PATENT DOCUMENT

Abstract:
A device for the in situ clearing of blockages in a tube includes a controller and a clearing member. The controller can have a housing and an actuator for generating repetitive motion. The clearing member can be releasably coupled to the controller and suitable for insertion in the tube. The tube can be at least partially disposed within a living being. The controller can be located external to the living being. The clearing member can have a first end releasably coupled to the actuator, at least one flexible section which permits axial displacement of the clearing member, and a second end suitable for repetitively engaging and disrupting the blockage. The flexible section permits the clearing member to repetitively engage and disrupt the blockage within one of a straight and a curved portion of the artificial tube.

Full Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     This continuation application claims the benefit under 35 U.S.C. §120 of U.S. application Ser. No. 12/964,252, filed on Dec. 9, 2010 entitled DEVICES FOR CLEARING BLOCKAGES IN IN-SITU ARTIFICIAL LUMENS, which is in turn a continuation-in-part application of U.S. Application Ser. No. 12/274,937, filed on Nov. 20, 2008 entitled FEEDING TUBE CLEANER which in turn claims the benefit under 35 U.S.C. §119(e) of U.S. Provisional Patent Application No. 60/989,484, filed on Nov. 21, 2007 entitled FEEDING TUBE CLEANER and of U.S. Provisional Patent Application No. 61/099,737, filed on Sep. 24, 2008 entitled DEVICE FOR CLEARING BLOCKAGES IN FEEDING TUBES and all of whose entire disclosures are incorporated by reference herein. 
    
    
     STATEMENT REGARDING FEDERALLY SPONSORED RESEARCH OR DEVELOPMENT 
     This invention was produced in part using funds from the Federal government under National Science Foundation Award ID nos. IIP-0810029 and IIP-0923861. Accordingly, the Federal government has certain rights in the invention. 
    
    
     BACKGROUND OF THE INVENTION 
     1. Field of Invention 
     The present invention generally pertains to cleaning or clearing devices and methods of using such devices for the in-situ clearing of artificial lumens within a living being including the in-situ clearing of feeding tubes. 
     2. Description of Related Art 
     The following is a description of the background of feeding tubes. It should be understood that the device and method of the present invention is not limited to the clearing of feeding tubes but is applicable to a range of artificial lumens such as indwelling catheters and that feeding tubes are being discussed simply by way of example. 
     A feeding tube is a medical device used to provide nutrition to patients who cannot obtain nutrition by swallowing. The state of being fed by a feeding tube is called enteral feeding or tube feeding. Placement may be temporary for the treatment of acute conditions or lifelong in the case of chronic disabilities. Varieties of feeding tubes are used in medical practice and are usually made of polyurethane or silicone. 
     A gastric feeding tube, or “G-tube”, is a tube inserted through a small incision in the abdomen into the stomach and is used for long-term enteral nutrition. The most common type is the percutaneous endoscopic gastrostomy (PEG) tube. Feeding tubes may also be of the nasogastric type commonly called “NG-tube”, which are introduced through the nose, down the esophagus and into the stomach in a procedure called Nasogastric intubation. PEG-tubes on the other hand are placed endoscopically: the patient is sedated, and an endoscope is passed through the mouth and esophagus into the stomach. The position of the endoscope can be visualized on the outside of the patient&#39;s abdomen because it contains a powerful light source. A needle is inserted through the abdomen, visualized within the stomach by the endoscope, and a suture passed through the needle is grasped by the endoscope and pulled up through the esophagus. The suture is then tied to the end of the PEG-tube that is to be external, and pulled back down through the esophagus, stomach, and out through the abdominal wall. The tube is kept within the stomach either by a balloon on its tip (which can be inflated or deflated) or by a retention dome which is wider than the tract of the tube. In the case of NG-tubes, once they are passed through the patient&#39;s nostril, a clinician must be careful not to accidentally slip the end of the tube into the patient&#39;s lungs. Additionally, upon placing the NG-tube in the patient&#39;s gastric system, for example the stomach, it is common for the tubes to slip as the primary securing means is to tape the tube to the patient immediately outside the nostril. Clinicians may pass nutrients to the patient&#39;s stomach or remove fluids from the patient via the lumen or NG-tube. 
     Approximately 410,000 PEG-tubes and 5 million NG-tubes are placed each year in the U.S. A down-side of the life-sustaining feeding tube is that they can become clogged. Based on a 35% clogging rate, US civilian medical facilities, treat over 1.7 million NG clogs and 140 k PEG clogs annually. 
     Numerous conditions that may necessitate enteral nutrition over long periods of time include but are not limited to traumatic injury or elderly illness such as Alzheimer&#39;s, Parkinson&#39;s, or Cancer. When long-term enteral access is needed, gastronomy—(G), jejunostomy—(J) or gastrojejunal—(GJ) tubes are often surgically inserted. J- and GJ-tubes are employed when gastric complications are present and improved nutrient uptake is necessary. Therefore, the J-tube distal end is positioned in the bowels. Reported clogging rates of GJ and J-tubes have been as high as 35% mainly due to the small bore, considerable length, and convoluted geometries of the tubes once placed. As the discussion below suggests, standard nursing protocols to clear tube occlusions are time consuming at best and are often unsuccessful. GJ- and J-tubes are especially challenging due to the curvature associated with placement. 
     When a patient&#39;s enteral feeding tube becomes clogged, the process of clearing it can be time-consuming and expensive, especially if the tube must be replaced. Additionally, a clog can interrupt the patient&#39;s supply of nutrients and cause him discomfort. Many nursing policies recommend flushing feeding tubes with water every four to six 5 hours, and before and after administering medications or checking gastric residuals. Even with these policies, the rate of feeding tube occlusion is approximately 12.5%. Small-bore tubes are even more prone to clogging than are large-bore tubes, and clogging of these tubes has been shown to be a major cause of feeding downtime. A patient with an occluded tube may miss several hours of feeding and receiving nutrients before the tube is unclogged or replaced. This concern, along with patients&#39; discomfort and the expense incurred by having to replace tubes that could not be unclogged, identifies problems to be corrected by the present invention. 
     Over time, feeding tubes become brittle and need to be replaced. A major cause of this is the accumulation of fungus inside the feeding tube. Standard feeding tube maintenance is to “flush” feeding tubes with water; however, this does not remove debris and fungus from the inner walls. Once a tube clogs, it is prone to reclogging. 
     Medications are the number one reason for tubes getting clogged. Certain medications, such as Metamucil or liquid pain reliever, build up on the inner walls of the tube and promote clogging. Other medications need to be crushed and mixed with water. If these medications are not adequately flushed or crushed finely, they will clog the tube. Older patients receive an average of 8-11 medications regularly throughout the day. Due to medical restrictions on fluid intake, or if the care-giver is rushed, an adequate flush may not occur. A clogged tube can leave an already compromised patient without medication or nutrition for hours, or even days, and is extremely frustrating to both the patient and the caregiver. 
     Patients with long-term feeding tubes are generally cared for at home or in a long term nursing facility. Advancements in technology and home nursing have allowed the utilization of home enteral nutrition to dramatically increase over the last few decades. While this is certainly positive, the down side is that when a feeding tube becomes clogged such that it cannot be unclogged with conventional methods, the patient must be transported to a specialty hospital to have the tube surgically removed and replaced. For persons recovering in rural areas, this could be even more problematic as an extensive car ride—several hours—may be necessary to reach the specialty hospital. This disruption is a time consuming, expensive, and agonizing experience for the patient and family members. Numerous hours without nutrients and medication could have significant adverse effects on recovery of wounded soldiers, elderly and chronically ill patients. 
     One product which claims the ability to assist in restoring feeding tubes by degrading the clogged matter is the CLOG ZAPPER™ available through CORPAK® MedSystems of Wheeling, Ill. and is disclosed in part in U.S. Pat. No. 5,424,299 (Monte). This product relies on a chemical solution being injected into an enteral feeding tube to clear remnant food from the tube and decontaminate the tube. The chemical solution mixture comprises maltodextrin, cellulase, alpha-amylose, potassium sorbate, papain, ascorbic acid, disodium phosphate, sodium lauryl sulfate, disodium EDTA, and citric acid. While the solution provides some assistance in degrading the clogged matter, some patients may be allergic to at least one of these ingredients and the system for introducing the chemical solution is not always successful. 
     The current state of science includes three approaches to remove a clog: (1) syringe flush, (2) chemical and enzymatic treatment, and (3) mechanical devices. 
     Syringe Flush 
     The most recommended approach is to use a ‘flushing syringe’. The first step is to insert the syringe into the tube and pull back on the plunger to attempt to dislodge the clog. If not successful, warm water is placed into the tube and pressure, alternating with syringe suction, is performed. This may need to be repeated for up to 30 or more minutes. However, this may not always be done with enough efficiency or regularity and a high percentage of tubes remain clogged. 
     Chemical and Enzymatic Treatment 
     Chemical approaches to clog removal involve a nurse flushing the tube with a variety of reported substances, such as enzymes, meat tenderizer, soda, and fruit juices. More recently developed chemical approaches include using a dose of pancrelipase (Viokase®) and sodium bicarbonate mixed with water. The Clog Zapper uses a syringe filled with an unclogging powder with a variety of ingredients. Product directions state to allow the solution to set for an hour before flushing the tube. The InTRO-ReDUCER is a catheter that allows the solution to be introduced directly at the clog site, which has been reported to be more effective than introducing the solution at the external end of the feeding tube. Chemical approaches to clog removal are not effective. Patients can also be allergic to the ingredients in the chemical approaches, or adversely affected by the high sodium content. 
     Mechanical Devices 
     Mechanical devices to remove clogs are also available. Tiny brushes on wires can be used to break up the clog, but have been reported to pack the material in some clogs even more densely. The Enteral Feeding Tube DeClogger® by Bionix is a plastic, flexible rod with a spiral tip on the end. The DeClogger can be twisted to break through or pull out obstructions. Even when successful, these approaches can take up to 30 minutes to several hours per patient, do not leave the tube walls clear, and do not progress through tortuous paths well. 
     What is needed is an apparatus capable of mechanically breaking up the clogged material from the sidewalls and inner portions of indwelling artificial tubes and catheters, and especially enteral feeding tubes. In addition, a regular maintenance schedule is preferred for using the apparatus to clean the walls of the tube. This regular maintenance cleans the tube walls of debris while stopping potential nucleation sites in which new clogs can grow from. 
     All references cited herein are incorporated herein by reference in their entireties. 
     BRIEF SUMMARY OF THE INVENTION 
     These and other features of this invention are described in, or are apparent from, the following detailed description of various exemplary embodiments of this invention. 
     It is hereby noted that the term “in situ” is defined as performing an act on an element while the element is being utilized for its commonly known function. For example, performing the act of clearing a clog or blockage from a feeding tube in situ refers to cleaning or clearing a clog or blockage in a feeding tube while the feeding tube is connected to the digestive system of a being, human or other. 
     It should be understood that it is the Applicant&#39;s belief that where the clearing member of the embodiments disclosed herein utilizes a brush or brush function along any portion of the clearing member that makes any entry into the artificial lumen, the clearing member also cleans that interior portion of the artificial lumen. 
     A device is disclosed for the in situ clearing of blockages in artificial tubes (e.g., feeding tubes, including pediatric feeding tubes, PEG-tubes, NG-tubes, GJ-tubes, NJ-tubes, etc.) completely or partially disposed within a living being. The device comprises: a controller that remains outside of the living being, and wherein the controller comprises an actuator (e.g., voice coil motor; DC motor; piezoelectric actuator such as amplified piezoelectric actuators and Langevin transducers; solenoid motor; pneumatic motor, etc.) for generating repetitive motion (e.g., reciprocating, rotating, etc.); a clearing member having a first end that is releasably coupled to the actuator and having a second working end that is insertable into an opening in the artificial tube; wherein the second working end has a portion that comes into repetitive contact with a blockage in the artificial tube for clearing the blockage therein, wherein the clearing member comprises a flexible material that permits  5  the clearing member to make repetitive contact with the blockage while the clearing member is positioned within a straight portion or within a curved portion of the artificial tube. 
     A method is also disclosed for the in situ clearing of blockages in artificial tubes (e.g., feeding tubes, including pediatric feeding tubes, PEG-tubes, NG-tubes, GJ-tubes, NJ-tubes, etc.) completely or partially disposed within a living being. The method comprises:  10  coupling a first end of a releasably-securable flexible clearing member to a controller and wherein the controller remains outside of the living being; inserting a second working end of the flexible clearing member into an opening in the artificial tube; energizing the controller such that the flexible clearing member experiences repetitive motion (e.g., reciprocating, rotating, etc.) and positioning the flexible clearing member such that the second working end  15  of the flexible clearing member comes into repetitive contact with the blockage for clearing the blockage therein; and wherein the flexible clearing member clears the blockage when positioned within a straight portion or within a curved portion of the artificial tube. 
    
