Patent Publication Number: US-2016243004-A1

Title: Devices for Clearing Blockages in Artificial Lumens

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
     The present application is a Continuation application and claims the benefit under 35 U.S.C. §120 of U.S. patent application Ser. No. 13/863,108 filed on Apr. 15, 2013 and entitled DEVICES FOR CLEARING BLOCKAGES IN SMALL BORE IN-SITU ARTIFICIAL LUMENS, which is a Continuation-In-Part of U.S. patent application Ser. No. 13/683,852 filed on Nov. 21, 2012 and entitled DEVICES AND METHODS FOR CLEARING OCCLUSIONS AND FOR PROVIDING IRRIGATION IN IN-SITU ARTIFICIAL AND NATURAL LUMENS, which issued as U.S. Pat. No. 9,308,348 on Apr. 12, 2016, which claims the benefit under 35 U.S.C. §119(e) of U.S. Provisional Patent Application Ser. No. 61/563,405 filed on Nov. 23, 2011 entitled DEVICES AND METHODS FOR CLEARING OCCLUSIONS AND FOR PROVIDING IRRIGATION IN IN-SITU ARTIFICIAL AND NATURAL LUMENS, the contents of all of which are incorporated by reference herein in their entireties. U.S. patent application Ser. No. 13/683,852 is also a Continuation-in-Part application and claims the benefit under 35 U.S.C. §120 of U.S. patent application Ser. No. 13/571,104 filed on Aug. 9, 2012 entitled DEVICES FOR CLEARING BLOCKAGES IN IN-SITU ARTIFICIAL LUMENS, which issued as U.S. Pat. No. 8,690,861 on Apr. 8, 2014, which in turn is a Continuation of U.S. patent application Ser. No. 12/964,252 filed on Dec. 9, 2010 entitled DEVICES FOR CLEARING BLOCKAGES IN IN-SITU ARTIFICIAL LUMENS, which issued as U.S. Pat. No. 8,262,645 on Sep. 11, 2012, which in turn is a Continuation-in-Part and claims the benefit under 35 U.S.C. §120 of U.S. patent application Ser. No. 12/274,937 filed on Nov. 20, 2008 entitled FEEDING TUBE CLEANER, now abandoned, and 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 made with government support under grant number HD065365 awarded by the National Institutes of Health, and grant numbers 0810029 and 0923861 awarded by the National Science Foundation, and grant number W81XWH-11-2-0099 awarded by the ARMY/MRMC. The 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 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. Enzymes are limited to breaking down medication and have no effect on medications. 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. Moreover, the DeClogger is only available for use in Tubes that are 14 French and larger. 
     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 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: 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 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. 
     In another embodiment, an occlusion clearing device includes a controller comprising at least one actuator for generating repetitive motion and a stem coupled to the at least one actuator. The stem can include a deformable reservoir, a port in fluidic communication with an internal volume of the deformable reservoir, a conduit member in fluidic communication with the deformable reservoir, and a reciprocating member disposed in the volume of the deformable reservoir and configured to accept the repetitive motion. 
     In yet another embodiment, a method of delivering fluid is disclosed. The method includes energizing at least one actuator to provide reciprocating motion to a deformable reservoir coupled thereto, the reciprocating motion of the actuator causing the deformable reservoir to be compressed, expanded, or both. Additionally, the method includes providing a flowable medium stored in the deformable reservoir through a distal end of a conduit which is in fluid communication with the reservoir. The method also includes providing the reciprocating motion of the at least one actuator to a reciprocating member that extends through an inner volume of the deformable reservoir, is also slidably disposed in the conduit, and is also coupled to the actuator. 
     In an additional embodiment, a method of delivering fluid is disclosed. The method includes energizing at least one actuator to provide reciprocating motion to a reciprocating member slidably disposed within a conduit. The method also includes providing a flowable medium through a distal end of the conduit, the flowable medium flowing through a volume defined by a space between the reciprocating member and a hollow portion of the conduit. Such space may be coaxial with same reciprocating member. 
    
    
     
       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  2 A- 2 A 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 (TC 1 ) 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 TC 1  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 TC 1  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 TC 1  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 TC 1  and TC 2  showing a small sheath channel for a very narrow hollow wire and a larger channel for aspiration/irrigation. 
         FIG. 30  illustrates an embodiment of a device for clearing occlusions which provides irrigation, and includes a stem coupled to a controller that further includes an actuator; 
         FIG. 31A  is a cross-sectional illustration of the device of  FIG. 30  showing a proximal end of a stem magnetically coupled to the actuator, with the deformable reservoir shown undisturbed; 
         FIG. 31B  is a cross-sectional illustration of the embodiment of  FIG. 31A  with the deformable reservoir shown filled with a flowable medium, for example, a fluid or a gas; 
         FIG. 31C  is a cross-sectional illustration of the embodiment of  FIG. 31B  with the deformable reservoir being compressed on a downstroke of the actuator (the force/motion of the downstroke indicated by the left-pointing arrow); 
         FIG. 31D  is a cross-sectional illustration of the embodiment of  FIG. 31A  with the deformable reservoir being stretched on an upstroke of the actuator (the force/motion of the upstroke indicated by the right-pointing arrow); 
         FIG. 32  is a side view showing a stem used in the device of, for example,  FIG. 30  with its deformable reservoir in fluidic communication with a conduit and a port; 
         FIG. 33A  is a view of an embodiment of a stem, including a port, conduit, reciprocating member and deformable reservoir; 
         FIG. 33B  is a view of the stem of  FIG. 33A  with the deformable reservoir filled with flowable medium; 
         FIG. 33C  is a view of the stem of  FIG. 33B  upon providing the deformable reservoir with a compressive force provided by the downstroke of an actuator (force/motion indicated by left-pointing arrow; actuator not shown) to which it is coupled, such that upon being compressed by a sufficient amount, a pressure is created so that the flowable medium flows through the conduit, for example, between reciprocating member slidably disposed therein and an inner diameter thereof so as to flow out of an open distal end of the conduit; 
         FIG. 33D  illustrates the stem of  FIG. 33C  upon providing the deformable reservoir with a tensile force by an upstroke of an actuator (force/motion indicated by the right-pointing arrow; actuator not shown), to which it is coupled such that upon being stretched, a vacuum forms of a sufficient amount to allow flowable medium to flow into the deformable reservoir from an external source (not shown) to replenish the fluid expelled during the stroke shown in  FIG. 33C ; 
         FIG. 34  is a cross sectional view of an embodiment of a stem; 
         FIGS. 35A-B  are cross sectional views of an embodiment of a reciprocating member; 
         FIG. 36  illustrates an embodiment of a device for clearing occlusions which provides irrigation, and includes a stem coupled to a controller that further includes an actuator; 
         FIG. 37A  is a cross-sectional illustration of the device of  FIG. 36  showing a proximal end of a stem, such as a pre-filled stem or a stem in fluidic communication with a fluid medium source, magnetically coupled to the actuator, without a deformable reservoir; 
         FIG. 37B  is a cross-sectional illustration of the embodiment of  FIG. 37A  with the reciprocating member being reciprocated on a downstroke of the actuator (the force/motion of the downstroke indicated by the left-pointing arrow); 
         FIG. 37C  is a cross-sectional illustration of the embodiment of  FIG. 37A  with the deformable reservoir being stretched on an upstroke of the actuator (the force/motion of the upstroke indicated by the right-pointing arrow); and 
         FIG. 38  is a cross sectional view of an embodiment of a stem. 
