastric intubation of a patient (100) comprising: a nasogastric tube (201 ); wherein a securing device (202) and a protecting device (204) are attached to the nasogastric tube (201 ). The securing device (202) is configurable between a first configuration in which it is small enough to pass through the nasal cavity (102) into the stomach (104) and a second configuration in which it functions to prevent the removal of the nasogastric tube from the stomach (104). The protecting device (204) is configurable between a first configuration in which it is small enough to pass through the nasal cavity (102) into the oesophagus (103) and a second configuration in which it functions to inhibit gastric contents passing through the oesophagus (103).

Description

Medical Apparatus

Cross Reference to Related Application

This application claims priority from United Kingdom Patent

Application No. 08 08 995.5, filed 1 7 May 2008, and from United Kingdom Patent Application No 08 17 493.0, filed 24 September 2008 the entire disclosure of which is incorporated herein by reference in its entirety.

Technical Field

The present invention relates to apparatus for the nasogastric intubation of a patient.

Background of the Invention

Nasogastric (NG) tubes are known and are currently in use throughout the world in hospitals and in health care settings. NG tubes are inserted through a patient's nose into the stomach and can be used to temporarily feed, or administer medicine, to a patient. A patient with an unsafe swallow could have a NG tube fitted to allow temporary feeding. An unsafe swallow is a condition that inhibits the normal swallowing reflexes that protect the respiratory system from aspiration, such conditions could be caused by a neurological condition, including a stroke, or by a muscular condition such as MND,

An NG tube can also be used on patients who are at risk of vomiting after surgery, the insertion of the NG tube causes a vacuum allowing any vomit to travel into a bag preventing the patient from aspiring gastric contents. However problems do arise from the use of current NG tubes, for example patients can easily pull out the NG tube. This carries a risk of the substance within the tube emptying into the respiratory system i.e. aspiration. This also causes problems in terms of cost, for example a new tube must be inserted and a trained individual must spend time fitting it, also clinical staff must spend time re-x-raγing patients in order to make sure that the tube is in the correct position. Another problem can arise if a patient vomits when a NG tube is fitted, the vomit can travel up the oesophagus into the pharynx or oral cavity which can lead to aspiration of the gastric contents.

Brief Summary of the Invention

According to an aspect of the present invention, there is provided apparatus for the nasogastric intubation of a patient comprising: a nasogastric tube; wherein a securing device and a protecting device are attached to said nasogastric tube; said securing device is configurable between a first configuration in which it is small enough to pass through the nasal cavity into the stomach and a second configuration in which it functions to prevent the removal of said nasogastric tube from the stomach; and said protecting device is configurable between a first configuration in which it is small enough to pass through the nasal cavity into the oesophagus and a second configuration in which it functions to inhibit gastric contents passing through the oesophagus.

According to a second aspect of the present invention, there is provided apparatus for the nasogastric intubation of a patient comprising: a nasogastric tube; and a securing device attached to said nasogastric tube; said securing device is configurable between a first configuration in which it is small enough to pass through the nasal cavity into the stomach and a second configuration in which it functions to prevent the removal of said nasogastric tube from said stomach; wherein said securing device is substantially umbrella- shaped when in said second configuration.

According to a third aspect of the present invention, there is provided apparatus for the nasogastric intubation of a patient comprising: a nasogastric tube; and a securing device attached to said nasogastric tube; said securing device is configurable between a first configuration in which it is small enough to pass through the nasal cavity into the stomach and a second configuration in which it functions to prevent the removal of said nasogastric tube from said stomach; wherein said securing device is further configurable from said second configuration into a third configuration, said third configuration allowing said securing device to pass from the stomach into the oesophagus.

Brief Description of the Several Views of the Drawings

Figure 1 shows an example of a nasogastric tube, in situ, according to the prior art;

Figure 2 shows a nasogastric tube according to the present invention;

Figure 3 shows a nasogastric tube, in situ, according to the present invention; Figure 4 shows the movement of a nasogastric tube, according to the present invention, in response to a patient pulling on the nasogastric tube;

Figure 5 shows the movement of a nasogastric tube from the position shown in Figure 4, after a patient has released the nasogastric tube;

Figure 6 illustrates further detail of a protecting device; Figure 7 shows a cross-sectional view of a protecting device; Figure 8 shows a top view of a protecting device; Figure 9 shows a nasogastric tube according to an alternative embodiment of the present invention;

Figure 1 0 shows a nasogastric tube as illustrated in Figure 9 in situ;

Figure 1 1 shows a nasogastric tube according to a further alternative embodiment of the present invention; Figure 1 2 shows a nasogastric tube according to a further alternative embodiment of the present invention; Figure 1 3 shows a nasogastric tube according to a further alternative embodiment of the present invention;

Figure 14 shows a nasogastric tube as illustrated in Figure 1 3 in situ; Figure 1 5 shows a nasogastric tube according to a further alternative embodiment of the present invention;

Figure 16 shows further detail of the nasogastric tube illustrated in Figure 1 5;

Figure 1 7 shows the movement of the nasogastric tube as illustrated in Figure 1 5, in situ, in response to a patient pulling on the nasogastric tube;

Figure 1 8 shows the configuration and location of the securing device as illustrated in Figure 1 5, in response to a patient repeatedly pulling on the nasogastric tube; Figure 1 9 shows a nasogastric tube according to a further alternative embodiment of the present invention; and

Figure 20 shows further detail of the nasogastric tube illustrated in Figure 1 9.