    
     
       BRIEF DESCRIPTION OF SEVERAL VIEWS OF THE DRAWINGS 
       Exemplary embodiments of this invention will be described with reference to the accompanying figures. 
         FIG. 1  is an isometric view of the control box and clearing stem of the present invention resting on a table; 
         FIG. 1A  is an isometric view of the control box and clearing stem of the present invention disposed on another device support (e.g., a pole cart, bed, etc.), shown in partial, adjacent the patient; 
         FIG. 2  is a top plan view of another control box with the lid removed; 
         FIG. 2A  is a cross-sectional view of the control box taken along line 2A-2A of  FIG. 2 ; 
         FIG. 2B  is a top plan view of an alternate embodiment of the control box of  FIGS. 1 and 1A  with the lid removed; 
         FIG. 3  is a side view of the clearing stem of the present invention; 
         FIG. 3A  is a cross-sectional view of the clearing stem taken along line  3 A- 3 A of FIG.  3 ; 
         FIG. 3B  is a partial view of the sheath depicting both integer and periodic length markings; 
         FIG. 3C  is a side view of an alternate clearing stem that is the preferred embodiment of the present invention; 
         FIG. 3D  is a cross-sectional view of the alternate clearing stem of  FIG. 3C  taken along line  3 D- 3 D of  FIG. 3C ; 
         FIG. 4  is top plan view shown in cross-section depicting the clearing stem inserted within an artificial lumen in a living being showing the clearing stem clearing a blockage and depicting the stem&#39;s radius of curvature; 
         FIG. 5A  is a partial view of the clearing stem whose distal end includes a plastic clearing tip on the distal end of the wire; 
         FIG. 5B  is a partial cross-sectional view of the clearing stem whose distal end includes an alternative hollow cylindrical clearing tip on the distal end of the wire including a tip compression spring (TCS); 
         FIG. 5C  is a partial cross-sectional view of the clearing stem whose distal end includes an alternative clearing tip on the distal end of the wire including a gripping or chopping mechanism; 
         FIG. 5D  is a partial view of the clearing stem whose distal end includes an alternative clearing tip on the distal end of the wire includes a welded ball; 
         FIG. 6  is a partial view of the clearing stem whose distal end includes a brush mounted on the wire tip; 
         FIG. 7  is a partial view of the clearing stem whose distal end includes a brush mounted on the distal end of the sheath; 
         FIG. 8  is a partial view of the clearing stem whose distal end includes a brush mounted on the distal end of the sheath with bristles swept toward the extreme distal end of the stem; 
         FIG. 9A  is a top view of the tube depth-control collar; 
         FIG. 9B  is a side view of the tube depth-control collar; 
         FIG. 9C  is a cross-sectional view of the depth-control collar taken along line  9 C- 9 C of  FIG. 9A ; 
         FIG. 9D  is a partial isometric view of a fixed tube depth-control collar with the clearing stem inserted into a feeding tube; 
         FIG. 10  is a plan view of an exemplary voice coil motor (VCM) for use in the present invention; 
         FIG. 10A  is a cross-sectional view of the VCM taken along line  10 A- 10 A of  FIG. 10 ;  FIG. 11  is a top plan view of another exemplary motor of the present invention with the lid removed and depicting a DC motor that drives a scotch yoke; 
         FIGS. 11A-11C  depict a sequence of the scotch yoke operation of  FIG. 11 ; 
         FIG. 12  is a top plan view of another exemplary motor of the present invention with the lid removed and depicting an amplified piezoelectric actuator (APA); 
         FIG. 12A  is a cross-sectional view of the APA control motor taken along line  12 A- 12 A of  FIG. 12 ; 
         FIG. 12B  is a cross-sectional view of Langevin transducer control motor; 
         FIG. 12C  is a functional diagram depicting the first four overtones of clearing stem motion introduced by the Langevin transducer; 
         FIG. 13  is a top plan view of another exemplary motor of the present invention with the lid removed and depicting a solenoid; 
         FIG. 13A  is a cross-sectional view of the solenoid motor taken along line  13 A- 13 A of  FIG. 13 ; 
         FIG. 14  is a top plan view of another exemplary motor of the present invention with the lid removed and depicting a pneumatic actuator; 
         FIG. 14A  is a cross-sectional view of the control motor taken along line  14 A- 14 A of  FIG. 14 ; 
         FIG. 15  is a cross-sectional view of the magnetic pattern used in the VCM showing driving members having opposite pole directions; 
         FIG. 16A  is a partial end view of the drive side of the control box depicting a sealing diaphragm; 
         FIG. 16B  is a partial end view of the drive side of the control box depicting an alternative clearing stem coupling and sealing diaphragm configuration; 
         FIG. 16C  is a partial end view of the drive side of the control box of  FIG. 16  showing the clearing stem being engaged with the control box of  FIG. 16B ; 
         FIG. 17A  is a block diagram of the control box electronics for the reciprocating tube clearer (TCI) configuration; 
         FIG. 17B  is an operational flow diagram of the microprocessor of the control box electronics of  FIG. 17A ; 
         FIG. 18A  depicts a hand-held version of the present invention showing the handset being gripped by the operator and including a tube depth control-collar on the clearing member; 
         FIG. 18B  depicts an alternative hand-held version of the present invention; 
         FIG. 18C  is a side view of the alternative hand-held version showing the hand grip in cross-section; 
         FIG. 19  is a cross-sectional view of the hand-held version of  FIG. 18A ; 
         FIG. 20  is a cross-sectional view of the DC motor using a planetary gear train configuration; 
         FIG. 21  is a cross-sectional view of the DC motor using a compound gear train configuration; 
         FIG. 22  is an enlarged cross-sectional view of the clearing member and its components; 
         FIG. 23  is an enlarged cross-sectional view of the distal end of the clearing member which uses a helical design; 
         FIG. 24  is an enlarged cross-sectional view of the push-button actuated tube depth-control collar; 
         FIG. 25  is an enlarged cross-sectional view of a torque-limiter that is designed to slip once a certain applied torque is exceeded; 
         FIG. 26  is a cross-sectional view of the hand-held version of the present invention depicting the multi-nodal harmonics while the clearing member is spinning; 
         FIG. 27  is a cross-sectional view of a prior-art hand-held device that generates rotatable motion depicting undesired operation with only a nodal point at the proximal end of the clearing stem; 
         FIG. 28  is a block diagram of the control box electronics for the rotating tube clearer (TC 2 ) configuration; 
         FIG. 29  is a partial isometric view of the distal end of the sheath of the tube clearers TCI and TC 2  showing aspiration/irrigation ports; 
         FIG. 29A  is a partial isometric view of the distal end of the sheath of the tube clearers TCI and TC 2  showing aspiration/irrigation ports; 
         FIG. 29B  is a partial isometric view of the distal end of the sheath showing a lumen or wire that is hollow; 
         FIG. 29C  is a partial isometric view of the clearing stem using only a hollow lumen or a wire only, without a sheath, effectively using the indwelling lumen as the sheath; 
         FIG. 29D  is a partial isometric view of the distal end of the sheath of the tube clearers TCI and TC 2  showing a very narrow hollow wire allowing aspiration/irrigation along sides of wire; and 
         FIG. 29E  is a partial isometric view of the distal end of the sheath of the tube clearers TCI and TC 2  showing a small sheath channel for a very narrow hollow wire and a larger channel for aspiration/irrigation. 
     
    
    