         FIG. 39  is a cross sectional view of an embodiment of a stem. 
         FIG. 40  is an isometric view illustrating the concept of the split conduit. 
         FIG. 41A  is a section view of the conduit cutter showing scalpel channel and conduit channel. 
         FIG. 41B  is a section view of the conduit cutter with a scalpel blade inserted and a conduit being passed through it. 
         FIG. 41C  is an isometric view illustrating the process of creating a split conduit by using the conduit cutter. 
         FIG. 42A  is an isometric view of the conduit splitter. 
         FIG. 42B  is a section view of the conduit splitter with a magnified view of the interior of the conduit splitter to show more detail of the hypodermic tubing and its corresponding channel. 
         FIG. 43A  is a section view of the conduit splitter with a magnified view of the split stem passing through it. 
         FIG. 43B  is a top view of the conduit splitter as the split conduit is spread out over the conical conduit guide. 
         FIG. 44  is a section view of an artificial tube with the conduit splitter inserted into it. 
     
    
    
     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 TC 1  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 TC 1  is preferred for use in nastrogastic (NG) feeding tubes, although it should be understood that TC 1  is not limited for only clearing NG feeding tubes.  FIGS. 1-17B, 29, 29B, 29C, 29D and 29E  are directed to TC 1 . 
     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 clearing PEG feeding tubes.  FIGS. 5A, 5D, 18A-28 , and  29 A- 29 D are directed to TC 2 . 
     Both types of tube clearers TC 1  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 TC 1  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 TC 1  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 TC 1  and TC 2  are reusable devices and the clearing stems are disposable. The clearing stems of TC 1  and TC 2  operate in narrow tube diameters, through several radial curves sufficient to reach, e.g., the bowel. Thus, the tube clearers TC 1  and TC 2  clear safely and with greater efficiency for NG-, PEG-, GJ- and NJ-tubes. Both tube clearers TC 1  and TC 2  require no complicated set up, e.g., no tuning is required. 
     Reciprocating Tube Clearer TC 1   
     As shown in  FIG. 1 , the tube clearer TC 1  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 TC 1 , the tube clearer TC 1  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  30  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 1A  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 TC 1  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 9A-9C ) 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, 3D and 9D . 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 guidewires. 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 TC 1   
     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 2-25 N and more preferably 6-14 N. 
     The reciprocating motion of the clearing stem  26  of the present invention TC 1  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, 10-10A and 15 ), DC motors  49  ( FIG. 11, 11A-11C ), 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, 10-10A, 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, 10A 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 TC 1  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  21 B 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 TC 1  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 TC 1  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.  12 C. 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  (24Vp-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 TC 1  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 TC 1  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 TC 1  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 TC 1  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 TC 1 . 
     Operation of the present invention tube clearer TC 1  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 TC 1 . 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 TC 1  means a device TC 1  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 TC 1 , 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 clearing 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 TC 1 , 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 29B-29E  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 TC 1  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. 
     Additional Embodiments 
     As discussed above, embodiments include devices, as well as methods for using and operating the devices, for effectively removing, moving or breaking up a clog from the internal portions of an artificial tube or catheter, among other types of lumens, including natural lumens such as veins, pulmonary channels, digestive pathways and the like. For example, the first type of tube clearing device discussed above, TC 1 , includes several embodiments that not only generate reciprocating motion of a clearing member for removing, moving or otherwise breaking up a clog in the artificial and natural tubes and lumens, but can also deliver a flowable medium, such as a fluid, including a liquid or a gas. For simplicity, such an embodiment shall be referred to as TC 1 ′. For example, additional features can be provided for delivering and/or removing fluid to/from an occlusion site in a feeding tube such as to/from or around blockages caused by medication or nutritional formulas, to/from or around a vascular occlusion such as a blood clot, or even to/from or around occlusions in feeding and endrotracheal tubes such as those occlusions caused by mucous or other natural fluids. Accordingly, additional embodiments of the Tube Clearing Device TC 1 , referred to herein as TC 1 ′, and corresponding features thereof, are shown in  FIGS. 30-37C  and described below. It is noted that features of the clearing device as described and labeled above for TC 1  may similarly be included in embodiments of TC 1 ′ so as to comprise a clearing and irrigation device  500  as described below. 
     As illustrated in  FIG. 30 , clearing and irrigation device  500  can include a controller (i.e., control box)  501  with an actuator (not visible), and a stem  526  that includes at least one fluid source, a reciprocating member  528 , and a conduit  593 . In an embodiment, the at least one fluid source can be selected from the group consisting of a deformable reservoir  527 A and port, as well as a conduit  593 . Accordingly, stem  526  can include at least one deformable reservoir and/or at least one port. That is, stem  526  can include one deformable reservoir and one port. Stem  526  can include one or more than one deformable reservoir but no port at all. Stem  526  can include one or more than one port but no deformable reservoir at all. The port, which can be at least one port, such as port  595  can be configured with or without valve  596 . Stem  526  can also include fixed adaptor  532 A coupled to reciprocating member  528 , and displaceable adaptor  533 B. 
     In some embodiments, controller  501  can include the features described above for activation unit/control box  1 , including at least one motor, such as motor  14 , for producing a reciprocating motion. The reciprocating motion can be achieved using a variety of motor technologies, such as, but not limited to, voice coil motors as described above, DC motors, piezoelectric transducers, including amplified piezoelectric transducers, piezoelectric actuators, active polymer compound actuators, solenoid motors, pneumatic motors, magnetostrictive transducers, electro restrictive transducers, and the like. Thus, controller  501  can include at least one actuator such as a voice coil motor (not visible) for generating repetitive reciprocating motion, separator  509 A and fixed support arm  583 . 
     In an embodiment, the clearing and irrigation device  500  can include at least one motor, for example at least one actuator for providing reciprocating motion, and a stem  526  (as shown in  FIGS. 31A and 31D ) that is coupled to the at least one actuator for receiving the reciprocating motion. The at least one actuator can be a voice coil motor, such as that shown in  FIGS. 2-2A, 10-10A and 15 , and previously described. The voice coil motor can include motor shaft  515 , as depicted in  FIGS. 31A-D , which can be coupled directly or indirectly to stem  526  via an adaptor  533 B. 