Description of the Best Mode for Carrying out the Invention Figure 1

An example of a nasogastric tube, in situ, according to the prior art is shown in Figure 1. Nasogastric (NG) tube 101 is inserted through nasal cavity 102, passed though oesophagus 103 and into the stomach 104 of patient 100; this is known as intubation of the nasogastric tube. It is then standard practice to tape the portion of the NG tube 101 left outside of a patients body, in place on the patients face at position 1 05. Holes 106 allow a substance to pass from the NG tube 101 into the stomach 1 04, this substance could be for example food or medicine. A metal tip 107 is present within NG tube 101 allowing the position of the NG tube 101 to be determined by x-raying the patient

100. Figure 2

A nasogastric (NG) tube 201 according to the present invention is shown in Figure 2. NG tube 201 has a diameter that is substantially narrower in the upper portion 208 when compared to the diameter of the lower portion 209. Open portion 205 of NG tube 201 allows substances, such as food, to pass into the NG tube 201 allowing feeding of a patient via the NG tube 201 . NG tube 201 also has an end portion 206 that sits in the stomach of a patient. Holes 1 06 are defined in portion 206 and allow a substance, such as food, to pass from the NG tube 201 into the stomach. Securing device 202 is attached to NG tube 201 and is positioned above the end portion 206. Protecting device 204 is attached to NG tube 201 and is positioned between securing device 202 and open portion 205. Second tube 203 runs within NG tube 201 , has an open portion 207 for receiving a fluid and attaches to both the protecting device 204 and the securing device

202.

After intubation of NG tube 201 securing device 202 is inflated, via second tube 203, with a fluid. After inflation, securing device 202 forms a substantially spherical shape, as illustrated in Figure 2. The securing device then sits in the stomach and in its inflated state functions to prevent removal of NG tube 201 . Protecting device 204 is also inflated, via second tube 203, with a fluid after intubation of the NG tube 201 . After inflation, protecting device 204 forms a substantially rigidised umbrella-like shape, as illustrated in Figure 2. The protecting device 204 then sits in the oesophagus, preferably above the lower oesophageal sphincter, and functions to inhibit the gastric contents, for example vomit, travelling outwards through the oesophagus of a patient. Securing device 202 and protecting device 203 will be described further with reference to later Figures. It is envisaged that a similar arrangement of apparatus may be used in other areas of the body. Figure 3

A NG tube 201 according to the present invention is shown in situ, in Figure 3. NG tube 201 is inserted through nasal cavity 102, passed though oesophagus 103 and into the stomach 104. It should be noted that during this process, securing device 202 and protecting device 204 are in a deflated state and are therefore small enough to pass through the nasal cavity 102 into the stomach 104, allowing intubation of NG tube 201 . The portion of the NG tube 201 that remains outside the body of the patient 1 00 is taped to the patient's face at position 105.

After intubation of NG tube 201 , both the securing device 202 and the protecting device 204 are inflated with a fluid via second tube 203. The securing device 202 sits in the stomach 104 of the patient 100 and the protecting device 204 sits in the oesophagus 103, preferably above the lower oesophageal sphincter, of the patient 100.

As described with reference to Figure 2, NG tube 201 has a diameter that is substantially narrower in the upper portion 208 when compared to the diameter of the lower portion 209. This allows increased comfort for patient 100 as the narrower portion 208 of NG tube 201 sits in the nasal cavity 102, pharynx and oral cavity of the patient 100, whereas, portion 209 of NG tube 201 is present in the oesophagus 103 and stomach 104 of patient 100.

After intubation of NG tube 201 and the inflation of protecting device 204 and securing device 202, NG tube 201 can be used in accordance with standard practice, for example to allow nasogastric feeding of the patient 100. Prior to removal of the NG tube 201 by a trained individual, the securing device 202 and the protecting device 204 should be deflated by removal of the fluid via second tube 203.

In an alternative embodiment, securing device 202 is inflated with a fluid via second tube 203. However protecting device 204 is inflated with a fluid via a third tube, which is concentric with NG tube 201 and second tube 203, forming a triple lumen. The third tube will be described further with reference to later Figures. In a further alternative embodiment, securing device 202 is inflated with fluid via a third tube and protecting device 204 is inflated with a fluid via second tube 203. Prior to removal of the NG tube 201 by a trained individual, the securing device 202 and the protecting device 204 should be deflated by removal of the fluid via the second tube 203 and the third tube respectively. It should be noted that the protecting device 204 is deflated first, followed by deflation of the securing device 202. This procedure is performed in order to ensure that mistakes are not made during removal of NG tube 201. For example, if the securing device

202 is deflated prior to deflation of the protecting device 204, it is possible that a trained individual may become interrupted during this procedure and forget to deflate the protecting device 204 before removing the NG tube 201. This could lead to damage being caused to patient 100.

