US 3046988 A
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y 1962 w. J. MOREAU ETAL ESOPHAGEAL NASOGASTRIC TUBE INVENTORQ WZZZ/a 772 uT/Varaaza Z6072 E/I/adzkze Mi QM flzfarzey.
Filed Dec. 1, 1958 Bfiibfibb Patented July 31, 1962 rice 3,046,938 ESOPI IAGEAL NASGGASTRIC TUBE William J. Moreau, lawtucket, and Leon R. Nadine, Cranston, R3,, assignors to Davol Rubber Company, Providence, 12.1., a corporation of Rhoda island Fiied Dec. 1, 1958, Ser. No. 777,241 Claims. (Cl. 128-325) The present invention relates generally to surgical apparatus and is more specifically concerned with the provision of a novel and improved esophageal nasogastric tube.
Esophageal nasogastric tubes hereinbefore in use have traditionally comprised an elongated flexible tube adapted to be passed through the esophagus into the stomach, there being a gastric balloon adapted to engage the cardia and hindus of the stomach when inflated and an elongated esophageal balloon in substantially abutting relation thereto adapted to engage the esophagus, said balloons cooperating to control hemorrhaging from the esophageal varices, as well as any hemorrhaging from a source in the stomach adjacent to the gastroesophageal junction.
it has been found, moreover, that prior art esophageal nasogastric tubes are not entirely efiective nor satisfactory for various reasons. First of all, it has been found that, due largely to the unusual contour of the stomach, the gastric balloon, when inflated, does not engage a willcient area of the fundus of the stomach to etfectively control any hemorrhaging which may exist at this location.
Secondly, it has been found that upon properly positioning and anchoring a tube of this type within a patient by exerting an outward pull thereon after the balloons have been inflated, there is a tendency for the esophageal balloon to pull away from the gastric balloon leaving a space therebetween, at which point uncontrolled bleeding may take place. Still another disadvantage resides in the fact that the upper end of the esopha eal balloon often causes a gagging reflex in the patient.
In order to overcome the above mentioned disadvantages, it is a primary object of the instant invention to provide an esophageal nasogastric tube having an improved gastric balloon whereby hemorrhaging in the fundus of the stomach and adjacent areas will be effectively controlled.
Another important object of our invention is the provision of an esophageal nasogastric tube having a redesigned esophageal balloon which will provide adequate hemostasis at bleeding sites, but which, nevertheless, will be unlikely to cause a gagging reflex in the patient.
A further object of the instant invention is the provision of a tube of the character described wherein means are provided for preventing the esophageal and gastric balloons from separating from each other, thereby insuring continuous pressure over the esophageal varices and the fundus of the stomach.
Another object is the provision of an esophageal nascgastric tube having improved position maintenance characteristics, including the use bf a novel and im roved nasal cuif.
Other objects, features and' advantages of the invention will become apparent as the description thereof proceeds when considered in connection with the accompanying illustrative drawings.
In the drawings which illustrate the best mode presently contemplated by us for carrying out our invention:
larged scale, illustrating the gastric balloon and the tube distal end;
FIG. 4 is a fragmentary sectional elevation, on an enlarged scale, illustrating the proximal end of the tube; and
FIG. 5 is a perspective detail, on an enlarged scale, of
V the nasal end which forms a part of our invention.
FIG. 1 is a side elevational view showing our improved It has been found desirable to provide an improved esophageal nasogastric tube wherein effective control of hemorrhage from esophageal varices is obtained, as well as eifective control over any hemorrhaging which may exist in the fundus or adjacent areas of the stomach. Thus, we have provided an elongated flexible tube or shaft 19 preferably of rubber, although it will be understood that any other suitable flexible material, such as plastic or the like, could be used. The tube 10 is provided with a main lumen 12 which extends completely through said tube, preferably terminating at the distal end of the tube in a so-called whistle tip 14. Adjacent the tip 14 there are provided a plurality of drainage eyes 15, and hence it will be understood that when reference is made to the fact that main lumen 12 extends completely through the tube 10, this language is to be broadly construed so as to cover the situation where tube 10 has a blunt, closed end, since in such a situation the eyes 15 will still be sufficient to enable eifective drainage to take place through lumen 12. Also integrally formed within tube 10 are a pairof inflating lumens 16, 18, the function of which will hereinafter be made apparent. The method of manufacturing tube 10 with its integral lumens 12, 1e and 13 therein actually forms no part of the instant invention, and'many different techniques may be employed, although we prefer to v utilize a dipping form in latex, as is conventional in the manufacture of a wide range of catheters.
