Shim device for enteral feeding system

Abstract: A shim device (10) is provided for use with a low profile gastrostomy device having a gastrostomy tube (11) fitted in a mature stoma and held in place between an internal retention mechanism disposed within a visceral organ of a patient and an external retention mechanism (32) seated on the outer abdominal wall of a patient. Further, the shim device (10) provides an adjustable shim body (12) which is inserted between the external retention mechanism (32) and the patient for accommodating the gradual growth of the patient during convalescence. The shim device (10) also operates to evenly distribute the weight of the low profile gastrostomy device over a patient's outer body.

Description: 1. Field of the Invention The present invention relates to a device for use with gastrointestinal tubes, and more particularly to a support arrangement for use with low profile gastrointestinal feeding systems. More specifically, the present invention relates to a step up shim for supporting a portion of the low profile gastrointestinal feeding system on the outer surface of a patient. 2. Prior Art It is known from US4861334 to provide a gastronomy tube which is retained in place without the use of any stitching. The tube is held in place through the use of a balloon inside the stomach and a collar pressing against the abdominal wall of the patient. A trocar is employed to elongate and implant the gastronomy tube. It is further known from US3961632 to provide a trans-abdominal stomach catheter placement system involving an external nasogastric intubation device. A modified Foley catheter is inserted through the abdomen wall into the stomach and secured therein, in order to effectively dispose the stomach for ready and reliably located penetration by a trocar or the like. The device has a mobile distal end and uses a magnetic intubation device and technique to distend or advance the forward portion of the stomach wall into relatively close proximity to the exterior abdomen wall, and in doing so laterally displacing intestinal or other members which might lie therebetween, whereby damage to or cutting of such members is avoided in implanting the catheter. Low profile gastrointestinal feeding systems are frequently used for long term tube fed patients who are ambulatory and/or in a combative state and require some type of gastrostomy device to provide nutrition to a patient unable to take nutrition orally. These gastrointestinal system comprise a feeding set attached to a source of nutrition at one end and a low profile gastrostomy tube at the other end. The low profile gastrostomy tube is normally inserted through a stoma formed in the patient's abdominal wall utilising an internal retention member disposed inside a patient's viscera to anchor the free end of the gastrostomy tube inside the viscera. The internal retention member attaches to a distal or free end of the low profile gastrostomy tube to hold and affix a hollow organ of choice, e.g. the stomach, against the posterior abdominal wall of a patient. The hollow organ is affixed by capturing the organ wall and the abdominal wall between the internal retention member seated on the outer abdominal wall outside a patient with a hollow tubular member attached between the respective retention members. The tubular member provides a fluid pathway between the feeding set connected to a source of nutrition and the internal retention member disposed inside the patient. A typical internal retention member is disclosed in U.S. Patent No. 5,248,302 to Patrick et al. entitled "Percutaneous Obturatable Internal Anchoring Device" which describes a deformable obturatable internal retention member designed to pass through a stoma formed in a wall of the abdomen and stomach or other viscera of a patient in order to secure the low profile gastrostomy tube within the organ of choice. The method of using this type orf obturatable internal retention member consists of insertingt an obturadtor rod into the lumen of the low profile gastrostomy tube until the rod abuts or engages the distal end of the internal retention member. The internal retention member comprises a plurality of flexible retaining arms attached to the hollow tubular member that mechanically elongate and thereby slenderize the silicone, latex or polyurethane retaining arms to a size about that of the diameter or the tubular member when the obturator rod is pushed axially toward the patient. Such slenderization of the retaining arms allows safe insertion or removal of the tubular member and internal retention member into or from an established, matured stoma of a patient. Such obturatable internal retention members are currently the most common means used to insert, anchor and secure the low profile gastrostomy tube in a matured stoma of a patient. After the internal retention member has been inserted inside the stomach, the obturator rod is withdrawn through the tubular member which allows the flexible retaining arms of the internal retention member to assume its preset enlarged shape, thereby retaining the internal retention member inside the stomach so that it cannot be withdrawn back through the stoma. Once the internal retention member assumes it s preset enlarged shape the feeding tube with a connection member at one end is attached to the external retention member of the low profile gastrostomy tube in order to establish fluid flow communication between the source of nutrition and the patient's stomach. In this way, nutrition is provided to the patient through the low profile gastrostomy tube. Unfortunately, the external retention member is