OPTICALLY GUIDED FEEDING TUBE, CATHETERS AND ASSOCIATED METHODS

• US 20100305503A1
• Filed: 04/07/2010
• Published: 12/02/2010
• Est. Priority Date: 04/09/2009
• Status: Active Grant

• Current Assignee: University of Utah Research Foundation (State of Utah)
• Original Assignee: University of Utah (State of Utah)
• Inventors: Fang, John, Adams, Mark, Richins, Brett, McCreedy, Dylan, Nieman, Tim, Gallano, Omar, Andrus, Shawn
• Granted Patent: US 8,361,041 B2
• Time in Patent Office: Days
• US Class Current: 604/96.01
• CPC Class Codes: A61B 1/00045 Display arrangement
• CPC Class Codes: A61B 1/00082 Balloons
• CPC Class Codes: A61B 1/00165 with light-conductive means, e.g. fibre optics A61B1/07 takes precedence
• CPC Class Codes: A61B 1/015 Control of fluid supply or evacuation
• CPC Class Codes: A61B 1/042 characterised by a proximal camera, e.g. a CCD camera
• CPC Class Codes: A61B 1/06 with illuminating arrangements
• CPC Class Codes: A61B 1/07 using light-conductive means, e.g. optical fibres
• CPC Class Codes: A61B 1/273 for the upper alimentary canal, e.g. oesophagoscopes, gastroscopes
• CPC Class Codes: A61B 1/2733 Oesophagoscopes
• CPC Class Codes: A61B 1/2736 Gastroscopes
• CPC Class Codes: A61J 15/0003 Nasal or oral feeding-tubes, e.g. tube entering body through nose or mouth
• CPC Class Codes: A61J 15/0007 inserted by using a guide-wire guide wires A61M25/09
• CPC Class Codes: A61J 15/0015 Gastrostomy feeding-tubes insertion tools or methods A61B17/34
• CPC Class Codes: A61J 15/0046 Expandable retainers inside body lumens of the enteral tract, e.g. fixing by radially contacting a lumen wall
• CPC Class Codes: A61J 15/0049 Inflatable Balloons balloon catheters A61M25/10
• CPC Class Codes: A61J 15/0069 Tubes feeding directly to the intestines, e.g. to the jejunum
• CPC Class Codes: A61J 15/0073 Multi-lumen tubes
• CPC Class Codes: A61M 25/01 Introducing, guiding, advancing, emplacing or holding catheters A61M25/10 takes precedence
• CPC Class Codes: A61M 25/0147 with movable mechanical means, e.g. pull wires

Abstract

The present invention provides devices and methods for safe, easy and cost effective means of placing and verifying proper placement of nasogastric and nasoenteric feeding tubes. Specifically, an integrated feeding device including a tube operable to deliver a nutritional and/or medicinal substance to the gastrointestinal tract, an optical system including a light source, flexible optical fibers or a camera, and a lens, and a steering system is disclosed. The components of the system, namely the optical system and the steering system, may be integrated into the tube.

Claims

1. A feeding tube comprising:

an elongate body having a distal end and one lumen having an opening through the distal end, the lumen configured for passing a feeding solution therethrough,

an optical system disposed within the body comprising a lighting structure for lighting tissue adjacent the distal end and an image transmitting structure for conveying images of tissue adjacent the distal end.

2. The feeding tube of claim 1, wherein the optical system comprises a camera.

3. The feeding tube of claim 1, wherein the optical system comprises a plurality of fiber optic fibers and a lens attached to the fiber optic fibers.

4. The feeding tube of claim 1, wherein the lumen having the optical system has an open distal end.

5. The feeding tube of claim 4, wherein the elongate body has a lumen having the optical system disposed therein, the optical system having a lens which is disposed within the lumen and wherein the lumen further comprises a fluid/air port disposed adjacent the lens for rinsing the lens.

6. The feeding tube of claim 5, wherein the lumen having the optical system further comprises bonding agent adjacent the distal end of the optical system so as to form the fluid port.

7. The feeding tube of claim 5, further comprising a deflecting projection disposed adjacent the lens for directing fluid flow over the lens.

8. The feeding tube claim 5, wherein the distal end of the optical system is deflected toward a central long axis of the feeding tube.

9. The feeding tube of claim 8, wherein the distal end of the optical system is deflected between 5 and 40 degrees.

10. The feeding tube of claim 9, wherein the distal end of the optical system is deflected between 15 and 25 degrees.

11. The feeding tube of claim 1, further comprising an anchoring device disposed adjacent the distal end of the feeding tube for anchoring the feeding tube in the gastrointestinal tract.