Figure 4

The movement 401 of NG tube 201 in response to patient 1 00 pulling on the NG tube 201 is shown in Figure 4. As stated above, it is not desirable to allow a patient to remove a NG tube as in some cases this can lead to aspiration.

The presence of securing device 202 on NG tube 201 functions to prevent patient 1 00 from removing NG tube 201 . When NG tube 201 moves in direction 401 , securing device 202 also moves in direction 401 until it meets resistance at the lower oesophageal sphincter 402.

Once the securing device 202 pushes against this region the patient 1 00 will feel resistance and should stop pulling on NG tube 201 . When NG tube 201 moves in direction 401 protecting device 204 also moves in direction 401 until the patient 1 00 stops pulling on the NG tube 201 in response to the resistance felt at the lower oesophageal sphincter 402 as a result of securing device 202.

As previously stated, in the present embodiment of this invention, when securing device 202 is inflated it forms a substantially spherical shape and will not substantially deform. Securing device 202 should therefore not move through the lower oesophageal sphincter 402 into the oesophagus 103. In alternative embodiments, other forms of securing device are used that are configured to resist deformation and movement through the lower oesophageal sphincter 402 into the oesophagus 103.

In the present embodiment of this invention, protecting device 204 forms a substantially rigidised umbrella-like shape when inflated. The protecting device 204 sits in the oesophagus 103, preferably above the lower oesophageal sphincter 402 and functions to inhibit gastric contents, for example vomit, passing through the oesophagus 103. Due to its rigidity and shape, protecting device 204 does not deform as a result of movement in direction 401. In alternative embodiments, other forms of protecting device are used that are configured to resist deformation in response to movement through the oesophagus 103 in direction 401.

Figure 5 The movement 501 of NG tube 201 after patient 1 00 has released NG tube 201 is shown in Figure 5. The weight of securing device 202 and gravity causes the securing device 202 to move in direction 501 , this in turn pulls NG tube 201 in direction 501 . As protecting device 204 is also attached to NG tube 201 , it also moves in direction 501 . The rigidity and the substantially umbrella-like shape of protecting device 204, resists deformation as a result of movement in direction 501 .

The NG tube 201 can now continue to be used in accordance with standard practice as a result of the securing device 202 preventing its removal by patient 1 00. Figure 6

Further detail of protecting device 204 is illustrated in Figure 6.

Protecting device 204 is shown in its inflated state, i.e. after inflation with a fluid via second tube 203, and forms a substantially rigidised umbrella-like shape. The protecting device 204 also comprises valve means 601 arranged to allow any saliva travelling down the oesophagus, to pass through the protecting device 204 into the stomach. However valve means 601 is also arranged to inhibit gastric contents, for example vomit, from passing through the oesophagus. In the present embodiment of the invention the valve means 601 could be in the form of a one-way valve.

In alternative embodiments, other forms of a valve are used that are configured to allow saliva to pass through the protecting device 204 into the stomach, and inhibit gastric contents such as vomit passing through the oesophagus.

Figure 7

A cross-sectional view of protecting device 204 is shown in

Figure .7. Protecting device 204 has been inflated with a fluid via the second tube causing it to form a rigidised umbrella-like shape. Regions such as regions 701 , 702 and 703 are filled with fluid resulting in the inflation of the protecting device 204.

Figure 8 A top view of protecting device 204 is shown in Figure 8. The regions 701 , 702 and 703, as well as further regions 801 , 802, 803, 804 and 805 of the protecting device can be seen from above. Valve means such as valve means 601 is present on each region allowing saliva to pass through protecting device into the stomach but also functioning to inhibit gastric contents such as vomit travelling outwards past the oesophagus. Protecting device 204 is attached to NG tube 201 and NG tube 201 has second tube 203 running within it. In an alternative embodiment, NG tube 201 has second tube 203 and a third tube 806 running within it, each of these three tubes are concentric with each other and form a triple lumen. The securing device is inflated with a fluid via second tube 203 and the protecting device 204 is inflated with a fluid via a third tube 806 or vice versa. NG tube 201 allows a substance such as food or medicine to be administered to a patient.

In further alternative embodiments, any of the tubes 201 , 203 or

806 can be used for any combination of functions described above. For example, any one of the tubes may be used to administer a substance to a patient, any one tube may be used to inflate the securing device and any one tube may be used to inflate the protecting device 204.