     DETAILED DESCRIPTION OF THE INVENTION 
     The preferred embodiments of this present invention are illustrated in  FIGS. 1-29E  with the numerals referring to like and corresponding parts. 
     The present inventions are portable devices, as well as methods for such devices, for effectively removing, moving or breaking up a clog from the internal portions of an artificial tube or catheter, enteral tube, and preferably a feeding tube, including pediatric feeding tubes. The action of removing clogs and clearing artificial tubes can also be referred to as a “maintenance action”. 
     As will be discussed in detail later, there are basically two types of tube clearers (TC) disclosed herein, both of which are mechanical tube clearers. The first type of tube clearer TCI includes several embodiments that generate reciprocating motion of a clearing member for removing, moving or otherwise breaking up a clog in the artificial tube. This tube clearer TCI is preferred for use in nastrogastic (NG) feeding tubes, although it should be understood that TCI is not limited for only clearing NG feeding tubes.  FIGS. 1-17B ,  29 ,  29 B,  29 C,  29 D and  29 E are directed to TCI. 
     The second type of tube clearer TC 2  involves the generation of rotational motion of a clearing member for removing, moving or otherwise breaking up a clog. This tube clearer TC 2  is preferred for use in percutaneous endoscopic gastric (PEG) feeding tubes, although it should be understood that TC 2  is not limited for only dealing PEG feeding tubes.  FIGS. 5A ,  5 D,  18 A- 28 , and  29 A- 29 D are directed to TC 2 . 
     Both types of tube clearers TCI and TC 2  are unique to feeding tube clearing and overcome major obstacles in critical and long-term care medicine by clearing clogged feeding tubes quickly and efficiently. As will be discussed in detail later, the tube clearer TCI and TC 2  can remove a clog much faster (e.g., in less than 6 minutes) and at a much greater success rate than other currently-available clearing methodologies/devices, while at the same time, resulting in cleaner tube walls. Existing methodologies/devices simply do not work at all, do not clear the clogs properly, or they take a considerable time to do so. 
     In both tube clearers TCI and TC 2 , an activation unit or controller remains external to the artificial tube and therefore the patient. The activation unit or controller delivers energy to a clearing stem (also referred to as a “clearing member”) which is inserted into the artificial tube and whereby the clearing stem destroys the clog (e.g., clogs of food and/or ground medication, etc.) and cleans the tube walls. As a result, the activation units in these clearers TCI and TC 2  are reusable devices and the clearing stems are disposable. The clearing stems of TCI and TC 2  operate in narrow tube diameters, through several radial curves sufficient to reach, e.g., the bowel. Thus, the tube clearers TCI and TC 2  clear safely and with greater efficiency for NG-, PEG-, GJ- and NJ-tubes. Both tube clearers TCI and TC2 require no complicated set up, e.g., no tuning is required. Reciprocating Tube Clearer TCI 
     As shown in  FIG. 1 , the tube clearer TCI comprises an activation unit (also referred to as the “control box” or “controller”)  1  which remains external to the artificial tube 39 (see  FIG. 4 ) being cleared, and therefore is also external to the patient (not shown). The activation unit  1  delivers energy to a clearing stem  26  which clears as it moves through the tube inner lumen  41  of the indwelling artificial tube  39 , destroying the clog  40  and clearing the walls of the artificial tube  39 , viz., the tube inner lumen  41  walls. Where feeding tubes are being cleared by the tube clearer TCI, the tube clearer TCI breaks up clogs of food and ground medication in a short time (e.g., less than 6 minutes). The reusable control box  1  includes a motor which drives (actuates) the disposable clearing stem  26 . The control box  1  is positioned and releasably secured onto a table, tray, or nursing cart  38 , such as shown in  FIG. 1 . Alternatively, the control box  1  can be positioned on a pole cart  38 A (see  FIG. 1A ), or bed rail or any other type of support that is adjacent, or which can be moved adjacent to the patient or living being. 
     As shown most clearly by way of example in  FIG. 3A , the clearing stem  26  comprises a wire  28  running concentrically through a sheath  30 . The wire  28  protrudes from the end of the sheath  30  and is actuated while the sheath  30  remains stationary and is secured to a non-moving portion of the control box  1 . The motion at the wire tip  29  clears the occlusion or clog  40 . 
     Control Box  1   
     As shown in  FIGS. 2-2B , the control box  1  comprises a motor  14 , drive electronics  10 , electrical connectors, wiring, and clearing stem connectors. The control box  1  is preferably constructed of polymer, although metallic, rubber, or a combination of all three materials may be used. The preferred polymer is flame-retardant ABS plastic, although other polymers such as polyurethane, polypropylene, and nylon, but not limited to such, may be used for, among other things, their lightweight composition and structural integrity. Metals such as aluminum, titanium, steel, brass in sheet or machined form may also be used, especially where certain motor technologies (e.g., amplified piezoelectric actuators (APAs)) are used; to maintain efficiency of APAs, the non-moving portion of them needs to be effectively clamped or else too much deflection on the side that should be clamped will greatly reduce the APAs&#39; efficiency; a metal control box provides sufficient rigidity to properly clamp. The control box  1  has a releasable securing mechanism such as rubber feet, mechanically actuated suction cup, screws, rubber stops, or magnetic feet, etc. that facilitates its use on a table or nursing cart. As such, the control box  1  remains portable but is stationary during use. The motor  14  drives a motor shaft  15  that generates the reciprocating motion. It should be understood that  FIG. 2B  depicts the preferred control box  1  because it comprises a novel clearing stem-control box interface, as will be discussed in detail later with regard to  FIGS. 16B-16C .  FIG. 2B  also depicts, by way of example only, the use of a counter balance mechanism  14 A to counteract vibration caused by the reciprocation of an actuating motor  14 , as will also be discussed later. 
     In another embodiment, the electronic circuit and componentry for example power indicator  3 , fault indicator  4 , enable switch  72  can be incorporated into a membrane switch such as XYMOX Technologies, Inc. Model No. 54894. 
     Clearing Stem/Member and Connectors 
     The clearing stem  26  comprises a sheath  30  which is fed into the clogged artificial tube. The preferred sheath material is polytetrafluoroethylene (PTFE) although other tube materials may also be used such as, but not limited to, nylon, polyvinyl chloride (PVC), polyurethane, polyethylene, polypropylene, fluoropolymer, Viton, Hytrel. As mentioned previously, within the sheath  30  is a wire  28 , which is attached to the motor  14 . The motor  14  supplies reciprocating (also referred to as “oscillating”) motion to the wire  28 , causing the wire  28  and its wire tip  29  to reciprocate back and forth. As can be seen most clearly in  FIGS. 3-3A , the wire  28  protrudes beyond the end of the sheath  30 , and into the clog  40  ( FIG. 4 ) which causes the disruption of the clog  40 . The length of the wire protrusion  28 A beyond the end of the sheath  30  strongly impacts the effectiveness of the clearing. In addition, the roundness of the wire tip  29  strongly impacts the ease of insertion of the clearing stem  26  into the artificial tube  39 . 
     The clearing stem  26  may comprise a length of 60 cm to 250 cm, but preferably 180-220 cm, and most preferably, 203 cm. In addition, the wire  28  may comprise a flexible wire most preferably stainless steel twisted wire, but could also be helical wrapped wire or a flexible stainless steel wire encased in a polymer wrapping, such as shrink wrap. The wire  28  protrudes from the end of the sheath a distance of 0 to 13 cm, but preferably 1 to 5 cm and most preferably 2.54 cm. The clearing stem  26  releasably secures to the control box  1  via a Luer clearing stem connector  6 . 
     It should be noted that that, alternatively, the wire  28  may be hollow to enable other features such as irrigation or aspiration of the artificial lumen, as will be discussed later. 
       FIGS. 3-3A  depict the clearing stem  26  which uses a magnetic-based and Luer lock connection to the control box motor  14 , a stem stiffener  31  at a proximal end of the clearing stem  26 , the amount that the wire tip  29  extends beyond the sheath  30  (referred to as the “protrusion” or “wire protrusion”)  28 A, a wire stop  27 , and tube depth-control collar  22 . In particular, the proximal end of the clearing stem  26  comprises a clearing stem magnet  33  and a Luer clearing stem fitting  32  ( FIGS. 3-3A ). The control box  1  includes a Luer clearing stem connector  6  ( FIGS. 2-2A ) along with a motor magnetic coupler  13  which itself includes an internal magnet  12  in the coupler bore. To releasably secure the clearing stem  26  to the control box  1 , the clearing stem magnet  33  is passed through the Luer clearing stem connector  6 , through a diaphragm  9  and into the motor magnetic coupler  13  where the clearing stem magnet  33  and magnet  12  come into contact to form the magnetic coupling. The Luer clearing stem fitting  32  and Luer clearing stem connector  6  are then engaged to form the Luer lock configuration. Advantages to this magnetic connector include: the omission of threads (which can suffer from stripping), the avoidance of any special tools to facilitate connection, reduced occurrence of bio-contamination, and the avoidance of having to disassemble any portion of the control box  1  in order to switch clearing stems  26 . The design of the mechanical components and the strength of the two magnets  33 / 12  are critical to avoid detaching the clearing stem  26  when the motor  14  is reciprocating. By way of example only, the magnets  12 / 33  may comprise rare earth magnets (e.g., neodymium) for holding the clearing stem wire  28  to the motor shaft  15 . The appropriately-sized magnets may provide from 0.5 to 3.0 lbs of holding force. The sheath is held fast to the control box  1  by the Luer lock connector/receptacle combination. It should be understood that clamping of the sheath  30  needs to have a certain force to secure the sheath  30 , but not crush the sheath  30 . The stiffness of the sheath  30  must be adequate to preserve the inner diameter cross section during operation. This is necessary to ensure the wire  28  is not pinched by the operator and its motion impeded. The wire  28  must also be flexible enough to navigate a small radius of curvature, such as 2.54 cm radius, while maintaining operation, as can be seen in  FIG. 4 . In particular,  FIG. 4  depicts a clog  40  blocking the tube inner lumen  41  of an artificial tube  39  and wherein the clearing stem  26  navigates a tight radius of curvature, R, and clears the clog  40  which is located past the radius of curvature R. The magnets  33 / 12  may be cylindrical in shape and the magnet  12  within the motor magnetic coupler  13  is recessed within the motor magnetic coupler  13  that fits over the motor shaft  15 . The magnet recess  12 A keeps the magnet from sliding along its surface plane and becoming detached while it is reciprocating. A sensor (magnetic or contact, not shown) may also be implemented to illuminate an indicator  75 A (e.g., an LED, see  FIGS. 2A and 17A ) on the control box  1  to confirm that the magnetic connection is securely made. This feature also alerts the user if the connection becomes broken during use. 
     In an alternate embodiment, the magnet  33  (or  12 ) may only be located on one of the mating pieces, and a disc or cylinder of magnetic material, be located on the other. 
     It should be understood that this magnetic Luer lock coupling is by way of example only. It is within the broadest scope of the invention to include other types of releasably securable connector mechanisms, such as, but not limited to, threaded couplings. 
     As mentioned previously, the control box  1  includes a diaphragm  9  which seals the control box  1  from contamination from the outside. As can be seen most clearly in  FIGS. 2-2A , the diaphragm  9  permits magnetic attachment of the clearing stem  26  so that the magnets  33 / 12  can make contact while at the same time sealing the box  1  such that no debris, biological or other, enters the control box  1 .  FIG. 16A  is an enlarged partial view showing the sealing diaphragm  9  that does not interfere with motor shaft  15  motion. The diaphragm  9  prevents, among other things, the ingress of liquids into the control box  1 . The diaphragm  9  may also be located externally or on the boundary of the control box  1  so that it can be cleaned more easily. 
     As also mentioned previously, the preferred control box  1  is that shown in  FIG. 2B  wherein a preferred novel clearing stem-control box interface is used. In particular,  FIGS. 16B-16C  depict the drive side of the control box  1  which includes a sheath attachment bracket  83 , an alternate diaphragm  9 A, a diaphragm sealing ring  84  (see also  FIG. 2B ), the motor (e.g., voice coil motor, VCM) shaft  15  along with an alternate motor magnetic coupler  13 A (e.g., a magnetic coupler for a VCM). As can be seen from  FIG. 16B , the alternate diaphragm  9 A contains no holes or apertures through which the clearing stem  26  passes. The diaphragm sealing ring  84  secures the compliant alternate diaphragm  9 A in place. To facilitate coupling the clearing stem  26  to this control box, as can be seen most clearly in  FIG. 16C , the proximal end of the clearing stem  26  comprises an alternate clearing stem fitting  32 A and an alternate clearing stem magnet  33 A positioned within an alternate clearing stem magnetic fitting  33 B. In order to couple the clearing stem  26  to the control box motor  14 , the alternate clearing stem magnet fitting  33 B is brought into close proximity with the alternate diaphragm  9 A such that the two magnets  12  and  33 A are magnetically coupled and abutting through the alternate diaphragm  9 A. Thus, there is no breach of the seal of the control box  1  because the alternate diaphragm  9 A remains closed. Simultaneously, the alternate clearing stem fitting  32 A is secured in the sheath attachment bracket  83 . As a result, reciprocation of the motor shaft  15  can occur without passing through any aperture or opening in the alternate diaphragm  9 A.  FIGS. 1  and IA depict a drive-end view of the clearing stem  26  coupled to the control box  1 . 
