1 2
cuff just prior to intubation and keeping the cuff in the METHOD AND DEVICE FOR PERCUTANEOUS collapsed state during the intubation procedure. INTUBATION
SUMMARY OF THE INVENTION BACKGROUND OF THE INVENTION 5 These and other problems of the prior art are over
The present invention generally pertains to intubation come accordance with this invention by evacuating devices and more specifically to a method and a device the retention cuff of an illustrative multi-lumen gastrosfor intubating a stoma. tomy tube at a time prior to the intubation procedure,
A percutaneous endoscopic technique is known, as such as during manufacture or just prior to packaging described for example in U.S. Pat. No. 4,795,430, 10 rather than in the surgical suite, and applying an exterwhereby an illuminating fiber optic endoscope is in- nal retaining device to maintain the cuff in a collapsed serted into a patient's mouth and advanced into the state. The multi-lumen tube comprises a lumen for constomach. The stomach is then inflated with air and the veying fluids between a first and a second end of the position of the endoscope may be externally visualized tube and an inflation lumen having a port communicatby the illuminating tip of the endoscope. The abdominal 15 ing with the cuff. The lumens are sealed at the one end and gastric walls are then pierced at the position of the of the tube. The sealed end is tapered and includes an endoscope and a stoma thereby formed. In order to attached device such as a loop of suture or atraumatic intubate the stoma, one end of a suture thread is passed wire secured thereto for drawing the tube through the externally through the stoma, snared by the endoscope patient during the intubation procedure, and drawn upward through the stomach, esophagus and 20 The cuff is filled with a resilient sponge-like material out the mouth of the patient. The suture is then tied to which has the property of maintaining a compressed the end of a specially prepared catheter equipped with shape for an ascertainable period of time after having a length of suture to permit the catheter to be tied to the 5^,1 maintained in the compressed state for a predeterone end of the suture extending from the patient's mined time period. In one embodiment of the invention, mouth. The catheter is then intubated by pulling it in a 25 ^ cuff ^ maintained m a collapsed state by means of a retrograde manner through the mouth, esophagus, and removable retaining sleeve. Advantageously, the retainmtoithe stomach and through the stoma. m sleeve is hed when the cuff fa compressed or
The catheter described m the above-mentioned U.S. at the time Gf manufacture or packaging of the
^ ;u l' ^prises a mult-lumen enteral tube. Just prior to insertion of the tube in the patient, the feeding tube having a retention cuff near the distal end 30 . . *: . . j» _a «
6 „ .. . . . retaining sleeve is simply removed from the cuff with
thereof which serves as a retention member to prevent . 0 .. c. , r , . , . the tube from exiting the stoma. The retention cuff, °ut *e ^f58^ °f takmg the time dunng the procewhich is inflatable and deflatable through the inflation durf.t0 and evacuate the cuff. The cuff remains
lumen of the tube, is substantially filled with a resilient m the "lapsed state dunng the procedure because the sponge-like porous material for maintaining the cuff in 35 sponge-like material retains its compressed shape after fully inflated position. At the one end of the tube is an havmf ^en maintained in the compressed state for a elongated tapered sleeve which encloses the one end of Penod of tune Pnor to the intubation procedure. Upon the tube and passes the suture loop therethrough for use completion of the mtubation procedure, the tapered end in intubating the catheter. The sleeve includes a skirt Plece of the tube is severed, opening the inflation lumen portion which creates a seal about a side port of the tube 40 t0 ambient air, allowing for expansion of the cuff. The which permits air to escape from the inflation lumen but sponge-like material used in the cuff will preferably prevents the ingress of air into the inflation lumen. Prior have the property that it has a very low rate of expanto intubating the catheter into a patient, the surgeon or sion in air and a faster rate of expansion in a liquid. To gastroenterologist performing the procedure must enhance expansion of the cuff after intubation, sterilized squeeze the cuff to expel air out of the cuff through the 45 water is injected via the inflation lumen into the cuff, inflation lumen. After the tube has been positioned in causing more rapid expansion of the sponge-like matethe patient, a portion of the proximal end of the tube, nal
including the sleeve and skirt are cut off, exposing the It" a further advantage of this invention that the tube inflation lumen to ambient air and allowing air to enter may be sealed in manufacture without requiring a spethe retention cuff. 50 cially designed sleeve having a skirt portion to prevent
The sleeve device described in the prior art patent is ingress of air as taught by the prior art. intended to act as a one-way valve to allow the escape BRffiF DESCRIPTION OF ^ DRAWING
of air from the inflation lumen and to prevent the ingress of air into the inflation lumen. Typically, in order The invention may be better understood from the to obtain a more complete deflation of the cuff, a sy- 55 following detailed description when read with referringe is inserted in the inflation lumen to evacuate the ence to the drawings in which:
cuff and the inflation lumen. Steps must then be taken to FIG. 1 is a perspective view of a preferred embodiassure that the vacuum is retained when the syringe is ment of the invention;
removed from the inflation lumen. The skirt of the FIG. 2 is a longitudinal section taken along line 2—2 sleeve or another device is installed to seal the inflation 60 in FIG. 1;
lumen. Such evacuation steps are awkward and unnec- FIG. 3 is a vertical cross section taken along line 3—3 essarily prolong the intubation procedure. This proce- of FIG. 2; and
dure may also lead to repeated cuff evacuation steps. Of FIG. 4 is a perspective view of the device of FIG. 1
particular concern is the unexpected inflation of the with an expanded cuff.
retention cuff while in the esophagus. As a result, the 65 DETAILED DESCRIPTION
patient experiences unnecessary trauma and the possi
bility of an emergency surgical procedure. Thus, a spe- FIG. 1 shows a catheter 17 representing an illustracific problem of the prior art lies in the collapsing of the tive embodiment of the present invention and compris
