Enteral feeding device

• US 4,826,481 A
• Filed: 03/24/1988
• Issued: 05/02/1989
• Est. Priority Date: 05/27/1987
• Status: Expired due to Fees

• Current Assignee: Abbott Labs
• Original Assignee: Abbott Labs
• Inventors: Gould, Arnold S., Manzo, Michael P., Ciannella, Michael A., Sacks, Barry A.
• Primary Examiner(s): Pellegrino, Stephen C.
• Application Number:
  US07/178,835
• Time in Patent Office: 404 Days
• Field of Search: 604/104-107, 604/264, 604/164, 604/174, 604/175, 604/280, 604/282
• US Class Current: 604/516
• CPC Class Codes: A61M 2025/0233 specifically adapted for attaching to a body wall by means which are on both sides of the wall, e.g. for attaching to an abdominal wall
• CPC Class Codes: A61M 25/01 Introducing, guiding, advancing, emplacing or holding catheters A61M25/10 takes precedence
• CPC Class Codes: A61M 25/02 Holding devices, e.g. on the body

Abstract

An enteral feeding catheter is characterized by being adapted for introduction through the mouth via a guidewire that extends from the mouth through the esophagus, stomach and abdominal puncture. The catheter has a relatively stiff leading portion of length sufficient to extend along the guidewire from the mouth through the abdominal puncture and of stiffness sufficient to permit it to be pushed along the guidewire, at least an initial length of the catheter being tapered to a narrow leading tip to enable the puncture to be dilated as its drawn therethrough. The catheter also has a relatively soft, large diameter trailing portion connected to the leading portion adapted to be drawn along said guidewire by grasping and pulling the stiff leading portion until the leading end of the soft portion extends outside the body through the widened puncture, while the trailing end remains in the stomach, whereby the relatively soft trailing portion can serve as a conduit for enteric feeding. A method of placing the device for enteral feeding is described, as is a retractable locking device of special configuration for use with the soft portion of this catheter, or others, the lock providing a relatively large, compared to the opening in an associated retainer, fixed protuberance about the catheter to prevent passage of the catheter through the opening absent application of abnormally high pulling force.

Claims

1. A enteral feeding device comprising

a catheter adapted to serve as a conduit for passage of sustenence through an abdominal wall into the body, the portion of said catheter which extends through said abdominal wall and into the stomach being sufficiently soft to avoid irritation of stomach tissue,

said catheter having retractable locking means for use with a retainer within the stomach, immediately distal of said locking means, and

said device further comprising a retainer of a size greater than the puncture in the stomach wall, disposed closely about said catheter between said locking means and said stomach wall,

said retainer having an opening of predetermined size, and

said retainer being sufficiently soft to avoid irritation of stomach tissue;

said locking means comprising a multi-wing formation disposed about the surface of said catheter, each said wing comprising a proximal component and a distal component, each said component having significant thickness, the inner ends of the components of each wing being joined to said catheter, the outer ends of said components being joined to each other,

said locking means being adapted to extend radially beyond the outer diameter of said catheter to inhibit passage of the end of the catheter through said opening in said retainer, said opening having diameter close to the local outer diameter of said catheter, and,

in locking position, the proximal and distal components of the wings of said locking means lying at acute angles measured from the axis of said catheter portion within the stomach, and the joined ends of said wing components lying closely adjacent each other,

wherey, when force is applied to draw said catheter proximally into said opening, the proximal wing component engages upon the retainer surface defining said opening and thus is urged distally, toward the distal wing component, which is urged toward the surface of the portion of said catheter within the stomach, said wing components thereby providing, in combination, a relatively large, compared to said opening in said retainer, fixed protuberance about said catheter portion, to prevent passage of said catheter through said opening absent application of abnormally high pulling force.

2. The enteral feeding catheter of claim 1 wherein the portion of said catheter adapted to serve as a conduit for enteric feeding has an inner diameter of at least about 3 mm.

3. The enteral feeding catheter of claim 1 wherein said wings are integral with said catheter.

4. The enteral feeding catheter of claim 3 wherein said wings are provided by slitting the wall of said catheter longitudinally over a predetermined length, and forming the segment of said wall lying between pairs of said slits into a said locking wing.

5. The enteral feeding device of claim 1 wherein said locking means are adapted to be retracted to permit passage of said catheter through said retainer opening when said catheter portion is urged directly relative to the body of said catheter proximal of said locking means.

6. The enteral feeding catheter of claim 5 wherein said catheter portion is an open-ended conduit, and said locking means are adapted for retraction when the inner surface of said catheter portion is engaged and urged distally relative to the body of said catheter proximal of said locking means.

7. The enteral feeding device of claim 6 wherein said device further comprises a feeding catheter sized for passage via said catheter into the body.

