Abstract:
A method of intubating a patient includes inserting a tracheal tube into the patient, inserting a gastric tube into the patient, attaching a gastric tube retainer to the tracheal tube, and engaging the gastric tube in the gastric tube retainer to thereby secure the gastric tube in position relative to the tracheal tube. The gastric tube is engaged in the gastric tube retainer by spreading apart portions of the gastric tube retainer along a slit, and sliding the gastric tube into the gastric tube retainer along the slit to a gastric tube opening having a diameter corresponding to the outer diameter of the gastric tube, so that the gastric tube is securely retained in an uncompressed condition in the gastric tube opening.

Description:
BACKGROUND OF THE INVENTION  
         [0001]    1. Field of the Invention  
           [0002]    The present invention relates to methods of retaining gastric tubes and more particularly to methods of securing a gastric tube relative to an intubated patient.  
           [0003]    2. Description of the Related Art  
           [0004]    A gastric tube, commonly called a Salem tube, is a hollow plastic tube usually made of polyvinylchloride (PVC), that is inserted through the nose or mouth, down the back of the throat, through the esophagus and into the stomach. Gastric tubes are commonly used in the treatment of patients in order to provide nutrition and/or for stomach emptying. Generally, gastric tubes inserted into the stomach are made stiff to resist collapsing when suction is applied. Gastric emptying is effected to prevent vomiting or to monitor how well a patient is tolerating being fed into the stomach. If the patient is not tolerating being fed into the stomach, the patient may tolerate being fed into the duodenum (past the stomach) via a longer duodenal tube. This duodenal feeding tube is made smaller, thinner and softer than a gastric tube because it is used just for feeding and not for stomach emptying. The duodenal feeding tube is weighted on its end and has a guide wire to aid the clinician in inserting this tube into the duodenum.  
           [0005]    Gastric tubes are available in six common sizes: 8, 10, 12, 14, 16, and 18 French (roughly 0.08 to 0.24 inches in outer diameter). The choice in size to use for a patient may relate to the size of the patient or the primary purpose of the gastric tube. Generally, for unconscious patients, bigger tubes are easier to insert, as they are more rigid and therefore resist curling in the oropharynx. Larger tubes also have less resistance and promote better flow and have less chance of obstructing.  
           [0006]    The securing of gastric tubes to critically ill patients has been a problem for many years. Past and current devices used to secure gastric tubes usually comprise an adhesive material. Tape is widely used because it is inexpensive and readily available. Different types of tape can be used and it is usually wrapped around the gastric tube and then stuck to the patient&#39;s nose or face.  
           [0007]    However, tape may come loose or may cause pressure sores by holding the gastric tube too tightly to the nostril and the patient can pull his/her gastric tube out fairly easily if it is only taped in place. Tape provides an inconsistent hold, depending on the type of tape used and the technique for applying it. Also, the presence of moisture and/or oil from the patient&#39;s skin can cause tape to loosen with time. As a backup, some hospitals tape the gastric tube directly to the tracheal tube, if the patient is intubated, or use a safety pin with tape to secure the gastric tube to the patient&#39;s gown, providing additional security.  
           [0008]    When using gloves, tape is difficult to handle, requiring the clinician to expose his or her hands to potentially infectious body fluids. Overall, tape is difficult to work with, takes longer to apply, and gives the patient an alarming appearance. Also, allergic reactions, skin irritations and nasal tissue necrosis have been reported from the use of tape. Replacing gastric tubes, and especially duodenal feeding tubes, is time consuming and costly, making it important to use a secure and reliable device.  
           [0009]    If the gastric tube is taped to the tracheal tube, however, reference marks along the tracheal tube are obscured and repositioning is difficult.  
           [0010]    Some tracheal tubes are accidentally cut too short prior to insertion, so that the hub of the tracheal tube is almost level with the patient&#39;s face. In this case, the gastric tube is usually just taped to the face of the patient.  
         BRIEF SUMMARY OF THE INVENTION  
         [0011]    According to the present invention, a method of intubating a patient comprises the steps of inserting a tracheal tube into a patient, attaching a gastric tube retainer to the tracheal tube, inserting a gastric tube into the patient, and engaging the gastric tube in the gastric tube retainer to thereby secure the gastric tube in position relative to the tracheal tube.  
           [0012]    The gastric tube is preferably engaged in the gastric tube retainer, before or after the attachment of the gastric tube retainer to the tracheal tube, by spreading apart portions of the gastric tube retainer along a slit, and sliding the gastric tube into the gastric tube retainer along the slit to a gastric tube opening having a diameter at least as great as the outer diameter of the gastric tube, so that the gastric tube is retained in an uncompressed condition in the gastric tube opening. 