     The stem  526  can include at least one fluid source which can include a deformable reservoir  527 A fluidically coupled to a port, such as port  595 , for example, a port integrated with stem  526  and including a flange-fitting (as that shown in  FIGS. 33A-D ) or the polyurethane tube (as that shown in  FIGS. 30, 32 and 34 ). The port  595  can be formed as a channel extending from an outside surface, through a sidewall, and to an inner surface of fixed adaptor  532 A and can be in fluidic communication with an internal volume of the deformable reservoir  527 A. In other words, the port  595  provides a pathway through which an external source of flowable medium can be fluidically connected to the deformable reservoir for transferring flowable medium between the external source  594  and the deformable reservoir  527 A. The stem  526  can further include a conduit  593  in fluidic communication with the deformable reservoir  527 A of the fluid source. 
     Referring now to  FIGS. 30-31 , the clearing and irrigating device  500  can include a reciprocating member  528 , such as an elongate wire portion of the stem  526 . Reciprocating member  528  can extend substantially the length of the stem  526 . A portion of the reciprocating member  528  can extend through deformable reservoir  527 A at a proximal end of the stem  526 . That is, reciprocating member  528  can at least be partially disposed within the conduit member. For example, reciprocating member  528  can be slidably disposed in the internal volume of the deformable reservoir, as depicted by the dashed line in  FIGS. 31A-31D . In other words, reciprocating member  528  can be configured to extend through and be slidably disposed in the conduit  593 . 
     In an embodiment, the at least one fluid source can include at least one port. The at least one port can include a first port. The first port, such as port  595 , can be in fluid communication with an internal volume of the stem to provide/remove, for example, a flowable medium, such as an irrigant/aspirant, to/from areas adjacent to the distal end of the stem. The internal volume can be defined by an internal volume of the deformable reservoir  527 A and a volume defined by the space between the outer diameter of the reciprocating member  528  and the inner diameter of the conduit  593 , the volume extending longitudinally from a proximal end of the stem to a distal end of the stem. Such a volume defined by that space can be illustrated by port  402  of sheath  30  in  FIG. 29D . 
     In an embodiment, the at least one port includes a first port and a second port. The first port, such as port  595 , can be in fluid communication with a first volume to provide/remove, for example, a flowable medium, such as an irrigant/aspirant to/from areas adjacent to the distal end of the stem. Such a first volume defined by that space can be illustrated by port  402  of sheath  30  in  FIG. 29D  and can be in communication with an internal volume of the deformable reservoir  527 A. The second port (not shown) to which an external fluid/aspiration source can be connected at a location along the length of the clearing stein but preferably at a distal portion thereof, can be in fluid communication with a second volume distinct from the first volume, to provide/remove, for example, at least the flowable medium as irrigant/aspirant to/away from areas adjacent to the distal end of the stem. The second volume can be defined by at least one channel formed longitudinally within the sidewalls of the conduit  593 , for example the at least one channel depicted as port  402  of sheath  30 E in  FIG. 29B  and/or sheath  30  in  FIG. 29E . 
     In an embodiment, the at least one port includes a first port, a second port, and a third port. The first port, such as port  595 , can be in fluid communication with a first volume to provide, for example, a flowable medium, such as an irrigant to areas adjacent to the distal end of the stem. Such a first volume defined by that space can be illustrated by port  402  of sheath  30  in  FIG. 29D  and can be in communication with an internal volume of the deformable reservoir  527 A. The second port (not shown) to which an external fluid/aspiration source can be connected at a location along the length of the clearing stem but preferably at a distal portion thereof, can be in fluid communication with a second volume distinct from the first volume, to provide/remove, for example, at least the flowable medium as irrigant/aspirant to/away from areas adjacent to the distal end of the stem. The second volume can be defined by at least one channel formed longitudinally within the sidewalls of the conduit  593 , for example the at least one channel depicted as port  402  of sheath  30 E in  FIG. 29B  and/or sheath  30  in  FIG. 29E . The third port (not shown) to which an external/aspiration source can be connected at a location along the length of the clearing stem but preferably at a distal portion thereof, can be in fluid communication with a third volume distinct from the first volume and the second volume, such as the volume defined by an internal hollow space along the length of the reciprocating member, for example, that of hollow lumen or wire  403  in  FIG. 29E . 
     In an embodiment, a single actuator can provide reciprocating motion to both the deformable reservoir  527 A and reciprocating member  528  as illustrated in  FIGS. 31A-D . Thus, in one example, an actuator can provide linear reciprocating compression motion to the deformable reservoir  527 A and linear reciprocating motion to the reciprocating member  528 . However, other configurations with more than one actuator are possible. 
     For example, an occlusion clearing device can include a first actuator configured to provide motion to the deformable reservoir  527 A, and a second actuator configured to provide motion, independent of the first actuator, to the reciprocating member  528 . For instance, the first actuator can be configured to provide linear reciprocating motion to the deformable reservoir (causing it to be compressed and expanded), and the second actuator can be configured to provide reciprocating linear and/or reciprocating rotational motion, and/or non-reciprocating axial rotational motion to the reciprocating member  528 . Alternatively, the second actuator can be configured to provide both reciprocating linear and/or axial rotational motion to the reciprocating member  528 . The motion of the deformable reservoir  527 A provided by the first actuator and the motion of the reciprocating member  528  provided by the second actuator can be the same or different with respect to at least one of amplitude, frequency and/or direction. 
     Stem 
     Referring now to  FIGS. 31-32 , stem  526  can include at least one fluid source, a conduit  593 , and a reciprocating member  528 . The at least one fluid source can be selected from the group consisting of: (i) a deformable reservoir  527 A and (ii) port  595 . Conduit  593  can be in fluid communication with port  595  and/or deformable reservoir  527 A. Port  595  can be configured as a channel through displaceable adaptor  533 B and/or a channel through fixed adaptor  532 A. Reciprocating member  528  can be coupled to displaceable adaptor  533 B and can be slidably disposed through or adjacent to fixed adaptor  532 A. The proximal end of the stem  526  can be releasably coupled to the at least one actuator. For example, the proximal end of the stem  526  can include displaceable adaptor  533 B to which ends of deformable reservoir  527 A and reciprocating member  528  can be coupled. 
     Stem  526  can be magnetically coupled to the actuator via displaceable adaptor  533 B, which itself can include a magnet for magnetically coupling with shaft magnetic adaptor  513 A of the actuator shaft  515 . In this way, the reciprocating member  528  and deformable reservoir  527 A can be configured to accept the repetitive motion of the motor via the linear, reciprocating motion of the shaft  515 . 
     An indirect coupling is formed when components of the stem and those of the actuator are physically separated from one another but still capable of being in mechanical communication. That is, the displaceable adaptor  533 B can be magnetically coupled to shaft  515  in a similar fashion as described above for clearing stem  26  when it is magnetically coupled to shaft  15  as depicted in  FIGS. 3 and 3A . In other words, displaceable adaptor  533 B can be coupled to the actuator via shaft magnetic adaptor  513 A, which is attached to shaft  515 , while being physically separated from adaptor  513 A by separator  509 A. Separator  509 A can be a flexible wall portion of the control box such as a polymer membrane. Thus, separator  509 A can be formed between the at least one actuator and the stem  526 , and separator  509 A can be of whatever thickness allows stem  526  and shaft  515  to remain magnetically coupled to one another, thus providing for indirect coupling of the stem to the actuator. 