Adjacent to but spaced from the distal end of tube 10 there is provided an inflatable gastric balloon 29. As will be seen most clearly in FIG. 3, balloon 20 is provided with hub portions 22 and 24 which maybe cemented or otherwise secured to the outer surface of the tube or shaft 16, it being specifically noted, however, that hub portion 24 is inverted toward the interior of the balloon Zilfor reasons hereinafter to be made apparent. As will be clearly seen, and reference is still made to FIG. 3, inflating lumen 18 communicates with balloon 20 by means of eye or aperture 26 whereby introduction of a fluid, preferably air, under pressure through lumen 18 will cause distention of the balloon 20.
Referring now to FIG. 2, it will be seen that the tube 1%) is provided with an elongated esophageal balloon 28 which is in communication with inflating lumen 16 by means of a plurality of eyes or apertures 30. Thus introduction of fluid under pressure through lumen 16 will cause inflation of the balloon 28. The esophageal balloon 28, like gastric balloon 20 abovedescribed, is preferably mounted to the outer surface of tube 10 by cementing or the like and is provided with mounting hubs 32, 34 for this purpose, it being noted that the lower hub 34 extends reversely into the interior of balloon 28 and hence is oppositely disposed with respect to mounting hub 24- of gastric balloon 20. By having the mounting hubs 24 and 34'extending in opposite directions as clearly illustrated in FIGS. 2 and 3, it is possible to have the balloons 20 and 28 in closely abutting relationship whereby it is virtually impossible for the ballons to be separated when the tube It is in use, as illustrated in FIG. 1. This insures that inflated balloons 20 and 28 will exert a continuous pressure over the fundus of the stomach, the adjacent areas, and the esophageal varices, illustrated at 36 and 38, respectively, in FIG. 1. since, if it were .possible for the balloons to be pulled apart when the tube was being properly positionedand This is of considerable importance spa-aces area at the lower end of the esophagus which would not be under pressure whereby bleeding would not be controlled at such a location.
Also of considerable importance is the fact that the esophagealballoon 28 is tapered at its upper extremity as at 40. This prevents upward expansion of the esophageal balloon durnig inflation and also prevents pressure from being exerted at a point where a gagging reflex would be likely to result. Tofurther insure that these results are obtained, balloon 28 is reinforced at its tapered portion 49 r by havinga slightly thicker wall at this portion.
Similarly, balloon 28is reinforced at its lower or distal end as at 42 (FIG. 2), whileballoon 20 is likewise reinforced at its Opposite ends as at 44 (FIG. 3), the primary purpose of these reinforced portions being to insure maximum lateral expansion of the balloons so as to provide adequate hemostasis over as large an area as possible.
In order to insure that gastric balloon 20 will provide adequate hemostasis at the fundus of the stomach, the balloon is specifically shaped so 'as to conform to-the configuration of the stomach, as will be clearly seenin FIG. 1., Thus, the balloon 20, when inflated, assumes an asymmetrical configuration as compared to prior art tubes of this type wherein the gastric balloons have always been symmetrical resulting in completely ineffective control of any hemorrhaging which exists in the fundus of the stomach. We prefer to provide our asymmetrical gastric balloon by a special dippingtechnique wherein the balloon is dipped at an'angle so as to have a somewhat thinner wall on one side, although it is conceivable that other techniques could be employed to arrive at an asymmetrical balloon of our design. Thus, for the first time there has been provided a gastricballoon which will conform to the stomac contour thereby enabling continuous pressure to be exerted over a much greater area. This constitutes one of the basicconcepts of the instant invention.
As will be seen most clearly in FIG. 1, tube It is provided at its proximal end withaplurality of integral fun- As illustrated most clearly nel portions 48, 50 and 52. in FIG. 4, the funnel portions 48,50 and 52 communicate with lumens 16, 12 and 18, respectively, it being obw'ous that any suitable inflation means 'may be applied to the portions 48 and 52 when it is desired to inflate the hallens 20' and 28 after introduction of thetube into the 7 patient. 7 W V In order to insure that the asymmetrical gastric balloon 20 is properly positioned within the stomach of the patient, graduating indici'a 54 are provided on the'tube 10,
'it'being understood that these markings will be in a specific position as the tube is inserted into the patient if the balloon is properly positioned. At the same time, of course, the indicia will serve to indicate the degree of penetration-of the tube into the patient.
our invention additionally contemplates the use of a a novel and: improved nasal end 56, preferably constructed ofi a non-toxic, highly absorbent, non-irritatingplastic sponge foam. The nasal cuff 56 is illustrated as being of substantially square configuration although it will be understood that this is not essential. The end is provided i with a bore 58 extending therethrough and a communicating slot 60 which enables the cuff 56 to be slidably mounted onto the proximal end of tube 10 and then slid into' snug engagement with the 'patients nose in a manner thought to be obvious and clearly illustrated inFIG. 1. Thus, the nasal cuff 56 not only absorbs a large amount of irritating and annoying nasal secretions, as well as reducing trauma to the nostril, but it also provides some traction and anchors any in-dwelling tube. Even if traction is not applied, the nasal cuff will obviously aid in position maintenance of the tube 10.
