Abstract:
A feeding tube extension may be used to extend the length of a feeding tube. The feeding tube extension may comprise an extension tube and a connector configured to be inserted into a feeding port of the feeding tube. So the flow of fluids is not unduly restricted, an inner diameter of the extension tube and a diameter of a connector lumen may be selected to be a predetermined size relative to the a diameter of a feeding tube lumen. A feeding syringe interface may facilitate use of a feeding syringe with the extension tube. Various mechanisms may be used to seal the extension tube when feeding is complete. A right-angle bolster and catheter securing device may be configured to secure the feeding tube so that it does not kink or move and cause irritation.

Description:
RELATED APPLICATIONS 
       [0001]    This application claims priority to U.S. Provisional Patent Application Ser. No. 61/718,114 filed Oct. 24, 2012, which is hereby incorporated by reference herein in its entirety. 
     
    
     TECHNICAL FIELD 
       [0002]    This application relates to methods, apparatuses, and kits for extending enteral feeding tubes. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0003]      FIG. 1  is a side perspective view of a first gastric feeding tube. 
           [0004]      FIG. 2  is a side perspective view of a second gastric feeding tube. 
           [0005]      FIG. 3  is a cross-section view of the second gastric feeding tube inserted into a stoma in an abdominal wall and stomach wall of the patient. 
           [0006]      FIG. 4  is a side perspective view of a feeding tube extension for extending the length of a feeding tube. 
           [0007]      FIG. 5  is a side perspective view of the feeding tube extension coupling to the second gastric feeding tube. 
           [0008]      FIG. 6  is a side perspective view of the feeding tube extension with a feeding syringe interface, an interface cap, and an adjustable tube clamp. 
           [0009]      FIG. 7  is a top perspective view of a catheter securement device. 
           [0010]      FIG. 8  is a top perspective view of an extension tube secured by the catheter securement device. 
           [0011]      FIG. 9  is a front perspective view of a patient wearing a feeding tube and feeding tube extension. 
           [0012]      FIG. 10  is a flow diagram of a method for extending a feeding tube. 
       
    
    
     DETAILED DESCRIPTION OF PREFERRED EMBODIMENTS 
       [0013]    A feeding tube, such as gastric feeding tubes (G-tubes), including percutaneous endoscopic gastronomy (PEG) tubes, jejunostomy feeding tubes (J-tubes), and the like, may be inserted through a stoma in an abdominal wall of a patient into the stomach and/or intestines of the patient. The feeding tube may be used to provide food, nutrition, and/or medication to the patient. The feeding tube may include a tubular member with a feeding lumen travelling the length of the tubular member. A feeding lumen wall may surround the feeding lumen. 
         [0014]    A plurality of ports may be coupled to a proximal end of the tubular member. A feeding port may be coaxial with the tubular member. The feeding port may be configured to receive nourishment, such as food in a liquid or other fluid form. The nourishment may be conveyed by the feeding port to the feeding lumen, which may deliver the nourishment to the patient&#39;s stomach. A medication port may be configured to convey medication, in a liquid or other fluid form, to the feeding lumen. A balloon port may also be coupled to the proximal end of the tubular member. A securing mechanism may secure at least a portion of the feeding tube within the abdomen and/or stomach of the patient. The securing mechanism may be coupled to a distal tip of the tubular member and may be sized larger than the stoma to prevent removal. In some embodiments, the securing mechanism may be a balloon. An inflation tube may extend from a proximal end of the lumen wall to a distal end of the lumen wall. The inflation tube may couple the balloon port to the balloon to allow the balloon to be inflated using the balloon port. 
         [0015]    The length of the feeding tube may cause a portion of the feeding tube external to the patient&#39;s body to be entirely or partially covered by the patient&#39;s clothing. As a result, the patient&#39;s clothing may need to be lifted to access the feeding tube. The patient may consider such accessing of the feeding tube to be annoying, invasive, and/or frustrating. Patients with a measure of dementia or other memory loss, for example, may be particularly sensitive to and/or annoyed by such accessing of the feeding tube. Also, the feeding tube may extend out from the patient&#39;s abdomen such that it is perpendicular to the patient&#39;s skin surface. In such cases, the feeding tube may be obtrusive, which may lead the patient to pull or adjust the feeding tube, inadvertently and/or unwittingly in some instances. Such pulling or adjustment may cause the feeding tube to be dislodged and/or misplaced. The dislodged and/or misplaced feeding tube may need to be reinserted by a healthcare practitioner and/or may cause infection or injury. 