Figure 9 A NG tube 901 according to an alternative embodiment is shown in Figure 9. NG tube 901 has a diameter that is substantially narrower in the upper portion 908 when compared to the diameter of the lower portion 909. Open portion 905 of NG tube 901 allows substances, such as food, to pass into the NG tube 901 allowing feeding of a patient via the NG tube 901 . NG tube 901 also has an end portion 906 that sits in the stomach of a patient. Holes 1 06 are defined in portion 906 and allow a substance, such as food, to pass from the NG tube 901 into the stomach. Securing device 902 is attached to NG tube 901 and is positioned above the end portion 906. Protecting device 904 is attached to NG tube 901 and is positioned between securing device 902 and open portion 905. Second tube 903 runs within NG tube 901 , has an open portion 907 for receiving a fluid and attaches to both the protecting device 904 and the securing device 902. After intubation of NG tube 901 securing device 902 is inflated, via second tube 903, with a fluid. After inflation, securing device 902 forms a substantially rigidised umbrella-like shape. The securing device then sits in the stomach and in its inflated state functions to prevent removal of NG tube 901. Protecting device 904 is also inflated, via second tube 903, with a fluid after intubation of the NG tube 901. After inflation, protecting device 904 also forms a substantially rigidised umbrella-like shape. The protecting device 904 then sits in the oesophagus, preferably above the lower oesophageal sphincter and functions to inhibit the gastric contents, for example vomit, travelling outwards through the oesophagus of a patient.

It is envisaged that a similar arrangement of apparatus may be used in other areas of the body.

Figure 10

NG tube 901 is shown in situ, in Figure 10. NG tube 901 is inserted through nasal cavity 102, passed though oesophagus 103 and into the stomach 104. It should be noted that during this process, securing device 902 and protecting device 904 are in a deflated state and are therefore small enough to pass through the nasal cavity 102 into the stomach 1 04, allowing intubation of NG tube 901 . The portion of the NG tube 901 that remains outside the body of the patient 100 is tapped to the patient's face at position 105.

After intubation of NG tube 901 , both the securing device 902 and the protecting device 904 are inflated with a fluid via second tube 903. The securing device 902 sits in the stomach 104 of the patient 100 and the protecting device 904 sits in the oesophagus 103, preferably above the lower oesophageal sphincter, of the patient 100.

As described with reference to Figure 9, NG tube 901 has a diameter that is substantially narrower in the upper portion 908 when compared to the diameter of the lower portion 909. This allows increased comfort for patient 100 as the narrower portion 908 of NG tube 901 sits in the nasal cavity 102, pharynx and oral cavity of the patient 100, whereas, portion 909 of NG tube 901 is present in the oesophagus 103 and stomach 104 of patient 100. After intubation of NG tube 901 and the inflation of protecting device 904 and securing device 902, NG tube 901 can be used in accordance with standard practice, for example to allow nasogastric feeding of the patient 1 00. Prior to removal of NG tube 901 by a trained individual, the securing device 902 and the protecting device

904 should be deflated by removal of the fluid via second tube 903.

In a further alternative embodiment, securing device 902 is inflated with a fluid via second tube 903. However, protecting device 904 is inflated with a fluid via a third tube, which is concentric with NG tube 901 and second tube 903, forming a triple lumen. In a further alternative embodiment, securing device 902 is inflated with fluid via the third tube and protecting device 904 is inflated with a fluid via second tube 903. Prior to removal of the NG tube 901 by a trained individual the securing device 902 and the protecting device 904 should be deflated by removal of the fluid via the second tube 903 and the third tube respectively. It should be noted that the protecting device 904 is deflated first, followed by deflation of the securing device 902. This procedure is performed in order to ensure that mistakes are not made during removal of NG tube 901 . For example, if the securing device 902 is deflated prior to deflation of the protecting device 904, it is possible that a trained individual may become interrupted during this procedure and forget to deflate the protecting device 904 before removing the NG tube 901 . This could lead to damage being caused to patient 100. In further alternative embodiments, any of the tubes 901 , 903 or a third tube, described with reference to Figure 8, can be used for any combination of functions described above. For example, any one of the tubes may be used to administer a substance to patient 1 (30, any one tube may be used to inflate securing device 902 and any one tube may be used to inflate the protecting device 904. Figure 11

A NG tube 1101 according to an alternative embodiment is shown in Figure 11. NG tube 1101 has a diameter that is substantially narrower in the upper portion 1108 when compared to the diameter of the lower portion 1109. Open portion 1105 of NG tube 1101 allows substances, such as food, to pass into the NG tube 1101 allowing feeding of a patient via the NG tube 1101. NG tube 1101 also has an end portion 1106 that sits in the stomach of a patient. Holes 106 are defined in portion 1106 and allow a substance, such as food, to pass from the NG tube 1101 into the stomach. Securing device 1102 is attached to NG tube 1101 and is positioned above the end portion 1106. Protecting device 1104 is attached to NG tube 1101 and is positioned between securing device 1102 and open portion 1105. Second tube 1103 runs within NG tube 1101, has an open portion 1107 for receiving a fluid and attaches to both the protecting device

1104 and the securing device 1102.

After intubation of NG tube 1101 securing device 1102 is inflated, via second tube 1103, with a fluid. After inflation, securing device 1102 forms a substantially rigidised umbrella-like shape. The securing device then sits in the stomach and in its inflated state functions to prevent removal of NG tube 1101. Protecting device 1104 is also inflated, via second tube 1103, with a fluid after intubation of the NG tube 1101. After inflation, protecting device 1104 forms a substantially spherical shape. The protecting device 1104 then sits in the oesophagus, preferably above the lower oesophageal sphincter and functions to inhibit the gastric contents, for example vomit, travelling outwards through the oesophagus of a patient.