required to be seated on the patient's stomach for long periods of time while the patient is being fed through the low profile gastrostomy tube. This long term, continuous contact between the legs of the external retention member and the patient's stomach can cause pressure necrosis of the skin area. Therefore, there appears a need in the art for a shim device for supporting an external retention member of a low profile gastrostomy tube in order to more evenly distribute the pressure applied by the legs of the external retention member over a wider area of the patient's skin. OBJECTS AND SUMMARY OF THE INVENTION In brief summary, the present invention overcomes and substantially alleviates the deficiencies in the prior art by providing a shim device according to claim 1. The shim device advantageously supports and evenly distributes the pressure applied by the legs of an external retention member seated on the patient's outer skin layer. The shim device comprises a shim body having a top side and a bottom side with a plurality of pads extending perpendicular from each side of the shim body. The plurality of pads are adapted to support and evenly distribute the weight of an external retention member of a low profile gastrointestinal feeding system over a portion of a patient's outer skin layer. The plurality of pads formed on one side of the shim body are of a greater height than the pads formed on the opposing side so that pads on one side will support the external retention member a greater distance from the patient's body than the pads located on the opposing side. This differential in pad height between the two opposing sides of the shim body provides the shim device of the present invention with two alternative heights for supporting the external retention member depending on which side the shim body is placed on the patient's outer skin layer. The shim body further includes a center portion which surrounds the axial opening and four leaf portions that extend outwardly from the center portion which, in conjunction with the pads, provide the means for evenly distributing the weight of the external retention member. Two small pads are provided along the outer edge of each leaf portion for evenly distributing the weight of the external retention member along the outer portions of the shim body, while four large pads are positioned around the center portion with one large pad located between each respective leaf portion. A pair of apertures are formed between two opposing ends of the axial opening adjacent each large pad. Finally, a radial slit is formed along one of the four leaf portions between the outer edge of the leaf portion and the axial opening which allows the user to spread apart both parts of the leaf portion in order to slide the axial opening around the bottom portion of the external retention member in order to engage the shim to the low profile gastrointestinal feeding system. Accordingly, the primary object of the present invention is to provide a shim device for supporting and evenly distributing the weight of a portion of a gastrointestinal feeding system; Another object of the present invention is to provide a shim device having a dual height feature which permits alternatively supporting a portion of a feeding system at two different heights depending on which side of the shim device is used. A further object of the present invention is to provide a shim device made of a flexible, resilient material. According to the invention, there is provided a shim device for use with gastrointestinal tubes comprising: a shim body having opposed sides, said shim body including an inner portion having an axial opening formed therethrough, said shim body further including at least one outer portion defining an outer edge radially extending outwardly from said inner portion, said at least one outer portion having a radial slit formed therethrough; whereby a first plurality of support pads is formed on one of said opposed sides and extends a first height; and . a second plurality of support pads is formed on the other of said opposed sides and extends a second height therefrom, wherein either one of said first or second plurality of support pads provides a base and the other of said first or second plurality of support pads provides a support surface. Preferably said at least one outer portion comprises four outer portions. In a preferred embodiment said first height is approximately about 2.5 millimeters, and wherein said second height is approximately about 4.0 millimeters. Said shim body may further comprise at least one aperture. Preferably said at least one aperture comprises two apertures oppositely disposed about said axial opening. In a preferred embodiment said radial slit extends between said axial opening and said outer edge. Said first plurality and said second plurality of support pads may each include a plurality of outer pads proximate said outer edge, and wherein said first plurality and said second plurality of support pads each include a plurality of inner pads disposed on said inner portion proximate said axial opening. In an alternative arrangement said first plurality and said second plurality of support pads may each include a plurality of outer pads proximate said outer edge, and wherein said first plurality and said second plurality of support pads each include a plurality of inner pads disposed proximate said axial opening. Preferably said outer pads comprise two outer pads disposed on said at least one outer portion. Preferably said inner pads comprise four pads disposed on said inner portion and aligned approximately between each of said four outer