       
    
    
     BRIEF DESCRIPTION OF THE DRAWINGS  
       [0013]    The invention will be more readily understood from the following description thereof, when taken in conjunction with the accompanying drawings, in which:  
         [0014]    [0014]FIG. 1 is a perspective view of a gastric tube retainer embodying the present invention;  
         [0015]    [0015]FIG. 2 is an exploded perspective view illustrating a step in the assembly of the retainer of FIG. 1 with a tracheal tube;  
         [0016]    [0016]FIG. 3 shows a view in perspective of a completed assembly of the retainer and the tracheal tube of FIG. 2;  
         [0017]    [0017]FIG. 4 shows a view similar to that of FIG. 3 but with the retainer being flexed to allow a gastric tube to be engaged with the retainer;  
         [0018]    [0018]FIG. 5 shows a view similar to that of FIG. 4 but with the gastric tube engaged and held by the retainer;  
         [0019]    [0019]FIG. 6 shows a modification of the retainer of FIG. 1 for use with gastric tubes of two different sizes;  
         [0020]    [0020]FIG. 7 shows a plan view of a further modification of the retainer of FIG. 1;  
         [0021]    [0021]FIG. 8 shows a view in side elevation of the retainer of FIG. 7;  
         [0022]    [0022]FIG. 9 shows a view in side elevation of a tracheal tube;  
         [0023]    [0023]FIG. 10 shows a view in perspective of a modification of the gastric tube retainer of FIG. 1 being installed in an intubated patient; and  
         [0024]    [0024]FIG. 11 shows a view in perspective of the room modified gastric tube retainer of FIG. 10 secured by an elastic band. 
     
    
     DESCRIPTION OF THE PREFERRED EMBODIMENTS  
       [0025]    [0025]FIGS. 1 and 2 show a gastric tube retainer, indicated generally by reference numeral  10 , which comprises a flat sheet or strip-shaped plastic material piece or lamina. One end  11  of the retainer  10  is rounded at the periphery of the retainer  10 , for safety, and has a tracheal tube opening  14 . An opposite end forms a gastric tube engagement portion indicated generally by reference numeral  16 , which includes a gastric tube opening  18 , and a pair of flaps  20  separated by a slit  22  extending from the gastric tube opening  18  to the periphery of the retainer  10 .  
         [0026]    To assemble the retainer  10  on a tracheal tube indicated generally by reference numeral  24 , a hub  26  on the tube is then inserted through the tracheal tube opening  14  in frictional engagement with the retainer  10 , which then abuts a flange  30  of the tracheal tube  24 . An elbow or swivel adapter  32 , forming a component of a ventilating circuit, as will be readily apparent to those skilled in the art, is then connected to the hub  26 , as shown in FIG. 3.  
         [0027]    Then, as shown in FIG. 4, the engagement portion  16 , which is resiliently flexible, is flexed to separate the flaps  20  and open the slit  22  and thereby to permit a gastric tube  34  to be inserted through the slit  22  into the gastric tube opening  18 . The flaps  20 , when released, return resiliently to their original positions, so that the gastric tube engagement portion  16  is thereby releasably engaged around the gastric tube  34 .  
         [0028]    The retainer  10  is thin enough so as not to impede the fit between the elbow connector/swivel adapter  32  and the hub  26  of the tracheal tube  24 .  
         [0029]    Alternatively, the gastric tube retainer  10  can be engaged, in the manner described above, with the gastric tube  34  before being attached to the tracheal tube  24 .  
         [0030]    [0030]FIG. 6 shows a modification of the retainer  10 , indicated generally by reference numeral  110 , which has a gastric tube opening  118  and a slit  122  corresponding to the opening  18  and the slit  22  of FIG. 1 and a further gastric tube opening  124 , which has a larger diameter than the opening  118  so as to fit a correspondingly larger gastric tube outer diameter, and a further slit  126  extending from the opening  124 . The slits  122  and  124  in FIG. 6 are spaced far enough apart so as not to impede the resilient memory of the retainer  110 . The slits  122  and  124  differ in length so that the openings  118  and  124  can be spaced apart sufficiently without having to make the retainer  110  wider.  
         [0031]    The modified retainer of FIGS. 7 and 8, which is indicated generally by reference numeral  210 , comprises a flat and circular disc-shaped retainer formed with six gastric tube openings  218   a - f  of different sizes, for receiving six correspondingly differently sized gastric tubes (not shown). Each of the openings  218   a - f  has a respective slit  222   a - f  extending from it to the periphery of the retainer  210 , the openings  218   a - f  and the slits  222   a - f  being distributed around a central tracheal tube opening  214  so that the gastric tube engagement portion is an annular portion of the retainer  210  extending around the opening  214 .  