     In other embodiments, the proximal end of stem  526  can be directly coupled non-magnetically to shaft  515 . Such a direct coupling can be made releasable if it is formed by corresponding male-female thread/screw fittings attached to the proximal end of stem  526  and distal end of the actuator stem  515 . This allows the stem to be suitably connected for device operation and easily separated from the actuator when the stem needs to be removed for disposal or sterilization. 
     In an embodiment, stem  526  is reusable. For example, stem  526  can be reused for several occlusion clearing procedures within a single patient. In another example, the stem  526  can be reused for more than one occlusion clearing procedure on different patients if it is cleaned and sterilized according to medical norms. In another embodiment, the stem  526  is single-use, for example, with respect to the use of the device in a single occlusion clearing procedure. 
     Stem  526  can also include a narrow tube-depth control collar  592  for preventing over-insertion of the stem when in use for clearing occlusions. The narrow tube depth control collar  592  can include a first portion having a first diameter and a second portion having a second diameter larger than the first diameter. When used for clearing occlusions in a feeding tube or other artificial lumen, the first diameter can be less than, equal to or larger than the artificial lumen&#39;s inner diameter, and the second diameter can be larger than the artificial lumen&#39;s outer diameter. The narrow tube-depth-control collar  592  can be a polymer. 
     The reciprocating member  528  can extend from a displaceable end  599 A of the deformable reservoir  527 A, through a fixed end  599 B of the deformable reservoir, and through the length of the conduit, protruding through a distal end  600  of the conduit member  593  at  528 A at all times. In an embodiment, rather than protruding through a distal end  600  of the conduit member  593  at all times, the reciprocating member can be caused to protrude through the distal end  600  on a positive stroke (e.g., actuation from right to left such as the direction depicted in  FIG. 31C ) of the actuator, and can recede either partially or completely back into the conduit  593  on a negative stroke (e.g., actuation from left to right such as the direction depicted in  FIG. 31D ). 
     In an embodiment, a stem can be provided with a fluid source that does not include a deformable reservoir as shown in  FIGS. 36-37C . In this embodiment, stem  526  can include reciprocating member  528 , displaceable adaptor  533 B, fixed adaptor  532 A, conduit  593 , and port  595 . The proximal end of the stem  526  can be releasably coupled to the at least one actuator as described above. For example, the proximal end of the stem  526  can include displaceable adaptor  533 B to which an end of reciprocating member  528  is coupled, and which can include a magnet for magnetically coupling with shaft magnetic adaptor  513 A of the actuator shaft  515  (such as those within controller  501  in  FIG. 31A-D ). In this way, the reciprocating member  528  (shown as dashed lines within stem  526  in  FIGS. 37A-C , and shown protruding from a distal end thereof as  528 A) can be configured to accept the repetitive motion of the motor via the linear, reciprocating motion of the shaft  515 . It is noted that in this embodiment, fluid source can receive a flowable medium provided by an external source such as external source  594  including a reservoir or an external pump. Thus, flowable medium provided by an external source can flow through a port  595  and through conduit  593  in fluid communication with the port. 
     In some embodiments, stem  526  with a fluid source that does not include the deformable reservoir can be provided “pre-filled” with a flowable medium included in the conduit  593  and provided thereto through port  595 . That is, conduit  593  can be provided pre-filled prior to attachment of the stem to an external source when it is coupled to controller  501 . Thus, a prefilled conduit  593  stores the flowable medium until the flowable medium is caused to exit the conduit, for example, when the reciprocating member  528  is caused to reciprocate by the actuator. 
     In some embodiments, stem  526  without a fluid source (i.e., without a deformable reservoir or a port) can be provided “pre-filled” with a flowable medium included in the conduit  593 . That is, conduit  593  can be provided pre-filled prior to attachment of the stem to an external source when it is coupled to controller  501 . Thus, a prefilled conduit  593  stores the flowable medium until the flowable medium is caused to exit the conduit, for example, when the reciprocating member  528  is caused to reciprocate by the actuator. 
     In an embodiment shown in  FIG. 39 , a stem can include components that allow for the clearing of occlusions of natural or artificial lumens having smaller inner volumes and/or diameters. For example, a stem having conduit  593  that includes a deformable proximal end, such as deformable distal end  593 ′, stem  526  can be used to clear occlusions from tubes such as those of sizes 8 Fr and below (i.e., inner diameters equal to or smaller than those of tubes rated size 8 Fr). The deformable distal end  593 ′ of conduit  593  can be the same rigidity or a different rigidity, such as being less rigid, compared to the remaining portions of conduit  593 . The deformable distal end  593 ′ of conduit  593  can be the same material or a different material from the remaining portions of conduit  593 . Deformable distal end  593 ′ of conduit  593  can have the same sidewall thickness or a different sidewall thickness than the remaining portions of conduit  593 . Conduit  593  can be of a length that it extends from a proximal end adjacent to or coupled to fixed adaptor  532 A, up to or beyond a distal end of reciprocating member  528 . Conduit  593  can be of a length that it is the same length or shorter than a length of the reciprocating member that extends from a proximal portion of the reciprocating member adjacent to the fixed adaptor  532 A. 
     During use, such as during a clearing procedure, a user can position the stem in such a manner that some or all of conduit  593  remains outside the tube that is being cleared, such as outside a proximal end  39 A of artificial tube  39 , while a distal portion  528 A of reciprocating member  528  is inserted/fed into the tube. As shown in  FIG. 39 , as the reciprocating member  528  is inserted into the artificial tube, the sidewalls at deformable distal end  593 ′ of conduit  593  can be configured to collapse. As the deformable distal end  593 ′ remains outside of the tube and collapses as the remaining portions of the stem are advanced toward it, and the distal end  528 A continues to be fed into the tube, the collapsed portion can be configured to attain a shape of collapsing bellows/accordion, or any other shape that allows for the reciprocating member to be fed into the tube. 
     It is to be understood that upon activating an actuator of a controller  501  to which the stem is coupled, such as described above and shown in  FIG. 39 , the reciprocating member  528  can be caused to reciprocate. As it is slidably disposed in conduit  593 , and generally supported by an inner surface of the conduit, at least the reciprocating member&#39;s distal end  528 A that protrudes from a distal end of the conduit is caused to displace, thereby allowing it to come into contact with occlusion material and clear the occlusion from the tube. Thus, the deformable distal end  593 ′ of the conduit, for example in a natural state or a collapsed state, should be configured so as to not prohibit the reciprocating member from performing the function of clearing an occlusion. The distal portion  528  of the reciprocating member is therefore supported by the inner surface of the tube. 