portions. These and other objects of the present invention are realised in the preferred embodiment of the present invention, described by way of example and not by way of limitation, which provides for a shim device for supporting and evenly distributing the weight of a gastrointestinal feeding system. Additional objects, advantages and novel features of the invention will be set forth in the description which follows, and will become apparent to those skilled in the art upon examination of the following more detailed description and drawings in which like elements of the invention are similarly numbered throughout. BRIEF DESCRIPTION OF THE DRAWINGS Fig. 1a is a planar view of the shim device according to the present invention; Fig. 1b is a planar view of the shim device showing the slit spread open according to the present invention; Fig. 2 is a side view of the shim device according to the present invention; FIGS. 3a-3d are isometric views of the engagement sequence showing the shim device being engaged to an external retention member according to the present invention; and FIG. 4 is a planar view of the external retention member engaged to the shim device according to the present invention. DETAILED DESCRIPTION OF THE INVENTION Referring to the drawings, the preferred embodiment of the shim device of the present invention is illustrated and generally indicated as 10 in FIG. 1a . The shim device 10 comprises a shim body 12 which forms four substantially identical outer portions 24 that surround an inner portion 26. Inner portion 26 forms an axial opening 22 through shim body 12 with a slit 20 that extends from opening 22 to outer edge 40 through one of the outer portions 24 . As shall be discussed in greater detail later, slit 20 is adapted to be spread apart, as shown in FIGS. 1b and 4 , so that the tubular member 36 of the low profile gastrointestinal feeding system may be slipped through slit 20 and engaged around axial opening 22 . Preferably, slit 20 is located so that one of the outer portions 24 is split evenly in half, although slit 20 may also be located along any portion of the shim body 12 as long as tubular member 36 can be slipped through slit 20 and engaged with axial opening 22. Two apertures are located on either side of axial opening 22 and are formed through shim body 12 for providing air flow to the patient's skin layer when the low profile gastrointestinal feeding system is attached to the patient. It should be understood from the foregoing that, while particular embodiments of the invention have been illustrated and described, various modifications can be made thereto.

Claims: A shim device (10) for use with gastrointestinal tubes comprising: a shim body (12) having opposed sides (28,30), said shim body (12) including an inner portion (26) having an axial opening (22) formed therethrough, said shim body (12) further including at least one outer portion (24) defining an outer edge (40) radially extending outwardly from said inner portion (26), said at least one outer portion (24) having a radial slit (20) formed therethrough; characterised in that a first plurality of support pads (14) formed on one of said opposed sides (28,30) and extending a first height; and a second plurality of support pads (14) formed on the other of said opposed sides (28,30) and extending a second height therefrom, wherein either one of said first or second plurality of support pads provides a base and the other of said first or second plurality of support pads provides a support surface. A shim device (10) according to claim 1, wherein said at least one outer portion (24) comprises four outer portions (15). A shim device (10) according to claim 1, wherein said first height is approximately about 2.5 millimeters, and wherein said second height is approximately about 4.0 millimeters. A shim device (10) according to claim 1, wherein said shim body (12) further comprises at least one aperture (18). A shim device (10) according to claim 4, wherein said at least one aperture (18) comprises two apertures (18) oppositely disposed about said axial opening (22). A shim device (10) according to claim 1, wherein said radial slit (20) extends between said axial opening (22) and said outer edge (40). A shim device (10) according to claim 1, wherein said first plurality and said second plurality of support pads (14) each include a plurality of outer pads (15) proximate said outer edge (40), and wherein said first plurality and said second plurality of support pads (14) each include a plurality of inner pads (16) disposed on said inner portion (26) proximate said axial opening (22). A shim device (10) according to claim 2, wherein said first plurality and said second plurality of support pads (14) each include a plurality of outer pads (15) proximate said outer edge (40), and wherein said first plurality and said second plurality of support pads (14) each include a plurality of inner pads (16) disposed proximate said axial opening (22). A shim device (10) according to claim 8, wherein said outer pads (15) comprise two outer pads (15) disposed on said at least one outer portion (24). A shim device (10) according to claim 8, wherein said inner pads (16) comprise four pads disposed on said inner portion (26) and aligned approximately between each of said four outer portions (24). A shim device (10) according to claim 1, wherein said shim device (10) is constructed from a flexible, resilient material.

Inventors: MEIER KEVIN C, NOECKER ANGELA M, MEIER, KEVIN C., NOECKER, ANGELA M.
Applicants: SHERWOOD SERV AG, SHERWOOD SERVICES AG
Application year: 2000
Main classification: A61J15
IPC codes: A61J15