12. The feeding tube of claim 11, wherein the anchoring device comprises a multi-lobe balloon.

13. The feeding tube of claim 11, wherein the anchoring device comprises a stent attached to the distal end of the feeding tube.

14. The feeding tube of claim 11, wherein the anchoring device is a coil.

15. The feeding tube of claim 1, wherein the elongate body has an outer wall and wherein the optical system is formed into the outerwall.

16. A feeding tube placement system comprising a feeding tube of claim 1, and further comprising:

a control unit comprising a light source configured for disposal in communication with the optical system in the feeding tube, and an image rendering device configured for disposal in communication with a portion of the optical system for receiving images of structures adjacent the lens.

17. The feeding tube placement system of claim 16, wherein the control unit comprises a display screen disposed in communication with the image rendering device.

18. The feeding tube placement system of claim 17, wherein the display screen is adjustable.

19. The feeding tube placement system of claim 16, wherein the control unit comprises a steering device.

20. The feeding tube placement system of claim 19, wherein the steering device comprises a trigger.

21. The feeding tube placement system of claim 16, wherein the optical system comprises a pair of projections and wherein the control unit comprises a plurality of holes formed therein for receiving the projections so as to align the projections with the light source and the image rendering device.

22. The feeding tube of claim 21, wherein the projections are configured to provide concentric orientation.

23. The feeding tube placement system of claim 22, further comprising an adapter disposed at a proximal end of the feeding tube, the adapter being configured to engage the control unit, and wherein the projections of the optical system extend from the adapter.

24. The feeding tube placement system of claim 23, wherein the feeding tube comprises a steering wire and wherein the steering wire extends from the adapter, and wherein the control unit has a steering mechanism configured for engaging or disengaging the steering wire to control the distal end of the feeding tube.

25. The feeding tube placement system of claim 16 wherein the optical system is permanently disposed in a lumen of the feeding tube.

26. The feeding tube placement system of claim 16, wherein the lumen having the optical system disposed therein has a fluid injection port disposed in fluid communication therewith.

27. The feeding tube placement system of claim 16, further comprising a deflecting projection disposed along the lumen having the optical system disposed therein for channeling fluid over the lens of the optical system.

28. The feeding tube placement system of claim 27, further comprising an end cap, and wherein the deflecting projection is disposed on the end cap.

29. A method of placing a feeding tube in a patient, the method comprising:

selecting a feeding tube having a distal end and having a lumen with an optical system disposed therein;

advancing the feeding tube through the nasal or oral canal and down the esophagus of the patient while generating an image of tissue adjacent the distal end of the feeding tube; and

at least periodically checking the image generated of tissue adjacent the distal end of the feeding tube to ensure that the feeding tube has advanced toward a desired location in a gastrointestinal tract of the patient.

30. The method of placing a feeding tube in a patient of claim 29, wherein the method comprises further advancing the feeding tube at least into the stomach of the patient while at least periodically viewing the image generated of tissue adjacent the distal end of the feeding tube until the distal end of the feeding tube reaches a desired location in the gastrointestinal tract.

31. The method according to claim 30, wherein the method comprises deploying an anchoring device adjacent the distal end of the feeding tube to help secure the distal end of the feeding tube in the desired location.

32. The method according to claim 31, wherein the method comprises supplying a solution selected from at least one of a medical solution or a feeding solution through a lumen of the feeding tube while leaving the optical system in feeding tube.

35. The method according to claim 29, wherein the method comprises attaching a control unit to the feeding tube and keeping the control unit attached to the control unit while advancing the feeding tube and removing the control unit from the feeding tube once the distal end of the feeding tube has reach a desired location in the gastrointestinal tract.

36. The method according to claim 35, wherein the method comprises periodically reconnecting the control unit to the feeding tube to confirm the location of the distal end of the feeding tube.

37. The method of claim 36, wherein the feeding tube further comprises a steering wire and wherein the control unit engages the steering wire to help steer the feeding tube through the gastrointestinal tract.

38. The method of claim 29, wherein the method comprises periodically flushing a fluid through the lumen holding the optical system to clean the optical system and enhance the relaying of images through the optical system.

33. The method according to claim 33, wherein the method comprises leaving the feeding tube in the patient for a period of longer than 24 hours while the optical system remains in the feeding tube.

34. The method of claim 33, wherein the method comprises periodically viewing the tissues of the gastrointestinal tract adjacent the distal end of the feeding tube through the optical system.

39. An integrated device, comprising:

a feeding tube operable to deliver a nutritional and/or medicinal substance into the gastrointestinal tract;

an optical system, said optical system including a light source for emitting light adjacent the distal end and a lens; and

a steering system;

wherein the optical system and the steering system are integrated into the feeding tube.