It will be seen that our invention achieves all of the he reinbefore enumerated objects by providing (1) as r 4 asymmetrical gastric balloon which, when infla'ted, conforms with the shape of the stomach and provides adequate hemostasis for gastric wall varices that may exist in the upper end of the stomach; (2) .a redesigned esoph- V ageal balloon which is tapered at its proximal end and reinforced at that area so to prevent upward'expansion of the balloon into the pharynx, thereby obviating the gag- 'ging reflex which so often resulted when the prior art nasogastric tube was used; (3) an esophageal balloon having a. relatively thin wall at' its side portions whereby when inflated it will immediately come in contact with the varices present in the lower end of the esophagus with ;a relatively low intra-balloon pressure which will still cause adequate hemostasis; (4) closely abutting gastric and esophageal balloons whereby the respective positions of said balloons are maintained more eifectively-hence i i fest to those skilled in the art that various modifications and rearrangements of the par-ts'may be made without departing from the spirit and scope of the underlying inventive concept and that the same is not limited to the particular forms herein shown and described except in so far as indicated by the scope of the appended claims.
We claim: 7 V
1. 'An esophageal nasogastric tube comprising a flexible shaft having a proximal and a distal end, a first lumen extending completely through said shaft from ,end to end, a gastric balloon aflixed to said shaft adjacent to but spaced from the shaft distal end, a separate and distinct elongated esophageal ballon aflixed to said shaft in abut-.
ting relation to the proximal end of said gastricballoon,
munication with said gastric balloon for inflation thereof,
and a third lumenrextending' through said shaft andin' communication with said esophageal balloon for inflation thereof, said gastric balloon normally having anasymmetrical configuration when inflated whereby to conform to the shape of the stomach.
2. An esophageal nasogastric tube comprising a flexible shaft having a proximal and a distal end, a first lumen extending completely through said shaft from end to end, a gastric balloon affixed to said shaft adjacent to, but spaced from the shaft distal end, a separate "and distinct elongated esophageal balloon afllxed to said shaft in abutting relation to the proximal end of said gastric balloon, a second lumen extending through said shaft and in communication with said gastric balloon for inflation thereof, and a third lumen extending through said shaft and in communication with said esophageal balloon for,
inflation thereof, said esophageal balloon having a gradual taper at its proximal end when inflated.
3. An esophageal nasogastric tube comprising a flexible shaft having a proximal and a distal end, a first lumen extending completely through said shaft from end to end, a gastric balloon aflixed to said shaft adjacent to but spaced from the shaft distal end, a separate and distinct elongated esophageal balloon med to said shaft in abutting relation to the proximal end' of said gastric balloon, a second lumen extending through said shaft and in communication with said gastric balloon for inflation thereof, and a third lumen extending through said shaft and in communication with said esophageal balloon for inflation thereof, said gastric balloon normally having an asymmetrical conflguration when inflated whereby to conform to the shape of the stomach, said esophageal balloon esophageal balloon being reinforced at its distal end and a second lumen extending through said shaft and in com, V
said gastric balloon being reinforced at its opposite ends to resist longitudinal expansion.
5. In the esophageal nasogastric tube of claim 3, said esophageal balloon being reinforced throughout its tapered portion whereby to resist lateral expansion at said portion.
References flied in the file of this patent UNITED STATES PATENTS 1,920,606 Dozier July 25, 1933 2,799,273 Oddo July 16, 1957 2,813,531 Lee Nov. 19, 1957 6 Tafilaw Apr. 22, 1958 Oddo Aug. 26, 1958 Pagano Oct. 7, 1958 Auzin June 30, 1959 Ritter et al Aug. 11, 1959 Gants May 17, 1960 OTHER REFERENCES Surgery, Gynecology and Obstetrics, volume 77, No. 4, 19 page 422 required. (Copy in Division 55.)
Surgery, Gynecology and Obstetrics, Feb. 15, 1937,
page 15 required.