In an alternative embodiment, NG tube 1101 has second tube 1103 and a third tube running within it, each of these three tubes are concentric with each other and form a triple lumen. Securing device

1102 is inflated with a fluid via second tube 1103 and protecting device 1104 is inflated with a fluid via a third tube or vice versa. NG tube 1 101 allows a substance such as food or medicine to be administered to patient.

In further alternative embodiments, any of the tubes 1 101 , 1 103 or a third tube, described with reference to Figure 8, can be used for any combination of functions described above. For example, any one of the tubes may be used to administer a substance to patient, any one tube may be used to inflate securing device 1 102 and any one tube may be used to inflate the protecting device 1 104.

Figure 12

A NG tube 1201 according to an alternative embodiment is shown in Figure 1 2. NG tube 1201 has a diameter that is substantially narrower in the upper portion 1 208 when compared to the diameter of the lower portion 1209. Open portion 1 205 of NG tube 1 201 allows substances, such as food, to pass into the NG tube 1 201 allowing feeding of a patient via the NG tube 1201 . NG tube 1201 also has an end portion 1206 that sits in the stomach of a patient. Holes 106 are defined in portion 1206 and allow a substance, such as food, to pass from the NG tube 1 201 into the stomach. Securing device 1 202 is attached to NG tube 1201 and is positioned above the end portion 1206. Protecting device 1 204 is attached to NG tube 1 201 and is positioned between securing device 1202 and open portion 1 205. Second tube 1 203 runs within NG tube 1201 , has an open portion

1207 for receiving a fluid and attaches to both the protecting device 1 204 and the securing device 1202.

After intubation of NG tube 1 201 securing device 1 202 is inflated, via second tube 1 203, with a fluid. After inflation securing device 1202 forms a substantially spherical shape. The securing device 1202 then sits in the stomach and in its inflated state functions to prevent removal of NG tube 1 201 . Protecting device 1204 is also inflated, via second tube 1203, with a fluid after intubation of the NG tube 1 201 . After inflation, protecting device 1204 also forms a substantially spherical shape. The protecting device 1 204 then sits in the oesophagus, preferably above the lower oesophageal sphincter and functions to inhibit the gastric contents, for example vomit, travelling outwards through the oesophagus of a patient.

In an alternative embodiment, NG tube 1201 has second tube 1203 and a third tube running within it, each of these three tubes are concentric with each other and form a triple lumen. Securing device 1 202 is inflated with a fluid via second tube 1203 and protecting device 1 204 is inflated with a fluid via a third tube or vice versa. NG tube 1201 allows a substance such as food or medicine to be administered to patient.

In further alternative embodiments, any of the tubes 1 201 , 1203 or a third tube, described with reference to Figure 8, can be used for any combination of functions described above. For example, any one of the tubes may be used to administer a substance to patient, any one tube may be used to inflate securing device 1 202 and any one tube may be used to inflate the protecting device 1 204. It is envisaged that a similar arrangement of apparatus may be used in other areas of the body.

Figure 13

A NG tube 1 301 according to a further alternative embodiment is shown in Figure 13. NG tube 1 301 has a diameter that is substantially narrower in the upper portion 1 308 when compared to the diameter of the lower portion 1 309. Open portion 1 305 allows substances, such as food, to pass into the NG tube 1 301 allowing feeding of a patient via the NG tube 1 301 . NG tube 1 301 also has an end portion 1 306 that sits in the stomach of a patient. Holes 106 are defined in portion 1 306 and allow a substance, such as food, to pass from the NG tube 1 301 into the stomach. Securing device 1 302 is attached to NG tube 1301 and is positioned above the end portion 1 306. Second tube 1 303 runs within NG tube 1301 , has an open portion 1 307 for receiving a fluid and attaches to the securing device 1302. After intubation of NG tube 1301 securing device 1 302 is inflated, via second tube 1303, with a fluid. After inflation securing device 1302 forms a substantially rigidised umbrella-like shape. The securing device then sits in the stomach and in its inflated state functions to prevent removal of NG tube 1 301 . It is envisaged that a similar arrangement of apparatus may be used in other areas of the body.

Figure 14

A NG tube 1 301 is shown in situ, in Figure 1 4. NG tube 1 301 is inserted through nasal cavity 1 02, passed though oesophagus 1 03 and into the stomach 1 04. It should be noted that during this process securing device 1 302 is in a deflated state and is therefore small enough to pass through the nasal cavity 1 02 into the stomach 1 04, allowing intubation of NG tube 1 301 . The portion of the NG tube 1 301 that remains outside the body of the patient 1 00 is then tapped to the patient's face at position 1 05.

After intubation of NG tube 1 301 , the securing device 1 302 is inflated with a fluid via second tube 1 303 and sits in the stomach 1 04 of the patient 1 00. As described with reference to Figure 1 3, NG tube 1 301 has a diameter that is substantially narrower in the upper portion

1 308 when compared to the diameter of the lower portion 1 309. This allows increased comfort for patient 1 00 as the narrower portion 1 308 of NG tube 1 301 sits in the nasal cavity 1 02, pharynx and oral cavity of the patient 1 00, whereas, portion 1 309 of NG tube 1 301 is present in the oesophagus 1 03 and stomach 1 04 of patient 1 00.