     As can be appreciated from  FIG. 3A , the wire stop  27  limits the amount of travel of the wire  28  to the right (i.e., towards the motor  14 ) during operation. In an alternate embodiment, as shown in  FIGS. 3C and 3D , the wire stop  27  has been removed and instead an alternate wire stop  27 A is used closer to the proximal end of the clearing stem  26 . This alternate wire stop  27 A comprises a stretchable/pliant (e.g., silicon) tube whose ends are bonded to the alternate clearing stem fitting  32 A on one side and to the alternate clearing stem magnet fitting  33 B on its other side. This alternate wire stop  27 A supports the wire  28  that passes through it. During operation, the alternate wire stop  27 A compresses and expands accordingly without interfering with wire  28  oscillation/travel. This alternate wire stop  27 A is preferred because it is located externally of the artificial tube  39  and thereby avoids having a stop at the working end of the wire  28  that could interfere with operation. Thus, the alternate wire stop  27 A serves to keep the wire  28  from sliding out of the sheath  30 . 
     As shown in  FIG. 3A , the wire tip  29  of the wire is rounded to allow the wire  28  to break up a clog  40  ( FIG. 4 ), and to resist penetrating an organ (e.g., stomach or other tissue/organ, etc.) should the wire tip  29  ever make its way close to an organ. The wire protrusion  28 A may also be given added flexibility by design compared to that of the rest of the wire  28 , to further reduce the risk of the clearing stem wire tip  29  having enough force to penetrate an organ (e.g., the stomach) and/or to increase displacement at the wire tip  29  and facilitate clearing of the clog  40 . As mentioned previously, the length of the wire protrusion  28 A beyond the end of the sheath  28  and the roundness of the wire tip  29  strongly impact the ease of insertion into an artificial tube. Ideally, the wire tip  29  radius is 0.5 to 2.0 times the overall wire  28  diameter. The stiffness of the sheath  30  comprises a balance between being stiff enough to prevent the operator from clamping down on the wire  28  and stopping wire  28  motion versus being flexible enough to enter an artificial (e.g., feeding) tube  39  and to navigate curves in the tube inner lumen  41  of the artificial tube  39 . 
     Another safety feature of the present invention TCI is that the force generated at the end of the wire tip  29  is less than 5% of the force generated at the motor  14  and therefore, this force reduction provides a safety feature of avoiding puncturing an organ accidentally but yet providing sufficient force to break up the clog  40  and helping to clear the walls of the tube. 
     As mentioned previously, a stem stiffener  31  ( FIGS. 3-3A ) is provided at the proximal end of the clearing stem  26  which prevents the operator from over-bending the clearing stem  26  and thereby stopping the reciprocation. The stem stiffener  31  may be constructed of the same material (of a larger diameter than the wire  28  or sheath  30 ), may be integrated into the sheath  30  via custom extrusion, or may be constructed of a different material, such as any polymer or metal. 
     To prevent the “over-insertion” of the clearing stem  26 , a tube depth-control collar  22  ( FIGS. 3-3A  and  9 A- 9 C) is provided. The tube depth-control collar  22  comprises a tube depth-control collar body  24  which includes an internal spring  25 . A tube depth-control collar push button  23  is provided to lock or unlock the tube depth-control collar  22 . In particular, as shown most clearly in  FIG. 9A , the depth control collar push button  23  has a central passageway of push button  23 A and the tube depth-control collar body  24  has a central passageway of collar body  24 A. A spring  25  acts to misalign these two passageways  23 A/ 24 A. Thus, to re-position the tube depth-control collar  22  along the length of the sheath  30  (not shown), the depth control collar push button  23  is depressed which momentarily relieves any clamping force on the sheath  30  and the tube depth-control collar  22  can then be moved. When the operator wishes to lock the tube depth-control collar  22  in position, he/she releases the tube depth-control collar push button  23  which results in the sheath  30  being clamped between an upper portion of collar body  24 B of the tube depth-control collar body  24  and a lower portion  23 B of the tube depth-control collar push button  23 . The force applied by the depth-control collar to the sheath  30  needs to be compressive enough to hold the tube depth-control collar body  24  in place against the sheath  30 , but not to clamp the sheath  30  onto wire  28 . Sheath length markings  30 A ( FIG. 3B ) and integer markings  30 B ( FIG. 3B ) are provided to facilitate positioning the tube depth-control collar  22  along the length of the sheath  30  depending on the length of the artificial tube  39  being cleared. The markings  30 A/integers  30 B are in ascending or descending order from the distal end  30 C of the sheath  30  to the proximal end  30 D. Along with the stiffness of the sheath  30 , the spring constant of the spring  25  comprises a balance between the force necessary to maintain the tube depth-control collar body  24  in place on the sheath  30  while avoiding the tube depth-control collar body  24  from clamping down on the wire  28  and stopping wire  28  motion. 
     It should be understood that it is within the broadest scope of the present invention to include fixed tube depth-control collars  22 A, such as that shown in  FIGS. 3C ,  3 D and  9 D. In particular, a plurality of clearing stems  26  may be provided, each having a fixed tube depth-control collar  22 A fixed at a predetermined length (e.g., 35 inches, 44 inches, etc.) along the sheath  30 .  FIG. 9D  shows the fixed tube depth-control collar  22 A abutting the proximal end of the feeding tube FT thereby preventing the sheath  30  from entering any further within the feeding tube FT. Using this embodiment, the operator selects one clearing stem  26 , from a plurality of clearing stems  26 , having a particular fixed tube depth-control collar  22 A and clearing stem  26  length that is appropriate for the particular feeding tube FT that contains a clog that is to be cleared. 
     To facilitate clearing, a brush may be included on the wire tip  29  or on the distal end of the sheath  30 . For example,  FIG. 6  depicts a wire tip brush  35  on the end of the wire  28  whereas  FIGS. 7 and 8  depict respective brushes with sheath tip brush  36  and forward swept sheath tip brush  37  on the end of the sheath  30 . Therefore, as the wire protrusion  28 A reciprocates, the wire tip brush  35  cleans the tube walls or when the sheath  30  is inserted into the artificial tube  39 , the insertion motion causes the brush  36  or  37  to clean the tube walls, as well as facilitate the movement of the dislodged blockage and/or its pieces. In particular, the small brush (e.g., polyester, foam, or twisted in wire) on the distal end of sheath ( 36  or  37 ) or wire ( 35 ) provides more thorough clearing of tube walls. With particular regard to brush  36  or  37 , mounted on the distal end of the sheath  30 , the brush  36  or  37  is non-moving in this embodiment, which helps to clear excess particles from tube walls after the wire protrusion  28 A has cleared the clog  40  and as the sheath  30  is retracted and moved out of the artificial tube  39 . The advantage of the brush  36  or  37  on the sheath  30  is that the brush  36  or  37  does not impede the wire  28  motion at all. It should be noted that the forward swept sheath tip brush  37  on the distal end of the sheath  30  shown in  FIG. 8  includes bristles that are swept in the distal direction. This makes clearing effective as the forward swept sheath tip brush  37  is inserted into the tube, but also allows for a smoother retraction because the sweep-direction of the bristles reduces the resistance of the forward swept sheath tip brush  37  when the operator is removing the clearing stem  26  from the artificial tube  39 . This reduced resistance minimizes the chance of dislodging the artificial tube  39  from the patient when the clearing stem  26  is removed. 
     Other configurations of the clearing stem  26  include a range of wire tip  29  designs. For example, a sphere (e.g., metal or plastic) anywhere along the length of the wire protrusion  28 A may be included, such as the ball tip  34 E in  FIG. 5D . If the sphere is included at the wire tip  29 , this helps prevent the inadvertent insertion into an organ (e.g., stomach) wall, and also prevents the inadvertent retraction of the wire protrusion  28 A into the sheath  30  during use, setup or clearing illustrated in  FIG. 5D . Another alternative end may comprise a plastic end wherein a plastic tip is fused or ultrasonically welded to the wire tip  29  and which may comprise the shape of a point, helix, or radius, etc., illustrated in  FIG. 5   a . In addition, these alternative tips may further comprise ridges or a pattern designed to sweep broken debris away from the clog  40  site.  FIG. 5A  depicts the distal end of the wire  28  with a plastic wire tip  34 . An alternative tip design may include a spring guide wire design possibly exemplified by Lake Region Medical Paragon Pre-coat guide wires. Another alternative tip could be flexible such as a Tecoflex® tip which causes the tip to slide across contacted tissue rather than puncturing tissue, thus providing an additional safety feature. 
       FIG. 5B  depicts another alternative end which may comprise a small spring mechanism which provides increased displacement and protection against an over-insertion puncture. In particular, a plastic or metal alternate tubing tip  34 A is positioned over the distal end of the wire  28 . The rear end of the alternate tubing tip  34 A is secured to one end of a tip compression spring TCS that is slid onto the wire  28 . A fixed member  34 B is secured to the wire  28  and to the other end of the tip compression spring TCS. Thus, the alternate tubing tip  34 A acts as a further protection against accidental contact with soft tissue, since the alternate tubing tip  34 A can only be retracted when it encounters a solid object, e.g., a clog, and whereby the wire tip  29  is then exposed to the solid object. Once the clog is cleared, the alternate tubing tip  34 A springs back in position ahead of the wire tip  29  to shield it from contact with bodily tissue or organs. Moreover, the wire tip  29  may also comprise a small gripping mechanism wherein the wire tip  29  contains a small cable-actuated gripping mechanism to dislodge clogs  40  or retrieve samples of clog material. In particular,  FIG. 5C  depicts gripping/chopping mechanism  34 C that are hinged or pivoted at pivot point  34 D. By actuating a control member (not shown, e.g., a cable, rod, electromechanical motor, piezoelectric motor etc.), the gripping/chopping mechanism  34 C can be closed around a clog specimen or used to tear away the clog material to dislodge clogs or retrieve a sample of the clog material. 
     An alternative design to the wire  28  is the provision of a flexible portion of wire  28  located between the end of the sheath  30  and the wire tip  29 . Thus, the wire protrusion  28 A may comprise a material that is more flexible than the remaining part of the wire  28  that couples to the motor shaft  15 . 
     Control Box Motor for TCI 
     As mentioned previously, the motor  14  drives the wire  28 , creating linear displacement. The back and forth displacement of the wire  28  allows it to break up and clear clogs  40  in artificial tubes (e.g., enteral feeding tubes and especially NG feeding tubes), while simultaneously cleaning debris from the tube walls. The wire tip  29  of the wire  28  has a linear displacement, preferably, in the range of 0.25 to 25 mm, more preferably 2-10 mm from the distal end of the sheath  30 . The frequency of operation of the motor shaft  15  preferably varies from 10 to 100 Hz but more preferably in the 15-40 Hz range. The motor  14  has a range of displacement preferably from 1-40 mm and more preferably in the range of 10-30 mm. The motor blocking force (i.e., the maximum force output) has a preferable range of 2-25N and more preferably 6-14N. 
     The reciprocating motion of the clearing stem  26  of the present invention TCI can be achieved using a variety of motor technologies, such as, but not limited to, voice coil motors (VCMs) as illustrated for the motor  14  ( FIGS. 2-2B ,  10 - 10 A and  15 ), DC motors  49  ( FIG. 11 ,  11 A- 11 C), piezoelectric transducers, including amplified piezoelectric actuator motors  59  (APA, such as those disclosed in U.S. Pat. No. 6,465,936 (Knowles, et. al), whose entire disclosure is incorporated by reference herein) ( FIGS. 12-12A ), piezoelectric actuators, active polymer compound actuators, solenoid motors  55  ( FIGS. 13-13A ), pneumatic motors  42  ( FIGS. 14-14A ), magnetorestrictive transducers, electrorestrictive transducers, etc. 
     As shown in  FIGS. 2-2A ,  10 - 10 A, and  15  the motor  14  may comprise a voice coil motor (VCM) having a VCM body  16  mounted within end bearings  18 , a displaceable motor shaft  15 , dampers or spring  19 , and magnets  20  mounted to the motor shaft  15 , with pole pieces  21  A,  21 B and  21 C ( FIGS. 2A ,  10 A and  15 ) located at the ends and within the center of the magnets  20 . Coil windings  17  are wound around the VCM body  16  and thus do not interfere with VCM motor shaft  15  displacement. Motor mounts  7  and motor mount dampers  8  secure the motor  14  within the control box  1  while avoiding direct coupling against the bottom surface of the control box  1 . A motor printed circuit board (PCB)  11  distributes the current commands from the electronics  10  to the coil windings  17  through wires  53 . When an electric current is applied through the coil windings  17 , a magnetic field, due to Ampere&#39;s Law, is produced inside the coil windings. The non-uniform magnetic field at the ends exerts a force on the permanent magnets  20 . Alternating the current alternates the direction of the magnetic field gradients and results in a reciprocating motion of the motor shaft  15  with respect to the VCM body  16 . The magnitude of the force is determined by the magnetic flux density, which is proportional to the number of turns per length of the coil, current magnitude, cross-sectional area of the coil, as well as the strength of the permanent magnets  20 . The springs  19  absorb the energy associated with abrupt changes in the direction of the inertial force of the magnets  20  and VCM body  16  when actuated, resulting in a lowering of vibration and increasing the tube clearer TCI usability and efficiency. 