8. The enteral feeding device of claim 6 further comprising an elongated releasing means sized to extend from outside the body through said catheter into said catheter portion, and having an expansible head portion adapted for expansion within said catheter portion to engage the surfaces of the catheter portion and, when said releasing means with said head expanded is urged distally within said catheter, to urge said catheter portion distally to release said locking means.

9. The enteral feeding device of claim 1 wherein creases are formed at the ends of said wing components to provide flexible hinges for resisting return of said wings to an axially aligned configuration during exposure to the heat of sterilization.

10. The enteral feeding device of claim 9 wherein said wing components and creases form spring means adapted to urge the distal portion of the wing to underlie the proximal portion in locking configuration.

11. A method for introducing an enteral feeding catheter through the mouth via a guidewire that extends from the mouth through the esophagus, stomach and abdominal puncture, said catheter comprising a relatively stiff leading portion of length sufficient to extend along said guidewire from the mouth through said abdomoinal puncture and said catheter comprising a relatively sift, large diameter trailing portion connected to said leading portion,

said method comprising

pushing said catheter along said guidewire from the mouth until the leading portion of said catheter exits at said admonial puncture and can be grasped, and

thereafter drawing said catheter along said guidewire by grasping the portion of said catheter that has exited said abdominal puncture and pulling until the leading end of said soft portion extends outside the body through said puncture while its trailing end remains in the stomach,

whereby the relatively soft trailing portion of said catheter can serve as a conduit for enteral feeding.

12. The method of claim 11 wherein at least an initial length of said leading portion of said catheter is tapered to a narrow leading tip, and said method further comprises gradually dilating said puncture opening as said tapered part is drawn therethrough.

13. A gastrostomy set for placing an enteral feeding catheter in an abdominal puncture to enable feeding directly to the stomach,

said set comprising a guidewire of a length sufficient to extend from the outside, through the abdominal puncture, the stomach, the esophagus and out of the mouth, and an elongated catheter member comprising leading and trailing portions, said catheter member being open at both ends to enable passage thereof over the guidewire, and said leading portion being of a length sufficient to extend along said guidewire from outside, through the mouth, the esophagus and stomach and through said abdominal puncture to the outiside, said leading portion being tapered to a relatively small opening to accommodate said guidewire and being of stiffness sufficient to permit it to be advanced along said guidewire solely by pushing forces applied at said mouth until the leading end of said portion emerges on said guidewire from said abdominal puncture and may be grasped, said trailing portion of said catheter member being softer relative to said leading portion, adapted to form the feeding tube that is to remain in the patient, said trailing portion being adapted to be drawn along said guidewire which passes therethrough, which guidewire extends from outside the mouth through the esophagus, the stomach, and out through the abdominal puncture in a relatively fixed condition, by grasping and pulling said emerged leading portion of said catheter member, until only the trailing end of said trailing portion remains in the stomach, to serve as a conduit for enteral feeding, the entire movement of said catheter member from the mouth, through the esophagus, the stomach and out through the abdominal puncture being controlled by said relatively fixed guidewire.

15. The enteral feeding catheter of claim 13 or 14 wherein the length of said leading portion is about 60 cm.

16. The enteral feeding device of claim 13 or 14 further comprising a bumper means disposed about the trailing end of the soft trailing portion of the cathetrer within the stomach, the trailing end of said catheter, distal of said bumper, having the form of a permanently fixed lock over which the bumper means cannot pass.

17. The enteral feeding device of claim 13 or 14 further comprising a fixed bumper means permanently disposed about the trailing end of the soft trailing portion of the catheter within the stomach.

18. The enteral feeding catheter of claim 13 or 14 wherein the portion of said catheter adapted to serve as a conduit for enteric feeding has an inner diameter of at least about 3 mm.

14. A catheter member for forming an enteral feeding catheter in an abdominal puncture to enable feeding directly to the stomach,

said catheter member comprising leading and trailing portions, said catheter adapted for use with a guidewire of a length sufficient to extend from the outside, through the abdominal puncture, the stomach, the esophagus and out of the mouth,

said catheter member being open at both ends to enable passage thereof over the guidewire which is in a relatively fixed condition, and said leading portion of said catheter member being of a length sufficient to extend along said guidewire from outside, through the mouth, the esophagus and stomach and through said abdominal puncture to the outside, said leading portion being tapered to a relatively small opening to accommodate said guidwire and being of stiffness sufficient to permit it to be advanced along said guidewire solely by pushing forces applied at said mouth until the leading end of said leading portion emerges on said guidewire from said abdominal puncture and may be grasped, said trailing portion of said catheter member being softer relative to said leading portion , adapted to form the feeding tube that is to remain in the patient, said trailing portion being adapted to be drawn along said relatively fixed guidewire which passes therethrough, the opposite ends of which guidewire extend out of the mouth and out of the abdominal puncture, respectively, by grasping and pulling said emerged end of said leading end of the leading portion of said catheter member, until only the trailing end of said trailing portion remains in the stomach, to serve as a conduit for enteral feeding, the entire movement of said catheter member from the mouth, through the esophagus, the stomach, and out through the abdominal puncture being controlled by said relatively fixed guidewire.