         [0016]    A right-angle bolster may be used to direct the feeding tube along the patient&#39;s skin surface so the feeding tube is less obtrusive. A curved bolster lumen may extend through the right-angle bolster. The bolster lumen may be sized such that the tubular member may be passed through the bolster lumen. The bolster lumen may direct the distal tip of the tubular member into the patient&#39;s stomach and may direct the proximal end of the tubular member along the patient&#39;s skin surface. To so direct the tubular member, an angled formed by a proximal axis of a proximal end of the bolster lumen and a distal axis of a distal end of the bolster lumen may be at least 60 degrees, at least 70 degrees, or at least 80 degrees. A skin cushion may surround the distal end of the bolster lumen and extend radially outward from the distal end of the bolster lumen. The skin cushion may comprise a smooth, flat surface configured to rest against the patient&#39;s skin and prevent irritation of the skin near the stoma. 
         [0017]    A catheter securement device may also be used to make the feeding tube less obtrusive. The catheter securement device may include an adhesive surface configured to couple the catheter securement device to the patient&#39;s skin. The catheter securement device may also comprise one or more tube holders configured to selectively secure the tubular member to the catheter securement device. For example, the one or more tube holders may each comprise a first strap with an aperture and a second strap with locking members configured to removeably interlock with the aperture. The first and second strap may be configured to encircle the tubular member and to frictionally engage with the tubular member when tightened around it. 
         [0018]    In some embodiments, the tubular member may be made from a non-deformable, flexible polymer. In such embodiments, the non-deformable polymer may prevent kinks from forming in the tubular member. Alternatively, the tubular member may be made from a deformable, flexible polymer. The deformable polymer may allow obstructions to be removed from the tubular member by pinching or squeezing the tube and forcing the obstruction forward. However, the deformable polymer may be susceptible to kinking. To prevent kinking, the right-angle bolster and catheter securement device may be positioned to maintain the tubular member in a fixed, kink-free position as long as the tubular member is engaged by the right-angle bolster and the catheter securement device. 
         [0019]    A feeding tube extension may allow food and medications to be passed to the feeding tube without invasive access to the feeding tube. The feeding tube extension may include an extension tube and a connector. The extension tube may be configured to be cuttable at one or both ends to achieve a desired length. A universal connector may comprise a plurality of tiers with differently sized diameters that allow the universal connector to interface with a plurality of different sized ports including feeding ports and medication ports. However, an aperture of the universal connector and a diameter of the corresponding extension tube may need to be sized for the smallest feeding tube with which the feeding tube extension is designed to interface. Thus for some feeding tubes, the diameter of the aperture and the diameter of the corresponding extension tube may be less than half or less than one-third of the diameter of the feeding lumen. The resulting cross-sectional area may be ten percent to twenty-five percent of the size of the cross-sectional area of the feeding lumen. Significantly more obstructions may result from the reduced cross-sectional area. 
         [0020]    In other embodiments, an inner diameter of the extension tube and/or a diameter of a connector lumen may each be configured to be no less than 50%, 60%, 70%, 80%, 90%, or 100% of the diameter of the feeding lumen. The larger size of the extension tube and connector lumen may result in fewer obstructions. To accommodate the larger size of the connector lumen, a diameter of the feeding port may be at least as large the diameter of the feeding lumen. The feeding port may also include a plurality of coaxial circular ridges on an inner surface to interface with the connector. A distal end of the connector may be conically-shaped with a plurality of conical ridges configured to frictionally and mechanically grip the plurality of coaxial circular ridges, thereby removeably coupling the connector to the feeding port. Alternatively, the feeding port may be substantially smooth on the inner surface, and the plurality of conical ridges may frictionally grip the inner surface. In either embodiment, the feeding port may be made of a flexible polymer that stretches radially outward to receive the connector thereby increasing the strength of the frictional engagement between the inner surface and the connector. In some embodiments, the length of the connector and the width of the distal end of the connector may be configured to block the medication port and prevent reflux of liquids out of the medication port. 