     Additionally, the conduit  593  is configured to allow irrigant, provided from the stem&#39;s fluid source, to reach an inner volume of the tube (or for aspirant to be removed from the tube). That is, during use, the conduit  593  can be in fluid communication with the tube  39 . Accordingly, an interface between a proximal end of the tube  39 A and collapsible distal end  593 ′ of the conduit can be configured to form a leak-proof seal. Fluid can also or instead be provided from an external source that is fluidically coupled to the tube  39  via a tube port (not shown). It is noted that the stem that includes a conduit  593  with a deformable distal end  593 ′ may or may not also include deformable reservoir  527 A and/or port  595 . 
     Conduit and Reciprocating Member 
     As described above, reciprocating member  528  can be slidably disposed within conduit  593 . In an embodiment, the reciprocating member  528  can be a wire having an outer diameter that allows it to reciprocate within the conduit. Accordingly, the conduit  593  can be a hollow flexible tube and the reciprocating member can be an elongate, flexible wire with an outer diameter equal to or less than an inner diameter of the conduit. 
     A volume defined by the space between the outer diameter of the reciprocating member and an inner diameter of the conduit  593  can provide a coaxial route through which flowable medium can flow through a proximal end and through a distal end  600  of the conduit  593 . For example, flowable medium stored in a volume of the deformable reservoir  527 A can be caused to flow out of the volume during an actuation cycle, via the reciprocating motion of the actuator, such as that depicted in  FIGS. 31A-D . While not limited to any particular theory, it is believed that the flowable medium can be caused, during compression of the deformable reservoir, such as depicted in  FIG. 31C , to flow from an internal volume of the deformable reservoir, through an open end of the deformable reservoir, such as at fixed end  599 B, and through a fixed adaptor and through the conduit, then finally exiting through a distal end  600  of the conduit. 
     Conduit  593  can be a single tube as shown or can be more than one tube formed in series to provide a continuous channel for flowing flowable medium as shown in  FIG. 34 . The conduit can be hollow through its length including open distal and proximal ends. Likewise, reciprocating member  528  can be a single elongate member, such as a single wire, or can be formed of more than one wire connected in series to form a single continuous member as shown in  FIGS. 34 and 35A -B. Reciprocating member  538  can be longer than the conduit  593 , allowing it to extend through the conduits distal and proximal ends. For example, a distal tip  528 A of reciprocating member  528  can be configured to protrude past a distal opening of conduit  593  at all times, or during certain times when the device is operated. 
     As shown in  FIG. 34 , conduit  593  can include a first portion  593 A and a second portion  593 C, each having an end bonded to conduit interdisposed tubing member  593 B. The first  593 A and second  593 C portions of conduit  593  can each be about 20-30 cm lengths of coiled sheath of nylon 12 tubing, such as cut from 55.12″ length of Coiled Sheath available from AdancedCath Technologies, Inc. (San Jose, Calif.), having an inner diameter of 0.039″+/−0.001″, an outer diameter of 0.0565″+/−0.0015″ with a braid of 0.002″/304 SS/60 PPI/16 count, and inner liner and outer jacket made of VESTAMID® L2101 extruded, unfilled polyamid 12 (available from Evonik Industries of Marl, Germany). The first portion  593 A and second portion  593 C of conduit  593  can be separated by an interdisposed tubing member  593 B made of Nylon 11 having an outer diameter of 0.1.25″, an inner diameter of 0.073″ and a length of about 4 cm. In another embodiment, the conduit  593  comprises a single length of teflon tubing AWG 18-24. 
     Reciprocating member  528  can be formed of a distal portion  529  including guide-wire formed of a core section  529 B and a coiled section  529 A, and a proximal portion  530  including a stranded wire. Interdisposed connecting member  531 , as shown in  FIG. 35A-B , can be formed between the proximal portion  530  and distal portion  529  of reciprocating member  528 . The proximal  530  and distal  529  portions of reciprocating member  528  can each have an end bonded to the interdisposed connecting member  531 . Alternatively, rather than being formed of the distal portion  529 , interdisposed connecting member  531 , and the proximal portion  530 , reciprocating member  528  can be formed of a single section, such as a length of the guide-wire described above. However, for costs savings, less of the guide-wire can be used if the reciprocating member  528  is formed in three sections instead of a single section. 
     As shown in  FIG. 35B , the core section  529 B and coiled section  529 A of the guide-wire can be adapted from the guide wire used in a Cope Gastrointestinal Suture Anchor Set (Part No. GIAS-100 available from Cook Medical Inc. of Bloomington, Ind.). The coiled portion  529 A can have an outer diameter of 0.035″ and a length of 25 cm. The core portion  529 B can have an outer diameter of 0.018″, a length of 50 cm, and can extend through (not visible) the coiled portion as further described below. The proximal stranded wire portion  530  can be 1×7 Stranded Wire (Part No. 3461T4 available from McMaster-Carr of Santa Fe Springs, Calif.), having an outer diameter of 0.02″ and length of 65 cm. The interdisposed connecting member  531  can be a PEEK tubing adaptor having an outer diameter of 0.625″, an inner diameter of 0.03″ and a length of about 2-4 cm. An end of proximal stranded wire portion and an end of distal portion guide-wire can be inserted into opposing ends of the interdisposed tubing member adaptor, and bonded inside the adaptor using TRA-Bond epoxy, cured at 150° C. for 10 minutes. 
     In an embodiment, the reciprocating member  528  can include a core section  529 B and a coiled section  529 A of 304 stainless steel, such as that shown in  FIG. 38 . At a distal portion of the core section, the core section  529 B tapers from one diameter to another diameter, the other diameter defining a distal end of the core section. For example, the core wire can have an outer diameter of 0.035+/−0.003 inches and taper down to an outer diameter of 0.0060+/−0.0005 inches. The core section  529 A can be subject to a gradual taper grind in order to provide these diameters. At one portion, for example at a distal end of the core section, the coiled section can be brazed onto the core section. At another portion, the coiled section can be welded onto the core section. The coiled wire  529 A can be a flattened wire having cross-sectional dimensions such as 0.005 in×0.010 in. The weld can form a ball-shape which provides a rounded distal end to the reciprocating member. Due to the coiled section extending over the tapered section of the core, the distal portion of the reciprocating member has added flexibility as compared to sections where the core is not tapered. 
     Deformable Reservoir 
     As shown in  FIGS. 30-34 , and more particularly with reference to  FIG. 31 , the deformable reservoir  527 A is coupled between a first end of the reciprocating member  528 , such as its proximal end, and a stationary/fixed fitting/adaptor  532 A. Thus, the motion provided by the at least one actuator, as described above, provides displacive motion to at least an end, for example displaceable end  599 A, of the deformable reservoir  527 A. The proximal end of the reciprocating member  528  and an end, such as displaceable end  599 A of the deformable reservoir, can be fixed to a common fitting, such as a moveable/displaceable fitting/adaptor  533 B. Fixed end  599 B of the deformable reservoir  527 A is configured to remain fixed relative to displaceable end  599 A. In one embodiment, fixed end  599 B is coupled to fixed adaptor  532 A which is supported by fixed support arm  583  extending from control box/controller  501  as shown in  FIGS. 31A-31D . 