19. A catheter member for forming an enteral feeding catheter in an abdominal puncture to enable feeding directly to the stomach,

said catheter member comprising leading and trailing portions, sid catheter adapted for use with a guidewire of a length sufficient to extend from the outside, through the abdominal puncture, the stomach, the esophagus and out of the mouth,

said catheter member being open at both ends to enable passage thereof over the guidewire, and said leading portion of said catheter member being of a length sufficient to extend along said guidewire from outside, through the mouth, the esophagus and stomach and through said abdominal puncture to the outside, said portion being shaped and being of stiffness sufficient to permit it to be advanced along said guidewire solely by pushing forces applied at said mouth until the leading end of said portion emerges on said guidewire from said abdominal puncture to be grasped, said trailing portion of said catheter member being softer relative to said leading portion, adapted to form the feeding tube that is to remain in the patient, said trailing portion being adapted to be drawn along said guidewire by grasping and pulling the leading portion of said catheter member, until only the trailing end of said trailing portion remains in the stomach, to serve as a conduit for enteral feeding,

said catheter having retractable locking means associated with its trailing portion adapted for use with a retainer having an opening of predetermined size, and

said catheter having a portion within the stomach, immediately distal of said locking means;

said locking means comprising a multi-wing formation disposed about the surface of said catheter, each said wing comprising a proximal component and a distal component, each said component having significant thickness, the respective inner end of each of the proximal and distal components of each wing being joined to said catheter, the respective outer ends of each adjacent pair of proximal and distal components being joined,

said locking means being adapted to extend radially beyond the outer diameter of said catheter to inhibit passage of the end of the catheter through said opening in said retainer, said opening having a diameter close to the local outer diameter of said catheter, and,

in locking position, the proximal and distal components of the wings of said locking means lying at acute angles measured from the axis of said catheter portion within the stomach, and the joined ends of said wing components lying closely adjacent each other,

whereby, when force is applied to draw said catheter proximally into said opening, the proximal wing component engages upon the surface defining said opening and thus is urged distally, toward the distal wing component, which is urged toward the surface of the portion of said catheter in the stomach, said wing components thereby providing, in combination, a relatively large, compared to said opening in said retainer, fixed protuberance about said catheter portion, to prevent passage of said catheter through said opening absent application of abnormally high pulling force.

20. The enteral feeding catheter of claim 19 wherein said locking means are adapted to be retracted to permit passage of said catheter through said retainer opening when said catheter portion is urged distally relative to the body of said catheter proximal of said locking means.

21. The enteral feeding catheter of claim 20 wherein said catheter portion is an open-ended conduit, and said locking means are adapted for retraction when the inner surface of said catheter portion is engaged and urged distally relative to the body of said catheter proximal of said locking means.

22. The enteral feeding catheter of claim 19 wherein said wings are integral with said catheter.

23. The enteral feeding catheter of claim 22 wherein said wings are provided by slitting the wall of said catheter longitudinally over a predetermined length, and forming the segment of said wall lying between pairs of said slits into a said locking wing.

24. The enteral feeding device of claim 19 wherein said locking means are adapted to be retracted to permit passage of said catheter through said retainer opening when said catheter portion is urged distally relative to the body of said catheter proximal of said locking means.

25. The enteral feeding catheter of claim 24 wherein said catheter portion is an open-ended conduit, and said locking means are adapted for retraction when the inner surface of said catheter portion is engaged and urged distally relative to the body of said catheter proximal of said locking means.

26. The enteral feeding device of claim 25 wherein said device further comprises a feeding catheter sized for passage via said catheter into the body.

27. The enteral feeding device of claim 25 further comprising an elongated releasing means sized to extend from outside the body through said catheter into said catheter portion, and having an expansible head portion adapted for expansion within said catheter portion to engage the surfaces of the catheter portion and, when said releasing means with said head expanded is urged distally within said catheter, to urge said catheter portion distally to release said locking means.

28. The enteral feeding device of claim 19 wherein creases are formed at the ends of said wing components to provide flexible hinges for resisting return of said wings to an axially aligned configuration during exposure to the heat of sterilization.

29. The enteral feeding device of claim 28 wherein said wing components and creases form spring means adapted to urge the distal portion of the wing to underlie the proximal portion in locking configuration.