         [0021]    The proximal end of the connector may be cylindrically shaped to removeably couple with the extension tube. The proximal end of the connector may couple to a distal end of the extension tube by creating a frictional engagement with an inner or outer surface of the extension tube. The extension tube may be made of a deformable, flexible polymer that stretches when the proximal end of the connector is coupled to the extension tube. This stretching may increase the force of the frictional engagement making the connection more secure. Also, the stretching may allow the diameter of the connector lumen to be as large as the diameter of the extension tube. In some embodiments, the proximal end of the connector may be inserted into the extension tube. Alternatively, the extension tube may be inserted into the proximal end of the connector. For a connector configured to be inserted into the extension tube, the diameter of the connector lumen may be substantially uniform for the entire length, or substantially the entire length, of the lumen. A connector configured to receive the extension tube may have a connector lumen with a first diameter at the proximal end equal to an outer diameter of the extension tube and a second diameter at the distal end equal to an inner diameter of the extension tube. In other embodiments, a connector configured to receive the extension tube may have a connector lumen of substantially uniform diameter. 
         [0022]    A proximal end of the extension tube may be coupled to a feeding syringe interface. The feeding syringe interface may be cylindrically shaped with an interface lumen travelling the length of the feeding syringe interface. An inner surface of the feeding syringe interface may be tapered, staggered, or the like at the distal and/or proximal ends, so the interface lumen is narrower in the middle than at one or both ends. At its smallest, a diameter of the interface lumen may be configured to be no less than 50%, 60%, 70%, 80%, 90%, or 100% of the inner diameter of the extension tube and/or the diameter of the interface lumen may be configured to be no less than 50%, 60%, 70%, 80%, 90%, or 100% of the diameter of the feeding lumen. The distal end of the feeding syringe interface may be coupled to the proximal end of the extension tube through a frictional engagement. The inner surface may comprise one or more coaxial circular ridges to facilitate the frictional engagement with the extension tube. The tapered and/or staggered inner surface may allow fluids injected by a feeding syringe to experience a substantially constant diameter as they flow from the interface lumen to the extension tube. The extension tube may be inserted into the feeding syringe interface and/or the feeding syringe interface may be inserted into the extension tube. The proximal end of the feeding syringe interface may be configured to frictionally engage with the feeding syringe to hold it in place. Alternatively or in addition, the feeding syringe may be secured to the feeding syringe interface with luer lock. The feeding tube extension may be coupled to the medication port when a luer lock is used. The proximal end of the interface lumen may be configured to receive feeding syringes of a plurality of different sizes. 
         [0023]    When the feeding tube extension is not in use, an interface cap and/or an adjustable tube clamp may be used to block fluids from refluxing up and/or out the extension tube. The interface cap may be secured to the extension tube by an extension attachment. The extension attachment may be a loop or ring that encircles the extension tube. The interface cap may also include a cylindrically-shaped interface cover, which goes over the feeding syringe interface to enclose the distal end of the interface. A link may connect the extension attachment to the interface cover. The adjustable tube clamp may have a plurality of clamping tabs to pinch the extension tube closed and block the passage of fluids through the tube. A locking mechanism may allow a user to selectively control positioning of the clamping tabs and lock the clamping tabs in a selected position. 
         [0024]      FIG. 1  is a side perspective view of a first gastric feeding tube  100 . The gastric feeding tube  100  may comprise a tubular member  110 , which defines a feeding lumen to carry liquids, fluid nourishment, aqueous medications, and the like (collectively and generally referred to herein as “fluids”) into a patient&#39;s stomach. A feeding port  120  may be configured to receive fluids, which are then delivered to the patient&#39;s stomach by a distal tip  112 . A balloon  130  may also be located at the distal tip  112 . A balloon port  150  may be used to inflate the balloon  130  remotely. An inflation tube  135  may be located in a feeding lumen wall  115 . The inflation tube  135  may convey fluids from the balloon port  150  to the balloon  130  to inflate the balloon  130 , or the inflation tube  135  may be used to deflate the balloon  130 . The feeding port  120  may have a plug  125 , which may be inserted into the feeding port  120  to block liquids from being refluxed out of the feeding port  120 . The feeding tube  100  may also comprise a straight bolster  140  to rest against the patient&#39;s skin. The straight bolster  140  may prevent undesired movement of the feeding tube  100 , which can result in irritation of the patient&#39;s skin. The straight bolster  140  may cause the feeding tube  100  to protrude straight out from the patient&#39;s stomach in an obtrusive manner. For deformable, flexible feeding lumen walls  115 , the tubular member  110  may kink closed if the feeding tube  100  is bent at an angle. 