     By way of example only, the spring constant of the springs  19  can range from 0.5-5 lb/in, and more preferably 1.5-2.5 lb/in. 
     A soft stop SS may be installed at the free end of the VCM motor shaft  15  because the shaft tends to drift off center during use. 
     A further variation of the use of a plurality of magnets is to arrange the plurality of magnets into two “driving members” disposed between the pole pieces  21 A- 21 C, mentioned previously. Pole pieces  21 A- 21 C are typically ferromagnetic and are preferably stainless steel. As shown most clearly in  FIG. 15 , the south poles of the first magnetic driving member  20 N and the south poles of the second magnetic driving member  20 S are fixedly secured to the opposing faces of the pole piece  2  IB in order to provide a zone of maximum magnetic flux density which extends radially outwardly from the central portion of the pole piece  21 B, similar to the configuration disclosed in U.S. Pat. No. 4,363,980 (Peterson) whose entire disclosure is incorporated by reference herein. Alternatively, each magnetic driving member  20 N and  20 S may be replaced with a single elongated permanent magnet, rather than using a plurality of magnet elements as shown in  FIG. 15 . In either case, the driving members  20 N and  20 S have opposite pole directions. 
     It is within the broadest scope of the present invention that the relative positions of the coil windings  17  and the magnets  20  are reversed (not shown), i.e., the coil windings  17  are wound directly around the motor shaft  15  and the magnets  20  are positioned around the VCM body  16  and thus do not interfere with the motor shaft&#39;s  15  reciprocation. 
     Alternatively, a dual coil motor or actuator (also not shown) is also within the broadest scope of the present invention. In particular, instead of using magnets  20 , two coil windings are used wherein one coil is wound directly around the motor shaft  15  and a second or outer coil is wound around the first or inner coil but without interfering with shaft displacement. Each coil is supplied with respective alternating current sources which generate respective electromagnetic fields that also generate a reciprocating motion of the motor shaft  15 . The inner coil may conduct direct current DC while the outer coil conducts alternating current AC. Alternatively, the inner coil may conduct alternating current AC while the outer coil conducts direct current DC, or both the inner coil and the outer coil may conduct alternating current AC. 
     Moreover, to reduce vibration caused by the oscillating motion of the motor shaft  15 , a secondary VCM or counter balance mechanism  14 A of similar size (also referred to as a “countermass” or “counterbalance”) may be included and driven at an opposite phase (e.g., 180° phase lag) for cancelling vibration caused by the motor  14 . See  FIG. 2B . Thus, when the tube clearer TCI is operated such that the first VCM is activated to cause the motor shaft  15  to move, a first momentum vector is produced. The second VCM is operated such that it creates a second momentum vector equal in magnitude but opposite in direction to the first momentum vector, such that the net sum of the first and second momentum vectors is minimized and preferably equal to zero. In particular, to maximize vibration reduction, the moving parts (shaft, magnets, pole pieces, attachments, etc.) of the counter balance mechanism  14 A should have a moving mass and velocity (frequency and displacement) equal to that of the moving parts of the actuating motor  14 . This is based on the principle of Conservation of Momentum. The sine waves that actuate both VCMs must have a 180 degree phase lag between them. This causes their forces to be opposite and (ideally) equal, cancelling each other out. As such, operation of the tube clearer TCI does not cause “chatter” and therefore there is no irritation to the operator or patient. 
     DC Motor  49   
     The motor may also comprise DC or DC brushless motor  49  for creating reciprocating displacement via a scotch yoke SY or similar mechanism.  FIG. 11  depicts the control box  1  using a DC motor  49  and scotch yoke SY as the actuating mechanism. No signal generating electronics are needed for this application since the DC motor  49  is simply turned on to cause a rotating crank CR to drive the scotch yoke slider  50  and the scotch yoke shaft  52  in reciprocating motion. The adapter  51  transmits the scotch yoke SY motion to the scotch yoke shaft  52 .  FIGS. 11A-11C  show three still frames as an example of scotch yoke SY motion.  FIG. 11A  and  FIG. 11B  show Scotch yoke forward displacement direction  50 A and  FIG. 11C  shows Scotch yoke rearward displacement direction  50 B are moving in a reciprocating motion. 
     APA Motor  59   
     An amplified piezoelectric actuator (APA)  60  creates reciprocating displacement in the lower range, preferably (0.1 to 2.0 mm), anchored to the control box  1 . One or more APA motors  59  can be used in series, as this increases displacement.  FIGS. 12-12A  depict the control box  1  with an APA as the actuating mechanism. In particular, the APA actuator  60  is mounted to the control box via an actuator mount  61  which is indirectly coupled to the control box  1  bottom via motor mount damper  8 . An actuator shaft  62  conveys the reciprocating motion, from APA actuator  60  expansion and contraction, to the clearing stem (not shown) via the magnetic coupling discussed earlier for the other embodiments. 
     Langevin Transducer  77   
     A Langevin transducer  77  can be used for the motor  14 . As shown in  FIG. 12B , the Langevin transducer comprises a plurality of piezoelectric elements  78  are arranged to cause a horn  81  to vibrate to form the reciprocating motion. The horn  81  is secured to an actuator mount  61  using a pre-stress bolt  79 . The Langevin transducer  77  includes a tail mass  80  for bolt-clamping the Langevin transducer  77  to the actuator mount  61 . The forward end of the horn  81  is tapered such that a distal end of the horn passes through the control box alternate diaphragm  9 A. A clearing stem attachment  82  is provided to receive/mate with the clearing stem  26  as discussed previously. A power source (not shown) that provides the proper activation energy is coupled through the power plug  5  and via electronic control wires  53 . 
     It should be noted that activation of the Langevin transducer  77  creates reciprocating motion with the introduction of several overtones (viz., first-fourth overtones), shown in  FIG. 12C . As part of the design of the present invention, the lateral displacement caused by these overtones is kept to a minimum. In particular, the piezoelectric elements  78  (e.g., a plurality of piezoelectric ceramic discs) are held in compression between the tail mass  80  and horn  81 ; and the pre-stress bolt  79  passing from a proximal end of the tail mass  80  and threading into the horn  81 . Vibratory motion is caused by the activation of the piezoelectric elements  78  upon being exposed to an alternating electric field such as from an AC electrical current applied to electrical contacts (not shown) formed on opposing sides of each of the piezoelectric elements  78 . The vibratory motion is translated as a standing harmonic wave spanning longitudinally across the horn  81  and to the clearing stem (not shown). Therefore, when operated at ultrasonic frequencies, the Langevin transducer  77  translates the ultrasonic energy as a reciprocating vibration to the clearing stem  26 , and produces a standing wave within the flexible member. The horn  81  and tail mass  80  are made of a metal such as titanium, stainless steel or, preferably, aluminum. The pre-stress bolt  79  is generally of stainless steel, but not limited thereto. 
     Solenoid Motor  55   
     The solenoid motor  55  shown in  FIGS. 13-13A  mounted in the control box  1  operates in a very similar manner as does the motor  14 , discussed previously. A return spring  58  is required with the solenoid  56  since it has one-way actuation. In particular, the electronics  10  are configured to pulse the solenoid  56  such that during the pulse, the solenoid shaft  57  is driven to the left in  FIGS. 13-13A  and when the pulse is terminated, the return spring  58  restores the solenoid shaft  57  to the right. This action is repeated at the frequencies discussed previously. 
     Pneumatic Motor  42   
       FIGS. 14-14A  depict a pneumatic motor  42  for creating the reciprocating motion. In particular, the pneumatic motor shaft  44  is driven by the pneumatic motor  42  which receives pneumatic pulses from a pneumatic pulse generator (not shown) via an air supply inlet  54  on the control box  1  and through internal tubing  47 . The pneumatic motor  42  is positioned within a pneumatic motor housing  43  which includes a pneumatic motor diaphragm  46  for distributing the pneumatic pulse evenly to the pneumatic motor shaft  44 , thereby maintaining its alignment, while at the same time providing a tightly-sealed motor configuration. The pneumatic pulse causes the pneumatic motor shaft  44  to be driven to the left while compressing a return spring  58 . Once the pneumatic pulse is terminated, the return spring  58  restores the pneumatic motor shaft  44  to the right. This action is repeated at the frequencies discussed previously. 
     Electronics 
       FIG. 17A  provides a block diagram of the electronic system  63  contained within the electronics  10 . A microprocessor (e.g., MSP430F2618TPMR) controls the power electronics  73  to the motor  14 . Although not shown, a power supply (e.g., an Autodyne UL medically-approved power supply AMP6301-08) converts the 120 VAC from the wall outlet to 24 VDC. A microprocessor power unit MPU  69  (e.g., a voltage regulator circuit, such as the LM317/LM337) reduces the incoming (e.g., +24 VDC) power  67  to a lower power (e.g., +3.3 VDC indicated by  70 ) for use by the microprocessor  71 . The microprocessor  71  controls the motor  14  via power electronics  73 , as well as all of the associated indicators, such as LED indicators  3 ,  4 ,  75  and  75 A. The power electronics  73  convert the microprocessor  71  commands into a power signal to motor  76  (24V p-p AC) using internal inverters to activate the motor  14 . An enable switch  72  is provided to permit the clearing stem to be continuously reciprocated for a predetermined period of time (e.g., 4-20 minutes), which avoids running the device TCI for too long but provides sufficient time to effect clearing the clog. A control box power switch  2  is coupled to the microprocessor power unit (MPU)  69  via a fuse  66 . A power indicator (e.g., LED)  3  is provided on the control box  1 . When the control box  1  is externally powered, e.g., from 120 VDC, 60 Hz wall power, a power-cord (not shown) is supplied with the control box  1 , and which includes an AC/DC converter. It should be understood that this does not limit the operation of the present invention to wall power in any manner and that the control box  1  can be operated off any type of power source, including battery power. 
     The electronic system  63  may also include a displacement sensor DS (e.g., an LVDT (e.g., Macro Sensors CD 375-500) or force sensor/load cell (e.g., Futek LPM 200); or eddy current sensor (e.g., Micro-Epsilon eddy NCDT 3010), etc.) for accomplishing closed loop motor control as well as detecting changes in the clearing process. For example, the sensor DS forms a closed loop with microprocessor  71  for maintaining the motor shaft  15  in a centered position, which maintains the motor  14  where the force is the greatest and provides optimum control. Alternatively, the sensor DS may comprise a displacement/force feedback sensor or even an optical displacement sensor (e.g., Variohm Eurosensor). The DS sensor output may also be used for self-centering of the wire  28  during operation. As part of the closed loop control, it may be advantageous to also change any DC offset to alter the force profile at the wire tip  29  and to provide more power to one side. 
     In addition, an impedance sensor/current sensor IS may be included for detecting the change in voltage/current of the motor  14  and communicating with the microprocessor  71  for determining the status of the clearing process, such as initial contact with blockage, passage therethrough, etc. This status can be conveyed through a display or clearing status indicator  75  (e.g., LEDs, 7-segment displays, audible indicators, etc.) or a series of differently-colored LEDs  75  (e.g., from green to yellow to red). Alternatively, where the displacement sensor DS comprises a displacement/force feedback sensor, this sensor&#39;s output can be used to detect when the clog  40  is contacted and when it is penetrated. 
     As mentioned earlier, in order to indicate that the clearing stem magnet  33  and the control box magnet  12  are coupled properly, a magnetic/conductive sensor to determine if a solid clearing stem connection has been made which can then be provided to an indicator  75 A. By way of example only, a magnetic sensor could be implemented to determine safe connectivity between magnets in operation, such as a Honeywell Magnetometer, HMR2300. These magnetometers measure both magnetic field intensity and direction using their Anisotropic Magneto-Resistive sensors. The ability to acquire this information can be utilized by the microprocessor  71  to ensure the magnet polarities are correct, and that the magnets field intensity is at a safe level (e.g., they have not been de-magnetized). Similarly, an anti-tamper circuit may also be included in the electronic system  63  which interrupts operation if the control box  1  is attempted to be opened. A corresponding tamper sensor may also be provided that causes the indicator  75 A on the control box  1  to indicate if someone has opened, or attempted opening the lid of the control box  1 . Furthermore, control box screws can be configured to disable operation of the control box  1 , if they are attempted to be removed during activation. 
     The microprocessor  71  can be programmed to drive the electronic system  63  at the needed voltage and frequency, converting 120V 60 Hz wall power to needed parameters to drive the motor  14  at, for example 15-40 Hz (e.g., 25 Hz). In particular, several fault conditions are programmed into the microprocessor  71  for which it interrupts device TCI operation:
     V input &lt;20 VDC;   V input &gt;25 VDC;   Overtemperature condition pertaining to the amplifier IC;   Short circuit condition pertaining to the amplifier IC;
 