40. The integrated device of claim 39, wherein the flexible optical fibers are integrated into the feeding tube.

41. The integrated device of claim 39, wherein the optical system includes an image viewing component.

42. The integrated device of claim 41, wherein the image viewing component is an electronic screen.

43. The integrated device of claim 42, wherein the image viewing and or steering component(s) can be removed from the optical system.

44. The integrated device of claim 39, wherein the steering system includes steering controls.

45. The integrated device of claim 44, wherein the steering controls can be removed from the steering system.

46. A method of placing a feeding tube inside a gastrointestinal tract of a subject, comprising:

providing an integrated feeding tube device, said integrated feeding tube device comprising a tube operable to deliver nutritional and/or medicinal substance to the gastrointestinal tract, an optical system, said optical system including a light source, a mechanism for conveying an image, and a lens; and

a steering system, said optical system and said steering system being integrated into the integrated feeding tube device;

inserting a distal end of the integrated feeding tube device into a nasal or oral passage of a subject;

positioning the integrated feeding tube in the gastrointestinal tract of the subject using the steering system of the integrated feeding tube device; and

visually verifying placement of the integrated feeding tube in the gastrointestinal tract of the subject using the optical system of the integrated feeding tube device.

47. A device for treating a condition in the gastrointestinal tract, the device comprising:

an elongate catheter having a distal end with at least one open port therein;

a lumen extending from the distal end of the catheter to a port disposed along a section proximal from the distal end, the port being spaced apart from the distal end of the catheter a distance sufficient that the distal end may be disposed in a duct of the gastrointestinal system and the port being disposed in the intestine of the patient; and

an optical system disposed in the catheter, the optical system extending to a position adjacent the distal end such that the optical system can transmit images of tissue adjacent the distal end.

48. The catheter of claim 47, wherein the optical system is permanently disposed in the catheter.

49. A catheter system for treatment of ailments in the gastrointestinal tract, comprising the catheter of claim 47, and further comprising a control unit comprising a light source configured for disposal in communication with the optical system in the feeding tube, and an image rendering device configured for disposal in communication with a portion of the optical system for receiving images of structures adjacent the lens.

50. A method for draining fluid in the gastrointestinal tract, the method comprising:

selecting a catheter having a distal end, a first port disposed in the distal end and a second port disposed proximal from the distal end and in fluid communication with the first port, and an optical system extending substantially the length of the catheter;

advancing the catheter through the nasal canal, the esophagus and the stomach while at least periodically observing images relayed by the optical system; and

advancing the distal end of the catheter into a duct of the gastrointestinal system such that the second port is disposed in the intestine so as to allow fluid to drain through the lumen extending from the first port to the second port.

51. The method according to claim 50, wherein the catheter is left in place more than 24 hours and wherein the method comprises periodically viewing tissue and/or fluid in the duct through the optical system.

52. A method for placing a feeding tube into the gastrointestinal tract, the method comprising:

selecting a feeding tube having a distal end and having a lumen with an optical system removably disposed in the lumen;

inserting the feeding tube into the nasal canal and advancing the feeding tube down the esophagus, and at least into the stomach while periodically viewing tissue adjacent the distal end of the feeding tube; and

using the optical system to confirm when the distal end it at a desired location in the gastrointestinal tract; and

removing the optical system and commencing feeding through the lumen of the feeding tube.

53. A method of placing a feeding tube inside a gastrointestinal tract of a subject, comprising:

providing an integrated feeding tube device, said integrated feeding tube device comprising a tube operable to deliver nutritional and/or medicinal substance to the gastrointestinal tract, an optical system, said optical system including a light source, a mechanism for conveying an image, and a lens; and

a steering system, said optical system and said steering system being integrated into the integrated feeding tube device;

inserting a distal end of the integrated feeding tube device into a portion of a patient'"'"'s gastrointestinal tract through a percutaneous gastrojejunal feeding tube;

positioning the integrated feeding tube in the gastrointestinal tract of the subject using the steering system of the integrated feeding tube device; and

visually verifying placement of the integrated feeding tube in the gastrointestinal tract of the subject using the optical system of the integrated feeding tube device.

54. The method according to claim 53, wherein the integrated feeding tube comprises a control unit adapter and wherein the method comprises advancing the integrated feeding tube until the control unit adapter is disposed adjacent the percutaneous gastrojejunal feeding tube.

55. A system for placing an feeding tube, the system comprising:

a control unit having a steering control and a display screen, the control unit; and

a feeding tube having an elongate body having a distal end, the feeding tube containing an optical system configured for lighting tissue adjacent the distal end and transmitting an image back to the control unit and a steering mechanism for controlling the distal end, and wherein the feeding tube is removably attachable to the control unit so that the control unit may be used repeatedly at different times on the feeding tube.