         [0025]      FIG. 2  is a side perspective view of a second gastric feeding tube  200 . Like the first gastric feeding tube  100 , the second gastric feeding tube  200  may have a tubular member  210 , a feeding lumen wall  215 , a feeding port  220 , a distal tip  212 , a balloon  230 , a balloon port  250 , and a inflation tube  235 . The second gastric feeding tube  200  may be inserted through a right-angle bolster  240 . The right-angle bolster  240  may angle the second gastric feeding tube  200  so that it is directed parallel, or substantially parallel, to the patient&#39;s skin. The right-angle bolster  240  may prevent the second gastric feeding tube  200  from kinking where the feeding tube  200  is bent. The second gastric feeding tube  200  may also have a medication port  260  to receive medication. The medication port  260  may be smaller than the feeding port  220 . The medication port  260  may have a plug  265 , which can be inserted into the medication port  260 . The feeding port  220  may have a plurality of coaxial circular ridges  222  to frictionally engage with connectors and feeding syringes. 
         [0026]      FIG. 3  is a cross-section view of the second gastric feeding tube  200  inserted into a stoma in an abdominal wall  320  and stomach wall  310  of the patient. The balloon  230  may be inflated to secure the feeding tube  200  within the patient. The right-angle bolster  240  may prevent the feeding tube  200  from entering too deeply into the patient or making other undesirable movements. The right-angle bolster  240  may also keep the tubular member  210  in close proximity to the patient&#39;s skin  330 . 
         [0027]      FIG. 4  is a side perspective view of a feeding tube extension  400  for extending the length of a feeding tube  100 ,  200 . The feeding tube extension  400  may include a connector  420  and an extension tube  410 . The connector  420  may have a conically-shaped distal end  421  with a plurality of conical ridges  422 . The connector  420  may also have a cylindrically-shaped proximal end  424  designed to be inserted into the extension tube  410 . A cylindrically-shaped middle section  426  and a lip  427  may join the proximal end  424  and distal end  421  of the connector. 
         [0028]      FIG. 5  is a side perspective view of the feeding tube extension  400  coupling to the second gastric feeding tube  200 . The plurality of conical ridges  422  may grip and/or frictionally engage with the plurality of coaxial circular ridges  222 . The connector  420  may cause the feeding port  220  to stretch and bulge outward. This may increase the frictional force between the connector  420  and the feeding port  220 . The lip  427  may limit insertion of the connector  420  into the feeding port  220 . In some cases, reflux may have sufficient force to dislodge the plug  265  from the medication port  260 . The connector  420  may have a length and width large enough to obstruct the medication port  260  and prevent reflux from coming out of the medication port  260 . 
         [0029]      FIG. 6  is a side perspective view of the feeding tube extension  400  with a feeding syringe interface  610 , an interface cap  620 , and an adjustable tube clamp  630 . The feeding syringe interface  610  may be removeably coupled to the extension tube  410 . It may be difficult for a feeding syringe to be inserted into the extension tube  410 . Accordingly, a distal end of the feeding syringe interface  610  may be configured to couple to the extension tube  410 , and a proximal end of the feeding syringe interface  610  may be configured to receive a feeding syringe. When the patient is not being fed, the interface cap  620  may be used to block a lumen of the feeding syringe interface  610 . The interface cap  620  may include a cylindrically-shaped interface cover  621  to enclose the interface lumen, a loop-shaped extension attachment  622  to couple the interface cap  620  to the extension tube  410 , and a link  623  to couple the interface cover  621  to the extension attachment  622 . Additionally, an adjustable tube clamp  630  may be used to pinch the extension tube  410 , thereby blocking flow through the extension tube  410 . The adjustable tube clamp  630  may comprise a plurality of clamping tabs  631  to pinch the extension tube  410  and a locking mechanism  632  to selectively control positioning of the clamping tabs  631 . 