Should any of these fault conditions occur, the microprocessor  71  activates a fault indicator  4 . Also, as discussed earlier, the enable switch  72  permits the operator to initiate the reciprocating motion without the need to hold any trigger. The enable switch  72  permits the control box  1  to maintain the reciprocating motion for a predetermined period of time (e.g., 4-20 minutes) before the reciprocating motion is terminated.
   

       FIG. 17B  provides a flow diagram of the microprocessor  71  operation: at step power up  85 , the microprocessor  71  is powered up following activation of the power switch  2  by the operator. The microprocessor  71  then conducts a one second step initialization  86 . Once the initialization  86  is completed the microprocessor  71  activates the power indicator  3  (e.g., typically a green light (GL) or indication). At this point, device TCI remains in a disabled state until the enable switch  72  is activated by the operator; “enable button pressed” step  89  of the flow diagram represents activation of the enable switch  72  resulting in the enabled state  88  of the device where the clearing stem  26  is being reciprocated as described previously. The microprocessor  71  then maintains operation of this reciprocation for the predetermined period (e.g., 4-20 minutes) shown as time interval  93  in the flow diagram. At the end of the predetermined period, the microprocessor  71  terminates the reciprocating movement of the clearing stem  26  and returns to step disabled  87 . In addition, upon activation of the enable switch  72  by the operator, the microprocessor  71  monitors the device TCI for the faults described above, indicated by the paths-fault detected  90  of the flow diagram. If a fault  91  is detected by the microprocessor  71 , the microprocessor  71  terminates clearing stem reciprocation and activates the fault indicator  4  (e.g., typically a yellow light (YL) or indication). The microprocessor  71  then shuts down (step power cycle  92 ) the device TCI. 
     Operation of the present invention tube clearer TCI is as follows: if wall power is being used, the connector end of the power cord (not shown) is inserted into power plug  5  ( FIGS. 2-2A ) on the control box  1  and the other end of the power cord is coupled to a power supply which is coupled to a standard 120V RMS/60 Hz three-prong outlet. The control box  1  is turned on using the power switch  2  which turns on the power indicator  3  which verifies that the control box  1  is operating properly. 
     A new clearing stem  26  is removed from its packaging (but not discarded since the contaminated clearing stem  26  will be placed in the packaging and then discarded). If a plurality of clearing stems  26  are provided with tube depth-control collars fixed at different positions, the operator needs to select the clearing stem which has the appropriate fixed collar position; if, the tube depth-control collar is adjustable, the operator needs to position the collar appropriately along the clearing stem. 
     The following discussion of the operation is based upon the control box shown in  FIGS. 2-2A , it being understood that this is by way of example only. The wire end of the wire  28  comprising the clearing stem magnet  33  is gently pulled out from within the sheath  30  and then the clearing stem magnet  33  is inserted into the bore of the Luer clearing stem connector  6  until the operator feels the pull of the clearing stem magnet  33  to the other magnet  12  and/or hears the magnets connect. The sheath  30  is then pushed until the Luer clearing stem fitting  32  is flush with the Luer clearing stem connector  6  on the control box  1 . The Luer clearing stem fitting  32  is then twisted onto the Luer clearing stem connector  6 . Next, the distal end wire tip  29  of the clearing member  26  is inserted a few inches into the artificial tube. The enable switch  72  is pressed to activate the reciprocating motion. While holding the artificial tube  39  in one hand, the clearing stem  26  is held in the other hand while the clearing stem  26  is advanced into the artificial tube. When the clog is initially encountered, the clearing status indicator  75  changes to alert to the initial contact, and the operator begins to apply a slight force to the clearing stem  26 . Facilitating clog clearance can be achieved by the operator moving the clearing stem  26  back and forth slightly to clear the clog. These steps are repeated until the clog has cleared, in which case, the clearing status indicator  75  showing that the clog has been cleared activates. If the clog is cleared before the predetermined period (e.g., 4-20 minutes) is reached, the operator can depress the enable switch  72  again to stop the reciprocating movement and then depress the power switch  2  to shut off power to the device TCI. The clearing stem  26  can then be removed from the artificial tube (e.g., feeding tube FT) and then the working end of the clearing stem  26  can be inserted into the packaging. The artificial tube should be flushed with water to verify that the clog has been cleared; if not, the working end of the clearing stem  26  should be removed from the packaging and the clearing procedure repeated. If the clog is verified as being cleared, the clearing stem  26  is disengaged from the control box  1  in accordance with the version of the control box  1  being used. For example, if the preferred control box  1  (e.g.,  FIG. 16C ) is being used, the alternate clearing stem fitting  32 A is disengaged from the sheath attachment bracket  83  and the alternate clearing stem magnet  33 A is pulled away from the alternate diaphragm  9 A; alternatively, where the Luer fitting version of the control box  1  (e.g.,  FIG. 16A ) is used, the operator twists the Luer clearing stem fitting  32  and removes the clearing stem magnet  33  end of the clearing stem  26  from the control box  1 . In either situation, the clearing stem  26  is placed back in the packaging and this is discarded in a suitable biohazard container. 
       FIG. 29  provides a partial isometric end view of a working end  401  of the wire  28  of the clearing stem  26  which utilizes a sheath with channels  30 E that includes ports  402  which can be used for irrigation and/or aspiration. These ports  402  form the end of conduits in the sheath with channels  30 E whose other ends are coupled to an aspiration source (not shown, e.g., a vacuum source, etc.) and/or an irrigation source (also not shown, e.g., a saline solution source, or other liquid source). During clog break-up, broken pieces of the clog can be aspirated out of the artificial tube using the sheath with channels  30 E and where irrigating the clog vicinity is required, the sheath with channels  30 E can be used to deliver such liquids. When aspirating and irrigating simultaneously, aspiration flow should equal irrigation flow rate. The appropriate flow rates are preferably 1-15 mL/min. 
     Another alternate clearing stem configuration is replacing the wire  28  with a hollow lumen or wire  403  to allow aspiration or irrigation down the hollow lumen or wire  403  to achieve the same purposes discussed with regard to  FIG. 29 . This alternative configuration is shown in  FIG. 29B . Thus, the sheath ports  402  and the hollow lumen or wire  403  may cooperate in different configurations to achieve irrigation/aspiration alternatively or simultaneously. By way of example, the sheath ports  402  can be irrigating while the hollow lumen or wire  403  is suctioning, or vice versa. Alternatively, all of the ports  402  and the hollow lumen or wire  403  can be operating as irrigators or aspiration. 
     Another alternate clearing stem configuration is to use the indwelling artificial tube  39  effectively as the sheath, as illustrated in  FIG. 29C . In this case, a wire  28  or hollow lumen or wire  403  is inserted directly into an artificial tube  39  without the sheath  30 . The motor  14  drives the wire  28  or hollow lumen or wire  403  with motion as described previously, to disrupt the clog  40 . Although not shown, the tube depth-control collar  22  may also be secured at the desired length to prevent over-insertion of the wire  28  or hollow lumen or wire  403 , with the collar  22  impacting the end of open proximal end of the artificial tube  39  during operation. Alternatively, the wire  28  or hollow lumen or wire  403  may include the fixed tube depth-control collar  22 A to also limit over-insertion. Using this configuration, the hollow lumen or wire  403  can achieve irrigation or suction alternatively. An advantage of this configuration is that elimination of the sheath can allow access to narrower lumens. The phrase “completely exposed” when used with the device TCI means a device TCI that does not use a sheath. 
     Another alternate clearing stem configuration is a very narrow hollow lumen or wire  403  compared to the sheath  30  such that the areal differential between the hollow lumen or wire  403  and sheath  30  allows for aspiration/irrigation as illustrated in  FIG. 29D . 
     Another alternate clearing stem configuration is the sheath  30  has two ports. One is quite small and is possibly used for a very narrow hollow lumen or wire  403  and the port  402  is used for aspiration/irrigation as illustrated in  FIG. 29E . 
     Rotating Tube Clearer TC 2   
     As with TCI, tube clearer TC 2  is a mechanical tube clearer but instead of generating reciprocating motion, tube clearer TC 2  generates rotating motion to achieve artificial tube clearing, preferably for PEG feeding tubes.  FIG. 18A  depicts the tube clearer TC 2  which comprises a reusable handset  115  (which remains outside the artificial tube and the patient) having a motor  108  (e.g., a DC motor) that drives (rotates) a disposable or limited-reuse clearing member  114 . The handset  115  is held by the operator&#39;s hand  136  during the clearing procedure. 
     It should be noted that, alternatively, clearing member  114  may also be hollow for irrigation or aspiration, or other features. 
     The tube clearer TC 2  ( FIG. 19 ) comprises a clearing member  114  that includes a magnetic connector  103  at one end which attaches to a torque limiter  105  of the handset  115 . Attached at the distal end of the clearing member  114  is a narrow flexible rod, preferably a polymer piece of tubing with a clearing brush  101  located on its distal end. The clearing member  114  can be solid or hollow. In the solid embodiment, the distal end of the clearing member  114  is attached to the clearing brush  101  and the proximal end of the clearing member  114  is attached to a magnetic connector  103 . In the hollow embodiment, the wire holding the clearing brush  101  may extend the central length of the clearing member  114  to the magnetic connector  103 . The clearing member  114  is flexible in order to conform to various radius of curvatures R. It is rotated by the motor  108  within the handset  115 . The rotary motion of the clearing brush  101  clears the clog, occlusion, or debris from the tube (not shown). 
     Clearing Member and Connectors 
     The clearing member  114  comprises a polymer tube with a clearing brush  101  inset at its distal end. The preferred polymer materials are nylon and polyurethane, although other materials may be used, such as polytetrafluoroethylene (PTFE), Polyvinyl chloride (PVC), polyethylene, polypropylene, and fluoropolymer. The length of the clearing member  114  is equal to the length of the feeding tube +/− one inch, depending on application.  FIG. 22  shows the layout of the clearing member  114 . At the proximal end of the clearing member  114  is a polymer magnetic connector  103  which includes a clearing member magnet adapter  104  in its inner bore and which sits flush to the proximal end of the clearing member  114 . To attach the clearing member  114  to the handset, as shown in  FIG. 19 , the magnetic connector  103  is inserted into a receiving bore  105 A within the torque limiter  105  of the handset  115 . Disposed within the bore end is a magnetic element  105 B and wherein when the magnetic connector  103  is inserted into the receiving bore  105 A, the clearing member magnet adapter  104  and magnetic element  105 B contact. To facilitate a tight connection, the magnetic connector  103  comprises a hexagonal-shape, or other non-round shape, that fits into a correspondingly-shaped receiving bore  105 A. DC motor  108  output is conveyed to the clearing member stem  102  through a gear train  107  and gear train output shaft  106 . 