After intubation of NG tube 1 301 and the inflation of securing device 1 302, NG tube 1 301 can be used in accordance with standard practice for example, to allow nasogastric feeding of the patient. Prior to removal of the tube by a trained individual, the securing device 1 302 should be deflated by removal of the fluid via second tube 1 303.

In further alternative embodiments, any of tubes 1 301 and 1 303 can be used for any combination of functions described above. For example any one of the tubes may be used to administer a substance to the patient 100 and any one tube may be used to inflate securing device 1 202.

Figure 15

A NG tube 1 501 according to an alternative embodiment is shown in Figure 1 5. NG tube 1 501 has a diameter that is substantially narrower in the upper portion 1 508 when compared to the diameter of the lower portion 1 509. NG tube 1 501 has an open portion 1 505 for receiving a substance such as a fluid and an end portion 1 506 that sits in the stomach of a patient. Holes 1 06 are defined in portion 1 506 and allow a substance, such as food, to pass from the NG tube 1 501 into the stomach. Securing device 1 502 is attached to NG tube 1 501 and is positioned above the end portion 1 506. Securing device 1 502 has a substantially thin membrane present at both the proximal 1 51 1 and distal 1 51 2 ends of securing device 1 502. Securing device 1 502 also comprises a securing lumen 1 51 3 that extends away from securing device 1 502 at both the proximal 1 51 1 and distal 1 51 2 ends. When securing lumen 1 51 3 is in a deflated state as illustrated in the present Figure, it adheres to the contours of NG tube 1 501 .

NG tube 1 501 has a second tube 1 503 running concentrically within it. Second tube 1 503 has also has an open portion 1 507 for receiving a substance such as a fluid and runs the length of NG tube 1 501 until it reaches end portion 1 506. Securing device 1 502 is inflated with a fluid via NG tube 1 501 . A substance such as food or medicine is administered to a patient via second tube 1 503, the substance then being released into the patients stomach via holes 1 06 of end portion 1 506.

After intubation of NG tube 1 501 securing device 1502 is inflated, via NG tube 1 501 , with a fluid. After inflation, securing device

1 502 forms a substantially spherical shape. The securing device 1 502 then sits in the stomach and in its inflated state functions to prevent removal of NG tube 1 501 .

Figure 16

Further detail of securing device 1 502 is shown in Figure 16. As previously illustrated in Figure 1 5 securing device 1 502 forms a substantially spherical shape when in an inflated configuration, thus preventing the removal of NG tube 1 501 . Securing device 1 502 also comprises a substantially thin membrane present at both its proximal

1 51 1 and distal 1 512 ends as well as a securing lumen that extends away from securing device 1 502 at both the proximal 1 51 1 and distal

1 512 ends.

Figure 16 illustrates the altered configuration of securing device 1 502 in response to the rupture of the substantially thin membranes present at the proximal 1 51 1 and distal 1 512 ends, this process will be described further with reference to Figures 1 7 and 1 8. As the substantially thin membranes rupture the securing lumen is inflated as the fluid leaks from the ruptured membranes of securing device 1 502. This alters the shape of securing device 1 502 providing a substantially oblong shape 1601 .

Figure 17

The movement 1701 of NG tube 1 501 in response to patient 100 pulling on NG tube 1 501 is shown in Figure 1 7. As stated above, it is not desirable to allow a patient to remove an NG tube as in some cases this can lead to aspiration. The presence of securing device 1 502 on 2009/001247

19

NG tube 1 501 functions to prevent patient 100 from removing NG tube 1 501 . When NG tube 1 501 moves in direction 1701 , securing device 1 502 also moves in direction 1701 until it meets resistance at the lower oesophageal sphincter 402. Once the securing device 1502 pushes against this region the patient 100 will feel resistance and should stop pulling on NG tube 1501. However, if a patient continues to repeatedly pull upon NG tube 1501 causing securing device 1 502 to meet resistance at the lower oesophageal sphincter 402, the substantially thin membranes of securing device 1 502 will rupture, as previously described in Figure 16. This causes securing device 1 502 to form a substantially oblong shape allowing securing device 1 502 to move through the lower oesophageal sphincter 402 and sit in the oesophagus 103, reducing the pressure against the lower oesophageal sphincter 402. This will be described further with reference to Figure 18.

Figure J 8

The movement of securing device 1 502 into the oesophagus in response to a patient repeatedly pulling on NG tube 1 501 is shown in Figure 1 8. If a patient repeatedly pulls upon NG tube 1 501 securing device 1 502 will meet resistance at the lower oesophageal sphincter 402, which could cause damage to the lower oesophagus. In order to prevent damage to this area, but at the same time preventing a patient from removing NG tube 1 501 , securing device 1 502 moves through the lower oesophageal sphincter 402 into the oesophagus 103. This occurs as the substantially thin membranes present at the proximal and distal ends of securing device 1 502, rupture in response to the pressure caused by securing device 1 502 being pulled against the lower oesophageal sphincter 402. As the substantially thin membranes rupture the securing lumen is inflated as the fluid leaks from the ruptured membranes of securing device 1 502. This alters the shape of securing device 1 502 providing a substantially oblong shape 1601 . The securing device sits in the oesophagus 103 until such time as the device can be changed.