         [0030]      FIG. 7  is a top perspective view of a catheter securement device  700 . The catheter securement device may comprise one or more pairs of straps  710 ,  720 . A first strap  714 ,  724  in each pair  710 ,  720  may comprise apertures, and a second strap  712 ,  722  in each pair  710 ,  720  may comprise locking members configured to removeably interlock with the apertures. The straps and/or locking members may be made from a flexible polymer. 
         [0031]      FIG. 8  is a top perspective view of an extension tube  410  secured by the catheter securement device  700 . Each pair of straps  710 ,  720  may be configured to secure the extension tube  410  to the catheter securement device  700  by encircling and frictionally engaging the extension tube  410 . An adhesive surface  730  may couple the catheter securement device  700 , for example, to the patient&#39;s skin. The catheter securement device  700  may also be used to secure the tubular member  110 ,  210  of the feeding tube  100 ,  200  to the patient&#39;s skin. An additional catheter securement device  810  may be used to secure the proximal end of the extension tube in a desired location, which may also position the feeding syringe interface in a desired location. The additional catheter securement device  810  may comprise a tube holder, such as a pair of straps. The additional catheter securement device  810  may also comprise an adhesive surface, a safety pin, and/or the like to secure the additional catheter securement device  810  to the patient&#39;s clothing. 
         [0032]      FIG. 9  is a front perspective view of a patient  900  wearing a feeding tube  200  and feeding tube extension  400 . The right-angle bolster  240  may direct the tubular member  210  into the patient&#39;s stomach. The exposed portion of the tubular member  210  may be secured to the patient&#39;s skin by the catheter securement device  700 . The right-angle bolster  240  and catheter securement device  700  may prevent the tubular member from moving or kinking. The feeding port  220  may couple to the connector  420 . The extension tube  410  may travel up the patient&#39;s abdomen and emerge from the collar  922  of the patient&#39;s shirt  920 . The feeding syringe interface  610  may then be located near the patient&#39;s head making it easier for a healthcare practitioner to locate the feeding syringe interface  610  and inject food. The location near the patient&#39;s head may also facilitate interaction between the patient and healthcare practitioner during feeding. 
         [0033]      FIG. 10  is a flow diagram of a method  1000  for extending a feeding tube. The feeding tube  100 ,  200  may be set up before, during, and/or after preparing the feeding tube extension  400 . To set up the feeding tube  100 ,  200 , the feeding tube  100 ,  200  may be inserted  1002  through the right-angle bolster  240 . Then, the feeding tube  100 ,  200  may be inserted  1004  into a stoma in an abdominal wall of a patient. The balloon  230  may be inflated  1006  to secure the feeding tube  100 ,  200  in the patient. The exposed portion of the tubular member  110 ,  210  may be secured  1008  to the patient using the catheter securing device. 
         [0034]    To prepare the feeding tube extension  400 , the extension tube  410  may be cut  1010  to a desired length. A connector  420  may be coupled to the extension tube  410 . The connector  420  of the feeding tube extension  400  may be coupled  1012  to the feeding tube  100 ,  200 . The feeding syringe interface  610  may be coupled  1014  to the extension tube  410 . The feeding tube  100 ,  200  and extension  400  may then be used to feed the patient. To feed the patient, a feeding syringe may be inserted  1016  into the interface lumen. The feeding syringe may be used to inject  1018  food into the interface lumen. The feeding syringe may afterwards be removed  1020  from the interface lumen. The interface lumen may be covered  1022  using the interface cap  620 , and/or the extension tube  410  may be clamped  1024  closed by the adjustable tube clamp  630 . 
         [0035]    It will be understood by those having skill in the art that many changes may be made to the details of the above-described embodiments without departing from the underlying principles of the disclosure. The scope of the present disclosure should, therefore, be determined only by the following claims.