     The clearing brush  101  at the distal end has several unique features. It could be a twisted-in-wire type clearing brush  101  with a negative taper NT, as shown in  FIG. 23 . By way of example only, the clearing brush  101  may comprise a twisted-in wire type; alternatively, the brush  101  may comprise a helical-wound wire or other type brush design. “Negative taper” implies that the dealing brush  101  bristles are wider in diameter at the distal end than at the proximal end of the clearing brush  101 . There are several reasons for this configuration in the clearing member&#39;s  114  design. Most conventional brushes have a taper smaller at the distal end and larger at the proximal end. However, for this application it would require over-insertion to clear the full bore of the end of the artificial tube (e.g., feeding tube)  119 . The negative taper NT also allows the helix-type wound clearing brush  101  to be extended rearward, as shown by the path of freed clog particles arrow  120  in  FIG. 23 . When rotating (indicated by the rotation of brush arrow  121 ), this clearing brush  101  design forces wicking of the loosened clog debris away from the clog  122  also in the direction of the path of freed clog particles arrow  120 . This is important for fast, effective clearing. If the clog  122  was not removed from the clog site, it could be compacted further, making the clog  122  even more difficult to remove. The negative taper NT also allows for contact with the tube walls (in order to clean them), but only in a limited area. Having contact only in a limited area reduces the amount of drag on the artificial tube  119  and the torque transmitted to it and thus this minimizes any chance of dislodging the artificial tube  119  from within the patient when the clearing member  114  is removed from the artificial tube  119 . The shape of the (distal) tip of the clearing brush  101  is also important for this application. Unlike many standard twisted-in-wire brushes, which are cut at the ends after twisting, the TC 2  clearing brush  101  could possibly be wound with a rounded tip—the wire bends 180 degrees. This bend prevents any sharp end from coming into contact with the stomach, intestine, or other organs/tissues if over-inserted past the end of the artificial tube  119 . Thus, the clearing brush  101  transfers minimal torque due to its unique geometry, but its helical design is also able to remove loosened debris from the clog  122 . 
     In another embodiment, the brush tip  101 A ( FIG. 19 ) radius of the clearing brush  101  can be modified, e.g., rounded to allow the clearing brush  101  to break up a clog, but to not penetrate an organ (e.g., stomach or other tissue/organ, etc.) should the brush tip  101 A ever make its way close to an organ. The clearing brush  101  may also be retracted from the distal end of the clearing member to decrease the chance of the clearing brush  101  catching in stomach or other tissue. In another embodiment, the brush tip  101 A can be modified by the addition of a flexible tip such as a Tecoflex® tip. In another embodiment, brush tip  101 A can be modified by the addition of ball tip  34 E as illustrated in  FIG. 5D . 
     Handset  115   
     Preferably, the handset  115  is shaped like a pistol, with contours to fit the user&#39;s fingers comfortably while he/she is using it, as shown by the operator&#39;s hand  136  ( FIG. 18A ). An index finger trigger  109  controls operation. The trigger  109  is a momentary power switch that only provides power when being pressed. The handset  115  is composed of three parts, one battery cover and two halves which are fastened together by screws or built-in snap fit connectors to form a handset housing  113 . It also contains an isolated battery compartment  112  to facilitate battery  111  changes without exposing any components to contaminants that could cause device failure or reduce reliability. A control circuit  110  ( FIG. 19 ) conveys power to the DC motor  108 . 
     In this embodiment the handset contains an isolated compartment in which a common battery size is used. For example, the handset  115  can be designed to accommodate any battery size such as 9V, AA, AAA, or a specialty size and a plurality of batteries where required. Alternatively, the handset  115  may comprise a rechargeable battery such that there is no need to remove any batteries. A charger (not shown) may accompany the handset  115  such that the rechargeable battery can be inductively charged and this configuration has advantages over the battery operated setup, including: no panels are removable on the handset  115  which eliminates the possibility of contamination; and also reduces cost and disposal of batteries. The inductive charger may comprise a base unit, rechargeable battery, and circuitry. The base unit may comprise an enclosure with a slot or depression or cradle into which the handset  115  is positioned. The base unit plugs into a standard 120V outlet. A coil in the base unit transmits a magnetic field to a coil in the handset  115 , and a charging circuit would transform the signal to the correct voltage and route it to the rechargeable battery located in the handset  115 . 
     Motor 
     The motor  108  of the tube clearer TC 2  is preferably a DC motor or a brushless DC motor and gear combination. The gear mechanism may be a precision gear head, such as one utilizing a planetary gear train  116  or a compound gear train  118  utilizing two or more standalone gears. Motor and gear output speed ranges from 600 RPM to 1800 RPM, more preferably 740 to 1140 RPM. The torque limiter  105  is also preferred in this embodiment. The maximum output torque can preferably range from 20 mNm to 40 mNm with a more preferable torque of 24 to 34 mNm. A voltage of less than or equal to 9 volts DC is preferred to drive the motor  108 , such that standard commercially-available batteries can be used.  FIG. 20  shows a DC motor  108  with a planetary gear train  116  whereas  FIG. 21  shows a DC motor  108  with a compound gear train  118  configuration that is coupled to the motor output shaft  117 . Thus, torque, speed and geometry of the clearing stem define the optimal operation of the device TC 2 . Alternatively, the motor  118  itself may have a torque output of preferably 20 mNm to 40 mNm, with a more preferable torque of 24 to 34 mNm, in which case the torque limiter  105  would not be necessary. 
     In another embodiment, a DC or brushless DC motor  108  and gear combination is used in combination with a torque limiter  105 . The torque limiter  105  is attached in-line with the motor output shaft  117  and allows slippage once the maximum output torque is reached. In another embodiment, a DC or brushless DC motor  108  and gear combination is used in combination with a hammering device, similar to that found in hammer drills (U.S. Pat. No. 5,653,294 (Thurler, et al.) and whose entire disclosure is incorporated by reference herein). This device creates an oscillatory motion along with the rotary motion to clear the clog. In another embodiment, the DC or brushless DC motor in all examples above is replaced with a piezoelectric motor with similar specifications. 
     Tube Depth-Control Collar 
     As with TCI, tube clearer TC 2  comprises a tube depth-control collar  133 , as shown in  FIG. 24 . This depth-control collar permits one-handed operation using no special tools. The tube depth-control collar  133  mounts along the rod portion of the clearing member  114 . The tube depth-control collar  133  is formed to be well-balanced and lightweight so as to not cause unwanted harmonics in the clearing member  114  during rotation. The tube depth-control collar  133  comprises a lightweight, circular tube depth-control collar housing  129  which includes a displaceable tube depth-control collar push button  130  that acts against a preloaded spring  132  bias and which locks against the clearing member  114  which passes through the opening for clearing member  131 .  FIG. 18A  depicts the tube depth-control collar  133  on the clearing member  114 . 
     Motor Torque Limiting 
     In a preferred embodiment of the handset  115 , the torque applied to the clearing member  114  is limited by controlling the voltage and current applied to the DC motor and ultimately to the gears. These voltage and current limits are established by testing and determining the minimum angle of twist that are unacceptable when the clearing brush  101  is in a locked condition within tubes under test. An alternative method involves the use of a DC motor with a torque limiter  105  as depicted in  FIGS. 19 and 25 . The torque limiter  105  is a two-piece patterned disc, preloaded by a preload spring  125 . The spring force controls torque at which disc slippage occurs. In particular, the torque limiter  105  comprises an input coupler  123 , a torque limiter output shaft  135 , a preload collar  134  and a torque limiter profile  124 . The input coupler  123  couples to the gear train  107  and the torque limiter output shaft  135  couples the clearing member  114 . As can be appreciated, when a certain applied torque is exceeded, the torque limiter  105  is designed to slip at the interface or torque limiter profile  124  to disengage and thereby prevent the clearing member  114  from exceeding the torque limit. 
     Clearing Member Control 
     The tube clearer TC 2  must control harmonics so that the clearing member  114  does not become uncontrollable and cause injury/damage. During device activation, the tube clearer TC 2  rotates the clearing member  114  with a displacement diameter that is preferably from 0 mm to 40 mm and a more preferred diameter of 25.4 mm or less.  FIG. 26  shows multi-nodal harmonics (i.e., node points  126 ) occurring in the clearing member  114  while spinning and also depicts the maximum desired displacement  127 A. This is preferred as its shape limits the displacement by geometry. The distance between the first two nodal points  126  is indicated by distance between nodal points  128 , and as can be seen in  FIG. 26 , this distance decreases for subsequent nodal points  126 . The maximum desired displacement  127 A of the clearing stem is preferred to be kept to 25.4 mm or less. In contrast,  FIG. 27  depicts a commercially-available rotary tool  115 A (e.g., a hand-held drill) rotating the clearing member  114 , showing the undesirable profile of rotating stem  129 A (and its undesirable corresponding maximum radial displacement  127 B) of the clearing stem motion because there is only one nodal point at the proximal end of the clearing member  114 . This type of deformation is not preferred because it is more likely to be unstable. 
       FIG. 28  depicts a block diagram of the electronics of the device TC 2 . In particular, a DC motor  108  provides the rotational motion to the clearing stem  114 . The motor  108  receives its input voltage  140  from a voltage regulator  137  which in turn receives power  139  from a power source or battery  111  (e.g., 9V battery, a rechargeable battery, etc.) when the trigger  109  is activated by the operator. A power indicator  138  (see  FIG. 18A  also), driven by the voltage regulator, is also provided. 
       FIG. 29A  provides a partial isometric end view of the device TC 2  showing the clearing brush  101  coupled to the clearing member stem  102  which utilizes a sheath with channels  30 E that includes ports  402  which can be used for irrigation and/or aspiration. These ports  402  form the end of conduits in the sheath with channels  30 E whose other ends are coupled to an aspiration source (not shown, e.g., a vacuum source, etc.) and/or an irrigation source (also not shown, e.g., a saline solution source, or other liquid source). During clog break-up, broken pieces of the clog can be aspirated out of the artificial tube using the sheath with channels  30 E and where irrigating the clog vicinity is required, the sheath with channels  30 E can be used to deliver such liquids. When aspirating and irrigating simultaneously, aspiration flow should equal irrigation flow rate. The appropriate flow rates are preferably between 1-15 mL/min. The clearing brush  101  can also be placed back along the clearing member stem  102  away from the distal end of the clearing member  114  to decrease the potential for the clearing brush  101  grabbing or interacting with the stomach or other organ or tissue. Alternatively, the various configurations shown in FIGS.  29  and  29 B- 29 E can also be used with the device TC 2 . The phrase “completely exposed” when used with the device TC 2  means a device TC 2  that does not use a sheath. 
       FIGS. 18B-18C  depict an alternative voice coil motor tube clear device TC 2 . Instead of using a “pistol-style” housing, the device TC 2  of  FIGS. 18B-18C  comprise an elongated hand grip  301 . In addition, unlike the rotational motion of the TC 2  device shown in  FIG. 18A , the alternative voice coil motor tube clear device  300  generates reciprocating motion (as discussed previously with regard to the TCI devices). In particular, within the hand grip  301  is positioned a voice coil motor  305  that, when energized, causes the clearing stem  303  to reciprocate. The tip of the clearing stem  303  includes a clearing brush  304 . As shown most clearly in  FIG. 18B , a clearing stem adapter  302  is provided on an end of the hand grip  301  for securing the clearing stem  303  to the voice coil motor  305  in the hand grip  301 . A power indicator  138  is also provided to indicate when power is being provided to the clearing stem  303  for reciprocating motion. A power switch/trigger  109 A is provided so that the user can manually control the activation of the device, similar to the pistol-style embodiment. 
     It should be noted that, alternatively, clearing stem  303  may also be hollow for irrigation or aspiration, or other features and may have similar configurations as shown in  FIGS. 29-29E . 
     It should be further understood that the preferred embodiments of the present invention are for the in-situ clearing of artificial lumens in a living being, but that these embodiments can be used for clearing lumens located outside of the living being, as well as for clearing other types of lumens not associated with living beings. 
     Now that exemplary embodiments of the present invention have been shown and described in detail, various modifications and improvements thereon will become readily apparent to those skilled in the art. Accordingly, the spirit and scope of the present invention is to be construed broadly and limited only by the appended claims, and not by the foregoing specification. 
     