Figure 19 A NG tube 1 901 according to an alternative embodiment is shown in Figure 1 9. NC tube 1901 has a diameter that is substantially narrower in the upper portion 1 908 when compared to the diameter of the lower portion 1 909. NG tube 1901 has an open portion 1 905 for receiving a substance such as a fluid and an end portion 1 906 that sits in the stomach of a patient. Holes 106 are defined in portion 1 906 and allow a substance, such as food, to pass from the NG tube 1 901 into the stomach. Securing device 1902 is attached to NG tube 1 901 and is positioned above the end portion 1 906. Protecting device 1 904 is attached to NG tube 1 901 and is positioned between securing device 1 902 and open portion 1 905. Securing device 1 902 has a substantially thin membrane present at both the proximal 1 91 1 and distal 1 91 2 end of securing device 1 902. Securing device 1 902 also comprises a securing lumen 1 91 3 that extends away from securing device 1 902 at both the proximal 1 91 1 and distal 1 91 2 ends. When securing lumen 1 91 3 is in a deflated state as illustrated in the present Figure, it adheres to the contours of NG tube 1 901 .

NG tube 1 901 has a second tube 1 903 and a third tube 1 910 running within it, each of these three tubes are concentric with each other and form a triple lumen. Second tube 1 903 has an open portion 1 907 for receiving a substance such as a fluid and attaches to protecting device 1 904. Third tube 1910 has also has an open portion 1 914 for receiving a substance such as a fluid and runs the length of NG tube 1 901 until it reaches end portion 1 906. Securing device 1 902 is inflated with a fluid via NG tube 1901 and protecting device 1904 is inflated with a fluid via second tube 1903. A substance such as food or medicine is administered to a patient via third tube 1910, the substance then being released into the patients stomach via holes 106 of end portion 1 906.

In alternative embodiments, any of the tubes 1 901 , 1 903 or

1910 can be used for any combination of functions described above.

For example, any one of the tubes may be used to administer a substance to patient, any one tube may be used to inflate securing device 1 902 and any one tube may be used to inflate the protecting device 1 904.

After intubation of NG tube 1 901 securing device 1 902 is inflated, via NG tube 1 901 , with a fluid. After inflation, securing device 1902 forms a substantially spherical shape. The securing device 1902 then sits in the stomach and in its inflated state functions to prevent removal of NG tube 1 901 . Protecting device 1 904 is also inflated, via second tube 1 903, with a fluid after intubation of the NG tube 1901 .

After inflation, protecting device 1 904 forms a substantially rigidised umbrella-like shape. The protecting device 1 904 then sits in the oesophagus, preferably above the lower oesophageal sphincter and functions to inhibit the gastric contents, for example vomit, travelling outwards through the oesophagus of a patient. It is envisaged that protecting device 1 904 may form other configurations such as a the substantially spherical shape described with reference to previous

Figures.

Figure 20

Figure 20 illustrates the altered configuration of securing device 1902 in response to the rupture of the substantially thin membranes present at the proximal 1 91 1 and distal 1 91 2 ends of securing device 1 902. As the substantially thin membranes rupture the securing lumen is inflated as the fluid leaks from the ruptured membranes of securing device 1 902. This alters the shape of securing device 1 902 providing a substantially oblong shape 2001 .

Claims

1 . Apparatus for the nasogastric intubation of a patient comprising: a nasogastric tube; wherein a securing device and a protecting device are attached to said nasogastric tube; said securing device is configurable between a first configuration in which it is small enough to pass through the nasal cavity into the stomach and a second configuration in which it functions to prevent the removal of said nasogastric tube from the stomach; and said protecting device is configurable between a first configuration in which it is small enough to pass through the nasal cavity into the oesophagus and a second configuration in which it functions to inhibit gastric contents passing through the oesophagus.

2. Apparatus according to claim 1 , wherein said securing device is arranged to move from said first configuration to said second configuration by inflation with a fluid.

3. Apparatus according to claim 1 or claim 2, wherein said protecting device is arranged to move from said first configuration to said second configuration by inflation with a fluid.

4. Apparatus according to any of claims 1 to 3, wherein said securing device is substantially spherical in shape when in said second configuration.

5. Apparatus according to any of claims 1 to 3, wherein said securing device is substantially umbrella shaped when in said second configuration.

6. Apparatus according to any of claims 1 to 5, wherein said protecting device is substantially spherical in shape when in said second configuration.

7. Apparatus according to any of claims 1 to 5, wherein said protecting device is substantially umbrella shaped when in said second configuration.