     The deformable reservoir can store a volume of up to 10 mL of flowable medium. Accordingly, the deformable reservoir can be made of a polymer that expands upon providing it with the volume of flowable medium from an external source. In one embodiment the deformable reservoir is made of nitrile tubing having wall thickness of 0.004″. 
     The deformable reservoir can be made of nitrile tube. The tube can be formed by removing a portion of a nitrile finger cot (part no. 5516T2, available from McMaster-Carr of Santa Fe Springs, Calif.). The ends  599 B and  599 A of the deformable reservoir can be connected to fixed adaptor  532 A and displaceable adaptor  532 B, respectively, and held in place. The ends can be connected in a manner to prevent leakage of flowable medium at their respective attachment points. O-rings may be utilized to hold the ends of the deformable reservoir over outer surface portions of adaptors  532 A and  532 B. Alternatively, adaptors  532 A and  532 B may each be formed of snap-caps (a first cap that snaps into place with a second cap) or another kind of compression fitting, wherein each of the ends of the deformable reservoir are held in place between the first and second caps of the snap caps. Other methods, such bonding, including solvent or epoxy bonding, may be used to attach the deformable reservoir to the adaptors of the stem. In other embodiments, one end of the deformable reservoir, such as end  599 A, can be attached to only one adaptor, such as displaceable adaptor  532 B, and the other end, such as end  599 B can be attached to an outer surface of the stem, for example, an outer surface of conduit  593 . In such an embodiment, when the stem is attached to the control box and caused to be reciprocated by the actuator, a user can hold the stem or outer surface of the conduit in place as a substitute for the fixed adaptor  532 A. 
     In some embodiments, an end of the deformable reservoir can be connected to displaceable adaptor  532 B. The displaceable adaptor, as discussed above, can include a magnet which couples to a corresponding magnet of opposite polarity of the shaft of the actuator. When magnetically coupled, the displaceable adaptor  532 B does not need to physically contact the actuator but may be separated by the separator/diaphragm  509 A. In other embodiments, the shaft of the actuator may include an attachment member (not shown) which protrudes through separator/diaphragm  509 A and mates with a corresponding attachment member of the stem (also not shown). The attachment members may include a clip that includes features that allow the stem to be physically coupled, via the displaceable adaptor&#39;s clip, to the actuator and accept the actuators reciprocating motion and eliminates the expense of the magnets. In an embodiment, the displaceable diaphragm and actuator shaft may include a combination of magnets and attachment members, such as the clips described above, to hold the stem in place with the actuator. 
     In an embodiment, a proximal portion of reciprocating member  528  can be fixed in displaceable adaptor  533 B. To hold reciprocating member  528  in place, a proximal end thereof can be passed through on one end of the displaceable adaptor, and then bent in a manner so that it cannot be tugged from a distal end out of displaceable adaptor  533 B. 
     In an embodiment, the fixed adaptor  532 A is seated in fixed support arm  583 . Fixed support arm  583  can be made of metal or plastic and can include a portion to which a corresponding section of fixed adaptor  532 A is snapped into place. Fixed adaptor  532 A can be attached to control box  501  as shown in  FIG. 30 . 
     External Reservoir 
     In an embodiment, an external reservoir  594  can be in fluidic communication with the stem&#39;s fluid source such as the deformable reservoir  527 A via, for example, the port  595  such as illustrated in  FIG. 30 . The external reservoir can provide a flowable medium to the deformable reservoir  527 A. The external reservoir  594  can be a pump, such as a centrifugal pump, diaphragm pump, pneumatic pump or a syringe pressurized with a plunger as shown in  FIG. 30 . Upon filling the deformable reservoir with a flowable medium, valve  596  disposed between the external reservoir  594  and deformable reservoir  527 A can be closed to break fluidic communication between fluid source and external reservoir (e.g., the deformable reservoir  527 A and external reservoir  594 ). In other embodiments, either no valve is present or the valve discussed above can remain open so that the deformable reservoir  527 A and external reservoir  594  remain in fluidic communication during operation of the device, so that the external reservoir can continuously provide flowable medium to the conduit. In another embodiment, the external reservoir provides flowable medium to the conduit without the presence of the deformable reservoir. 
     An end of the deformable reservoir can be fluidically coupled to conduit  593 , for example at fixed end  599 B in  FIG. 30 , which can be an open end of the deformable reservoir through which the flowable medium, provided by the external source or by the deformable reservoir (for example in a pre-filled deformable reservoir), can flow. The device can be configured to prevent flow of the flowable medium from the deformable reservoir to a distal end of the stem when not in operation. On the other hand, the device can be configured to provide flow of the flowable medium from the deformable reservoir through the distal end of the stem when the actuator is in operation. For example, when the actuator is operated in the range of approximately 10-60 Hz, or preferably when the actuator is operated in the range of 15-40 Hz. The flow of the flowable medium can be provided at a volume of about 0.4 to about 0.5 ml/min to the occlusion site, preferably from the deformable reservoir and through a distal end of the stem. For example, conduit  593  can be provided with a valve along its length that, when it is “off” or closed, it prevents fluid from reaching the distal end of the conduit. In one example, tube-depth control collar  22  described above and shown in  FIGS. 3A and 9A-9C  that includes tube depth control push button  23  can be modified such that the spring  25  provides enough compression force against the stem, for example, a conduit on which the control collar is placed, so as to prevent fluid flow from the fluid source from reaching a distal end of the stem. 
     Methods of Use 
     Embodiments include non-limiting methods for operating device  500  to clear occlusions and/or deliver fluid. For example, at least one actuator, such as the actuator that includes actuator shaft  515  in  FIGS. 31A-D , can be energized to provide reciprocating motion to the deformable reservoir  527 A. The deformable reservoir, being coupled to the actuator, for example, via displaceable adaptor  533 B which is magnetically coupled to shaft magnetic adaptor  513 A, accepts the reciprocating motion. The reciprocating motion causes the deformable reservoir  527 A to contract (as shown in  FIG. 31C ) and expand (as shown in  FIG. 31D ). 
     Due to the compression and expansion of the reservoir, a flowable medium stored in deformable reservoir  527 A (as indicated by the expanded deformable reservoir  527 A shown in  FIG. 31B ) can be caused to flow through an open end of the reservoir. For example, the flowable medium can flow out of the reservoir via an opening at fixed end  599 B, through an opening at fixed adaptor  532 A, through conduit  593  and exit through a distal open end of the conduit. 