       
         
               
             
               
               
               
             
           
               
                 APPENDIX 
               
               
                   
               
               
                 Reference Characters and Their Associations 
               
               
                   
               
             
             
               
                   
               
             
          
           
               
                 APA 
                 Amplified Piezoelectric Actuator 
                 TCI 
               
               
                 CR 
                 Crank 
                 TCI 
               
               
                 DS 
                 Displacement Sensor 
                 TCI 
               
               
                 IS 
                 Impedance Sensor 
                 TCI 
               
               
                 NT 
                 Negative Taper Angle 
                 TC2 
               
               
                 SY 
                 Scotch Yoke 
                 TCI 
               
               
                 SS 
                 Soft Stop 
                 TC1/TC2 
               
               
                 TCI 
                 Tube Clearing Device 1 
                 TCI 
               
               
                 TC2 
                 Tube Clearing Device 2 
                 TC2 
               
               
                 TCS 
                 Tip Compression Spring 
                 TCI 
               
               
                 GL 
                 Green Light 
                 TCI 
               
               
                 YL 
                 Yellow Light 
                 TCI 
               
               
                 FT 
                 Artificial/Feeding Tube 
                 TC1/TC2 
               
               
                 R 
                 Radius of Curvature 
                 TCI 
               
               
                  1 
                 Control Box 
                 TCI 
               
               
                  2 
                 Power Switch 
                 TCI 
               
               
                  3 
                 Power Indicator 
                 TCI 
               
               
                  4 
                 Fault Indicator 
                 TCI 
               
               
                  5 
                 Power Plug 
                 TCI 
               
               
                  6 
                 Clearing Stem Connector 
                 TCI 
               
               
                  7 
                 Motor Mount 
                 TCI 
               
               
                  8 
                 Motor Mount Damper 
                 TCI 
               
               
                  9 
                 Diaphragm 
                 TCI 
               
               
                  9A 
                 Alternate Diaphragm 
                 TCI 
               
               
                  10 
                 Electronics 
                 TCI 
               
               
                  11 
                 Motor PCB 
                 TCI 
               
               
                  12 
                 Magnet 
                 TCI 
               
               
                  12A 
                 Magnet Recess 
                 TCI 
               
               
                  13 
                 Motor Magnetic Coupler 
                 TCI 
               
               
                  13A 
                 Alternate Motor Magnetic Coupler 
                 TCI 
               
               
                  14 
                 Motor 
                 TCI 
               
               
                  14A 
                 Counter Balance Mechanism 
                 TCI 
               
               
                  15 
                 Motor Shaft 
                 TCI 
               
               
                  16 
                 VCM Body 
                 TCI 
               
               
                  17 
                 Winding 
                 TCI 
               
               
                  18 
                 End Bearing 
                 TCI 
               
               
                  19 
                 Spring 
                 TCI 
               
               
                  20 
                 Magnets 
                 TCI 
               
               
                 20N-20S 
                 Magnetic Driving members 
                 TCI 
               
               
                 21A-21C 
                 Pole Pieces 
                 TCI 
               
               
                  22 
                 Tube Depth-Control collar 
                 TCI 
               
               
                  22A 
                 Fixed Tube Depth-Control collar 
                 TCI 
               
               
                  23 
                 Depth Control Collar Push Button 
                 TCI 
               
               
                  23A 
                 Central passageway of push button 
                 TCI 
               
               
                  23B 
                 Lower portion of press button 
                 TCI 
               
               
                  24 
                 Tube Depth-Control Collar Body 
                 TCI 
               
               
                  24A 
                 Central passageway of collar body 
                 TCI 
               
               
                  24B 
                 Upper portion of collar body 
                 TCI 
               
               
                  25 
                 Spring 
                 TCI 
               
               
                  26 
                 Clearing Stem 
                 TCI 
               
               
                  27 
                 Wire Stop 
                 TCI 
               
               
                  27A 
                 Alternate Wire Stop 
                 TCI 
               
               
                  28 
                 Wire 
                 TCI 
               
               
                  28A 
                 Wire Protrusion 
                 TCI 
               
               
                  29 
                 Wire Tip 
                 TCI 
               
               
                  30 
                 Sheath 
                 TCI 
               
               
                  30A 
                 Sheath length markings 
                 TCI 
               
               
                  30B 
                 Integer markings 
                 TCI 
               
               
                  30C 
                 Distal End 
                 TCI 
               
               
                  30D 
                 Proximal End 
                 TCI 
               
               
                  30E 
                 Sheath with Channels 
                 TCI 
               
               
                  31 
                 Stem Stiffener 
                 TCI 
               
               
                  32 
                 Clearing Stem Fitting 
                 TCI 
               
               
                  32A 
                 Alternate Clearing Stem Fitting 
                 TCI 
               
               
                  33 
                 Clearing Stem Magnet 
                 TCI 
               
               
                  33A 
                 Alternate Clearing Stem Magnet 
                 TCI 
               
               
                  33B 
                 Alternate Clearing Stem Magnet Fitting 
                 TCI 
               
               
                  34 
                 Plastic Wire Tip 
                 TCI 
               
               
                  34A 
                 Alternate Tubing Tip 
                 TC1/TC2 
               
               
                  34B 
                 Fixed Member 
                 TC1/TC2 
               
               
                  34C 
                 Gripping/Chopping Mechanism 
                 TCI 
               
               
                  34D 
                 Pivot Point 
                 TCI 
               
               
                  34E 
                 Ball Tip 
                 TC1/TC2 
               
               
                  35 
                 Wire Tip Brush 
                 TCI 
               
               
                  36 
                 Sheath Tip Brush 
                 TCI 
               
               
                  37 
                 Forward Swept Sheath Tip Brush 
                 TCI 
               
               
                  38 
                 Nursing Cart 
                 TCI 
               
               
                  38A 
                 Pole 
                 TCI 
               
               
                  39 
                 Artificial Tube 
                 TCI 
               
               
                  40 
                 Clog 
                 TCI 
               
               
                  41 
                 Tube Inner Lumen 
                 TCI 
               
               
                  42 
                 Pneumatic Motor 
                 TCI 
               
               
                  43 
                 Pneumatic Motor Housing 
                 TCI 
               
               
                  44 
                 Pneumatic Motor Shaft 
                 TCI 
               
               
                  46 
                 Pneumatic Motor Diaphragm 
                 TCI 
               
               
                  47 
                 Internal Tubing 
                 TCI 
               
               
                  48 
                 Scotch Yoke Motor 
                 TCI 
               
               
                  49 
                 DC Motor 
                 TCI 
               
               
                  50 
                 Scotch Yoke Slider 
                 TCI 
               
               
                  50A 
                 Scotch Yoke Forward Displacement 
                 TCI 
               
               
                   
                 direction 
               
               
                  50B 
                 Scotch Yoke Rearward Displacement 
                 TCI 
               
               
                   
                 direction 
               
               
                  51 
                 Adapter 
                 TCI 
               
               
                  52 
                 Scotch Yoke Shaft 
                 TCI 
               
               
                  53 
                 Wires 
                 TCI 
               
               
                  54 
                 Air Supply Inlet 
                 TCI 
               
               
                  55 
                 Solenoid Motor 
                 TCI 
               
               
                  56 
                 Solenoid 
                 TCI 
               
               
                  57 
                 Solenoid Shaft 
                 TCI 
               
               
                  58 
                 Return Spring 
                 TCI 
               
               
                  59 
                 APA Motor 
                 TCI 
               
               
                  60 
                 Actuator 
                 TCI 
               
               
                  61 
                 Actuator Mount 
                 TCI 
               
               
                  62 
                 Actuator Shaft 
                 TCI 
               
               
                  63 
                 Electronic System 
                 TCI 
               
               
                  66 
                 Fuse 
                 TCI 
               
               
                  67 
                 Power 
                 TCI 
               
               
                  69 
                 Micro Processor Power Unit (MPU) 
                 TCI 
               
               
                  70 
                 +3.3 VDC 
                 TCI 
               
               
                  71 
                 Microprocessor 
                 TCI 
               
               
                  72 
                 Enable Switch 
                 TCI 
               
               
                  73 
                 Power Electronics 
                 TCI 
               
               
                  75 
                 Clearing Status Indicator 
                 TCI 
               
               
                  75A 
                 Indicator 
                 TCI 
               
               
                  76 
                 power signal to motor 
                 TCI 
               
               
                  77 
                 Langevin Transducer motor 
                 TCI 
               
               
                  78 
                 Piezoelectric elements 
                 TCI 
               
               
                  79 
                 Pre-stress bolt 
                 TCI 
               
               
                  80 
                 Tail Mass 
                 TCI 
               
               
                  81 
                 Horn 
                 TCI 
               
               
                  82 
                 Clearing Stem Attachment 
                 TCI 
               
               
                  83 
                 Sheath Attachment Bracket 
                 TCI 
               
               
                  84 
                 Diaphragm Sealing Ring 
                 TCI 
               
               
                  85 
                 Power Up 
                 TCI 
               
               
                  86 
                 Initialization 
                 TCI 
               
               
                  87 
                 Disabled 
                 TCI 
               
               
                  88 
                 Enabled 
                 TCI 
               
               
                  89 
                 Enable Button Pressed 
                 TCI 
               
               
                  90 
                 Fault Detected 
                 TCI 
               
               
                  91 
                 Fault 
                 TCI 
               
               
                  92 
                 Power Cycle 
                 TCI 
               
               
                  93 
                 Time Interval 
                 TCI 
               
               
                 101 
                 Clearing Brush 
                 TC2 
               
               
                 101A 
                 Brush tip 
                 TC2 
               
               
                 102 
                 Clearing Member Stem 
                 TC2 
               
               
                 103 
                 Magnetic Connector 
                 TC2 
               
               
                 104 
                 Magnetic Adapter 
                 TC2 
               
               
                 105 
                 Torque Limiter 
                 TC2 
               
               
                 105 A 
                 Receiving Bore 
                 TC2 
               
               
                 105B 
                 Magnetic Element 
                 TC2 
               
               
                 106 
                 Gear Train Output Shaft 
                 TC2 
               
               
                 107 
                 Gear Train 
                 TC2 
               
               
                 108 
                 Motor 
                 TC2 
               
               
                 109 
                 Trigger 
                 TC2 
               
               
                 109A 
                 Power Switch/trigger 
                 TC2 
               
               
                 110 
                 Control Circuit 
                 TC2 
               
               
                 111 
                 Battery 
                 TC2 
               
               
                 112 
                 Battery Compartment 
                 TC2 
               
               
                 113 
                 Handset Housing 
                 TC2 
               
               
                 114 
                 Clearing Member 
                 TC2 
               
               
                 115 
                 Handset 
                 TC2 
               
               
                 115A 
                 Commercial Available Rotary Tool 
                 TC2 
               
               
                 116 
                 Planetary Gear Train 
                 TC2 
               
               
                 117 
                 Motor Output Shaft 
                 TC2 
               
               
                 118 
                 Compound Gear Train 
                 TC2 
               
               
                 119 
                 Artificial Tube 
                 TC2 
               
               
                 120 
                 Path of Freed Clog Particles 
                 TC2 
               
               
                 121 
                 Rotation of Brush Arrow 
                 TC2 
               
               
                 122 
                 Clog 
                 TC2 
               
               
                 123 
                 Input Coupler 
                 TC2 
               
               
                 124 
                 Torque Limiter Profile 
                 TC2 
               
               
                 125 
                 Preload Springs 
                 TC2 
               
               
                 126 
                 Nodal Points 
                 TC2 
               
               
                 127 A 
                 Maximum Desired Displacement 
                 TC2 
               
               
                 127B 
                 Undesirable Displacement 
                 TC2 
               
               
                 128 
                 Distance between nodal points 
                 TC2 
               
               
                 129 
                 Tube depth-control collar housing 
                 TC2 
               
               
                 129 A 
                 Undesired Profile of Rotating Stem 
                 TC2 
               
               
                 130 
                 Tube Depth-Control Collar Push Button 
                 TC2 
               
               
                 131 
                 Opening for Clearing Member 
                 TC2 
               
               
                 132 
                 Preloaded Spring 
                 TC2 
               
               
                 133 
                 Tube depth-control collar 
                 TC2 
               
               
                 134 
                 Preload Collar 
                 TC2 
               
               
                 135 
                 Torque Limiter Output Shaft 
                 TC2 
               
               
                 136 
                 Operator&#39;s Hand 
                 TC2 
               
               
                 137 
                 Voltage Regulator 
                 TC2 
               
               
                 138 
                 Power Indicator 
                 TC2 
               
               
                 139 
                 Power 
                 TC2 
               
               
                 140 
                 Input Voltage 
                 TC2 
               
               
                 300 
                 Voice Coil Motor (VCM) Tube Clear 
                 TC2 
               
               
                 301 
                 Hand Grip 
                 TC2 
               
               
                 302 
                 Clearing Stem Adapter 
                 TC2 
               
               
                 303 
                 Clearing Stem 
                 TC2 
               
               
                 304 
                 Clearing Brush 
                 TC2 
               
               
                 305 
                 Voice Coil Motor 
                 TC2 
               
               
                 401 
                 Working End 
                 TCI/TC2 
               
               
                 402 
                 Port 
                 TCI/TC2 
               
               
                 403 
                 Hollow Lumen or Wire 
                 TCI/TC2 
               
               
                   
               
             
          
         
       
     
     While the invention has been described in detail and with reference to specific examples thereof, it will be apparent to one skilled in the art that various changes and modifications can be made therein without departing from the spirit and scope thereof.