         [0032]    In use, one of the above-described retainers is pushed onto the tracheal tube hub  26  before or after a patient has been intubated. The swivel or elbow adapter  32  of the ventilating circuit is connected to the hub so the patient can be ventilated. As soon as the patient has thus been intubated, the patient is immediately ventilated either manually or mechanically. The gastric tube is then inserted into the patient via the mouth or nose and the adapter  32  is disconnected from the hub  26  to allow the latter to be inserted into the tracheal tube opening of the retainer  10 ,  110  or  210 .  
         [0033]    [0033]FIG. 9 of the accompanying drawings illustrates a part of the conventional tracheal tube, which is indicated generally by reference numeral  24   a  and which is provided, at it&#39;s the distal end, with a cuff  300 . As will be apparent to those skilled in the art, the cuff  300  is expanded, by being inflated, to the wall of the tracheal passage of a patient when the tracheal tube is in use. For that purpose, the tracheal tube  24  is provided with an auxiliary tube  301  through which air can be passed into the cuff  300 . The hub  26  is provided that the proximal end of the tracheal tube  24 .  
         [0034]    Referring now to FIG. 10 of the accompanying drawings, the method of intubation of a patient, employing a gastric tube retainer  310 , which is a modification of the gastric tube retainer  10 , will now be described. Parts of the gastric tube retainer  310  which are similar to corresponding parts of the gastric tube retainer  10  have been identified by the same reference numerals and, for convenience, will not be described again herein.  
         [0035]    The gastric tube retainer  310  differs from the gastric tube retainer  10  by having notches or cutouts  312  formed in its opposite side edges, as shown in FIGS. 10 and 11.  
         [0036]    As shown in FIG. 10, the tracheal tube  24  has been inserted into the mouth of a patient whose head is indicated generally by reference numeral  304 . The tracheal tube  24  is secured in position on the patients head  304  by means of a tape  306  or a cotton twill tie or other tie, which is wrapped around the patient&#39;s face and the back of his neck. The end of the tracheal tube  24  protruding from the patient&#39;s face is then inserted through the tracheal tube opening  14  in the retainer  310 , after which the elbow  32  is reconnected with the hub  26 .  
         [0037]    The flaps  20  of the gastric tube retainer  310  are then spread apart to enable the gastric tube  34  to be slid into the gastric tube retainer  310  along the slit between the flaps  20  to the gastric tube opening  18 . Then, an elastic band  314  is engaged in the notches  312  and around the tracheal tube  24 , as shown in FIG. 11, to secure the gastric tube retainer  310  in position relative to the tracheal tube  24 .  
         [0038]    In each case, the tracheal tube acts as an anchor once the gastric tube is engaged into the retainer and by situating the retainer on the tracheal tube, some complications associated with tape can be avoided. There is no added discomfort or significant weight to the tracheal tube from the retainer and the retainer is metal and latex-free, making it safe for X-rays and MRI. The retainer allows quick positional adjustments of the gastric tube, thus saving valuable time. Moreover, the retainer will help prevent the costs and discomfort associated with the re-insertion of gastric tubes in intubated patients. The present invention avoids the use of unreliable adhesive materials for attachment, and can provide a consistent securement for an extended period of time. Unlike most other holding means, the present retainer does not have to touch the patient, thus avoiding possible discomfort to the patient.  
         [0039]    The present retainer is particularly suitable for holding a gastric tube inserted through the mouth since, in that case, the gastric tube cannot be taped to the patient&#39;s nose. When the retainer is in use and the gastric tube is pulled, the retainer is designed to flex and hold instead of letting the gastric tube slide through. The present retainers will secure gastric tubes fast, provide quick repositioning and will last longer than tape.  
         [0040]    In each of the gastric tube openings of the gastric tube retainers of the present invention, the diameter of the gastric tube opening is selected, corresponding to the outer diameter of a corresponding standard gastric tube, so that the gastric tube is engaged around its entire outer surface by the thin retainer to enhance the area of contact of the retainer with the tube in order to keep the gastric tube from being displaced from the patient, while not gripping the gastric tube so tightly that the luminal diameter of the gastric tube becomes constricted. The gastric tube opening diameter is thus selected to ensure that the retainer does not pierce, kink or pinch the outer surface of the gastric tube and also to ensure that the gastric tube is held securely in position by the gastric tube retainer.