8. Apparatus according to claim 1 , wherein said nasogastric tube comprises an upper portion and a lower portion; said upper portion being substantially narrower in diameter than said lower portion.

9. Apparatus according to claim 1 , wherein said protecting device comprises valve means; said valve means arranged to allow saliva to pass through said protecting means into the stomach, and to inhibit gastric contents passing through the oesophagus.

1 0. Apparatus according to claim 9, wherein said valve means comprises at least one one-way valve.

1 1 . Apparatus according to any of claims 1 to 1 0, wherein said securing device is arranged to move from said first configuration to said second configuration by inflation with a fluid, and said apparatus further comprises a second tube, concentric with said nasogastric tube, arranged to carry a fluid to said securing device for inflating said securing device.

1 2. Apparatus according to any of claims 1 to 1 0, wherein said securing device is arranged to move from said first configuration to said second configuration by inflation with a fluid, and said apparatus further comprises a third tube, concentric with said nasogastric tube and said second tube, arranged to carry a fluid to said securing device for inflating said securing device.

1 3. Apparatus according to any of claims 1 to 12, wherein said protecting device is arranged to move from said first configuration to said second configuration by inflation with a fluid, and said apparatus further comprises a second tube, concentric with said nasogastric tube, arranged to carry a fluid to said protecting device for inflating said protecting device.

1 4. Apparatus according to any of claims 1 to 1 2, wherein said protecting device is arranged to move from said first configuration to said second configuration by inflation with a fluid, and said apparatus further comprises a third tube, concentric with said nasogastric tube and said second tube, arranged to carry a fluid to said protecting device for inflating said protecting device.

1 5. Apparatus according to any preceding claim, wherein said securing device and said protecting device are arranged to move from said first configuration to said second configuration by inflation with a fluid, and said apparatus further comprises a second tube, concentric with said nasogastric tube, arranged to carry a fluid to said securing device and said protecting device for inflating said securing device and said protecting device.

1 6. Apparatus for the nasogastric intubation of a patient comprising: a nasogastric tube; and a securing device attached to said nasogastric tube; said securing device is configurable between a first configuration in which it is small enough to pass through the nasal cavity into the stomach and a second configuration in which it functions to prevent the removal of said nasogastric tube from said stomach; wherein said securing device is substantially umbrella- shaped when in said second configuration.

1 7. Apparatus according to claim 16, wherein said securing device is arranged to move from said first configuration to said second configuration by inflation with a fluid.

18. Apparatus according to claim 1 7, wherein said apparatus further comprises a second tube, concentric with said nasogastric tube, arranged to carry a fluid to said securing device for inflating said securing device.

19. Apparatus for the nasogastric intubation of a patient comprising: a nasogastric tube; and a securing device attached to said nasogastric tube; said securing device is configurable between a first configuration in which it is small enough to pass through the nasal cavity into the stomach and a second configuration in which it functions to prevent the removal of said nasogastric tube from said stomach; wherein said securing device is further configurable from said second configuration into a third configuration, said third configuration allowing said securing device to pass from the stomach into the oesophagus.

20. Apparatus according to claim 19, wherein said securing device is arranged to move from said first configuration to said second configuration by inflation with a fluid.

21. Apparatus according to claim 19, wherein said securing device further comprises a substantially thin membrane positioned at the proximal and distal ends of said securing device.

22. Apparatus according to claim 21 , wherein said securing device further comprises a securing lumen, and said securing lumen extends away from said securing device at said proximal and said distal ends of said securing device.

23. Apparatus according to claim 22, wherein when said securing lumen adheres to the contours of said nasogastric tube when in a deflated state.

24. Apparatus according to claims 19 to 23, wherein said securing device is arranged to move from said second configuration to said third configuration in response to the rupture of said substantially thin membrane, whereby a fluid passes through said ruptured membrane inflating said securing lumen.

25. Apparatus according to claim 24, wherein said substantially thin membrane is ruptured in response to a patient repeatedly pulling upon said nasogastric tube, whereby said securing device meets resistance and the lower oesophageal sphincter increasing the pressure upon said securing device.

26. Apparatus according to claim 19, wherein said securing device is substantially spherical in shape when in said second configuration.

27. Apparatus according to claim 19, wherein said securing device is substantially oblong in shape when in said third configuration.

28. Apparatus according to any of claims 19 to 27, further comprising a protecting device configurable between a first configuration in which it is small enough to pass through the nasal cavity into the oesophagus and a second configuration in which it functions to inhibit gastric contents passing through the oesophagus.

29. Apparatus according to claim 28, wherein said protecting device is arranged to move from said first configuration to said second configuration by inflation with a fluid.

30. Apparatus according to claim 28 or claim 29 wherein said protecting device is substantially spherical in shape when in said second configuration.

31 . Apparatus according to claim 28 or claim 29, wherein said protecting device is substantially umbrella shaped when in said second configuration.

32. Apparatus according to claim 1 9, wherein said nasogastric tube comprises an upper portion and a lower portion; said upper portion being substantially narrower in diameter than said lower portion.

33. Apparatus for the nasogastric intubation of a patient substantially as herein described with reference to the accompanying Figures.