     Meanwhile, the reciprocating member  528  can also be coupled to displaceable adaptor  533 B and can, therefore, also be caused to reciprocate. In other words, because reciprocating member  528  extends through an inner volume of the deformable reservoir  527 A and is slidably disposed in the conduit  593  as described above, it reciprocates within the conduit and within the deformable reservoir  527 A. 
     While not limited to any particular theory it is believed that the flowable medium is caused to flow toward the distal end of the conduit by the reciprocating contraction/expansion motion of the deformable reservoir and/or the reciprocating back and forth motion of the reciprocating member. 
     Stem  526  can be provided “pre-filled” with flowable medium. That is, the deformable reservoir  527 A and/or conduit  593  can be prefilled to store the flowable medium until the flowable medium is caused to exit the reservoir and/or conduit, for example, when the deformable reservoir  527 A and/or reciprocating member  528  are/is caused to reciprocate by the actuator. Alternatively, an external source of flowable medium, such as a syringe, can be fluidically connected, via port  595 , to an internal volume of the deformable reservoir  527 A and/or conduit  593 . 
     Flowable medium can be provided from the external source  594  to the deformable reservoir  527 A, filling the deformable reservoir  527 A with a predetermined volume or predetermined pressure and causing the deformable reservoir to expand from a natural volume (such as shown in  FIG. 31A ) to an extended volume (such as shown in  FIG. 31B ). In one example, the external source provides the deformable reservoir with 10 mL of flowable medium. In another example, deformable reservoir is filled with flowable medium so as to be pressurized up to 150, 140, 130, or 120 mmHg or between 100-140 mmHg of pressure prior to operation of the device  500 . However, the deformable reservoir should not be overfilled because overfilling can cause the displaceable end  533 B to expand toward the controller  501 , thereby keeping the actuator stem  515  from reciprocating the reciprocating member  528 . In other words, if the reservoir is overfilled, the actuator stem is limited in reciprocating distally by the volume of the reservoir pushing it proximally. 
     Prior to insertion of the stem into a lumen such as a feeding tube, an outside surface of the stem can be lubricated with a hydrophobic coating such as PAM® cooking spray (available from ConAgra Foods of Omaha, Nebr.) or a hydrophilic coating such as HYDAK® (available from BioCoat, Inc. of Horsham, Pa.). 
     As discussed above, the device TC 1 ′ can be used for breaking up or eliminating occlusions in artificial lumens such as feeding tubes. In such a method of use, the device&#39;s stem is inserted directly through the feeding tube until the reciprocating member is brought into contact with the occlusion. The device can also be used for breaking up occlusions such as blood clots in veins. In such a method of use, the stem can be inserted into a vein via a catheter until the reciprocating member is brought into contact with the blood clot. In both methods of use, the reciprocating motion of the reciprocating member, caused by energizing the actuator, is used to break up the occlusion. It is advantageous, however, to provide a flowable medium, such as a liquid, for example, at least one of tissue plasminogen activator, water, enzyme (and other compatible fluids selected for successfully causing the occlusion to break apart), directly to at least a surface of the occlusion or adjacent to the occlusion. Thus, the flowable medium provided by the external source and/or the at least one fluid source (e.g., a port and/or a deformable reservoir), and flowed through the conduit, can be brought into contact with the occlusion or adjacent thereto. For example, after exiting from the distal opening of the conduit, the flowable medium may continue to flow distally toward the distal tip of the reciprocating member as it coats the reciprocating member. Such a flow can be characterized as pulses, or drop-by-drop delivery, of fluid at the distal tip of the reciprocating member. In other words, the flowable medium can flow beyond the distal end of the conduit along a distal portion of the reciprocating member, such as distal tip  528 A, that protrudes beyond the distal end of the conduit. However, the flowable medium need not coat the distal tip of the reciprocating member  528  upon exiting the conduit, but may exit from the distal opening of the conduit without coating the distal tip  528 A of the reciprocating member. Additionally, the flow of the flowable medium need not actually exit the conduit member in pulses or drop-by-drop fashion but may be a continuous stream, either in laminar or turbulent flow. 
     In some embodiments, the reciprocating member can be caused to reciprocate and the conduit is not configured to reciprocate. However, in other embodiments, the conduit can be configured to reciprocate either in the same direction as the reciprocating member or in opposite direction to the reciprocating member&#39;s reciprocating motion. To provide the conduit with reciprocating motion, it can be coupled to the same actuator as the reciprocating member and the deformable reservoir, or may be coupled to a different actuator. 
     Additionally, the conduit and the deformable reservoir can comprise a common section of tubed material. For example, a common section of tubed material can comprise a more flexible portion, such as a proximal portion thereof, relative to a less flexible portion, such as a distal portion thereof. In such an embodiment, the more flexible portion may accept motion from an actuator and work in a similar fashion as described in the above deformable reservoir  528 . In some embodiments, the more and less flexible portions of the common section of tubed material may be made of the same material, or of different materials joined together to form the common section of tubed material. In some embodiments the deformable reservoir can comprise bellows. 
     In another embodiment, at least one actuator, for example the actuator in controller  501 , is energized to provide reciprocating motion to reciprocating member  528  slidably disposed within conduit  593 . A flowable medium can be provided to the conduit  593 , for example, from a fluid source of stem  526 , and caused to flow through the conduit&#39;s distal end. The flowable medium can be caused to flow by providing it with a pressure so that it flows through a volume defined by the space between an outer side of the reciprocating member and an inner side of the conduit. 
     Appropriate fluids for clearing occlusions in feeding tubes are known in the art and can include enzyme based fluids, water, weak acid, saline, or a combination of each. Appropriate fluids for clearing occlusions in vascular systems, such as blood clots, are known in the art and can include tissue plasminogen activator (tPA) and the like. 
       FIG. 39  illustrates a stem that can include components that allow for the clearing of occlusions of natural or artificial lumens. For example, during use, such as during a clearing procedure, a user can position the stem in such a manner that some or all of the conduit  593  remains outside of the artificial tube  39  being cleared, while the distal portion of the reciprocating member/wire  528  is inserted/fed into the tube. 
       FIG. 40  illustrates the concept of the split stem  526 A. The split stem  526 A is comprised of a reciprocating member/wire  528  and a split conduit  593 E. The splitting of the split conduit  593 E allows for the reciprocating member/wire  528  to be peeled out away from the split conduit  593 E. The split stem  526 A is the basis for the novel solution to inserting only the reciprocating member/wire  528  into a clogged lumen while maintaining its reciprocation for the purposes of clearing it. 
     Although called a split conduit  593 E, it is to be understood that the object with the slit can be a tube in other exemplary embodiments, and may thus be referred to as a split tube. The tube may be a sheath, a conduit, or another member in accordance with yet additional exemplary embodiments. The tube is referred to as a conduit, and hence a split conduit  593 E for purposes of explanation and example in the present description. Other elements that incorporate the term “conduit” are also described in this manner for purposes of explanation and example and this term may be removed in other instances when the tube is not a conduit. 
       FIG. 41A  and  FIG. 41B  illustrate the interior construction of a cutter which may be a conduit cutter  601  which is used to create the split conduit  593 E. The conduit splitter  601  is made up of two symmetrical pieces, one of which is shown in  FIG. 41A . There are two channels which are machined into the interior surface. The first is the conduit channel  604  which is machined to be slightly larger than the diameter of the conduit  593 . The second channel is the scalpel blade channel  603  which is machined to allow a No. 15 scalpel blade  602  to sit recessed in it.  FIG. 41B  is the same view as  FIG. 41A  with the addition of the No. 15 scalpel blade  602  and a conduit  593 .  FIG. 41B  illustrates an uncut conduit  593  passing through the conduit channel  604  which guides the conduit  593  passed the No. 15 scalpel blade  602 . This process turns the uncut conduit  593  into the split conduit  593 E.  FIG. 41C  is an illustration of the two halves of the conduit cutter  601  fastened together with the conduit  593  being passed through it. The slit in the split conduit  593 E may extend some or all of the axial length of the conduit  593 E and may extend completely through a wall of the conduit  593 E in various exemplary embodiments. The slit may have a length in the axial direction that is longer than its length in the radial direction of the conduit  593 E. 
       FIG. 42A  and  FIG. 42B  illustrate the construction of the splitter which may be a conduit splitter  605  used to take the input of the split stem  526 A and give an output of the reciprocating member/wire  528 .  FIG. 42A  is an isometric view of the conduit splitter  605  which is further explained in the section in  FIG. 42B . The interior of the conduit splitter  605  is comprised of three concentric channels. The first concentric channel is the stem channel  609 , which has a diameter slightly larger than the diameter of the split stem  526 A. The stem channel  609  extends to the proximal terminal end of the conduit splitter  605 . This allows the passage of the split stem  526 A into the interior of the conduit splitter  605 . As seen in the magnified view in  FIG. 42B , the next concentric channel is the hypodermic tubing channel  608 , which is machined to have a slightly larger diameter than the hypodermic tubing  607  which is placed into it. In turn the inner diameter of the hypodermic tubing  607  is slightly larger than the diameter of the reciprocating member/wire  528 . 
     The hypodermic tubing  607  is located distal to the stem channel  609 . As used herein, distal refers to the direction closer to the patient and thus away from the health care provider, while proximal references the direction closer to the health care provider and thus moving away from the patient. 
     The final concentric channel is the wire channel  610  which is slightly larger than the reciprocating member/wire  528 . The wire channel  610  is distal to the hypodermic tubing channel  608 . The final portion of the conduit splitter  605  is the spike  606  which is used to secure the conduit splitter  605  to the lumen which requires clearing. The reciprocating member/wire  528  would exit the wire channel  610 , enter the spike  606 , and exit out through the spike exit port  606 A. The spike exit portion  606 A extends to the distal terminal end of the conduit splitter  605 . 
       FIG. 43A  is a section view which illustrates the moment when the split stem  526 A approaches the hypodermic tubing  607  and the reciprocating member distal tip  528 A first enters the hypodermic tubing  607 . The size of the hypodermic tubing  607  allows it to position itself in the space between the reciprocating member/wire  528  and the split conduit  593 E. Therefore the reciprocating member/wire  528  continues through the interior lumen of the hypodermic tubing  607  unimpeded. At this moment the hypodermic tubing  607  simultaneously widens the slit in the split conduit  593 E and guides it over the outer diameter of the hypodermic tubing  607 . The split conduit  593 E may never be located within the hypodermic tubing  607  and at all times be on the outside of the hypodermic tubing  607  while the reciprocating member/wire  528  is located within the hypodermic tubing  607 . 
     From this point on the reciprocating member/wire  528  is isolated from the split conduit  593 E and is contained by the sequential channels of the conduit splitter  605 . Because the hypodermic tubing  607  widens the split conduit  593 E and guides it away from the reciprocating member  528 , there is no chance for the cut edges of the split conduit  593 E to impede the motion of the reciprocating member/wire  528 . 
       FIG. 43B  is an illustration of how the continued advancing of the split stem  526 A in the distal direction causes the split conduit  593 E to reach a conical guide  611  that may be a conical conduit guide  611 . In order to better visualize the splitting of the split conduit  593 E, it has been shaded. Because the conical conduit guide  611  increases in diameter in the distal direction the Split Conduit  593 E is forced to continue to split apart over the outer surface of the conical conduit guide  611 . The reciprocating member/wire  528  will at all times be located within the conical conduit guide  611  and will at no time engage the outer conical surface of the conical conduit guide  611 . 
     One or more openings may be present in the conduit splitter  605  that are located along a portion of the length of the conduit splitter  605  at some point between the proximal terminal end and the distal terminal end of the conduit splitter  605 . The opening may extend through an outer wall of the conduit splitter  605 , and can be seen for example in  FIGS. 42A and 43B . The opening is made such that the conical guide  611  is visible. The opening does not extend circumferentially around the entire diameter of the conduit splitter  605  but rather part way around. An identical opening located 180 degrees from the illustrated opening may be present on the other side, or a single opening may only be included. The split conduit  593 E after separation from the reciprocating member/wire  528  can move up along the conical guide  611  and then through the opening illustrated in order to be moved outside of the conduit splitter  605 . The split conduit  593 E after moving through the opening can continue to move in the distal direction as the reciprocating member/wire  528  moves in the distal direction. Alternatively, the split conduit  593 E due to its material of construction may curl backwards and in fact move in the proximal direction as the reciprocating member/wire  528  moves in the distal direction. Regardless of its direction of travel, the split conduit  593 E remains separated from the reciprocating member/wire  528  upon movement of the reciprocating member/wire  528  in the distal direction through the conduit splitter  605 . The device may be arranged so that the reciprocating member/wire  528  never moves through the one or more openings through which the split conduit  593 E moves. 
       FIG. 44  is an illustration of how the tapered spike  606  is inserted into an artificial tube  39  to secure the conduit splitter  605  in place. Once in position, the split stem  526 A can be advanced as far as desired for the reciprocating member/wire  528  to reach and break up the occlusion. The tapered spike  606  can be retained to the artificial tube  39  through a frictional fit engagement between the outside of the tapered spike  606  and the interior of the artificial tube  39 . The reciprocating member/wire  528  may exit out of the tapered spike  606  through the terminal distal end of the conduit splitter  605 . 
     The split stem  526 A may be advanced through the conduit splitter  605  so that at least 10% of the length of the reciprocating member/wire  528  is located outside of the lumen of the split conduit  593 E. The length located outside of the lumen may be the distal most portion of the reciprocating member/wire  528 . The split stem  526 A may be advanced so that at least 50% of the length of the reciprocating member/wire  528 , which is the distal most portion, is located outside of the lumen of the split conduit  593 E. In other arrangements, the split stem  526 A can be advanced so that from 60%-80%, from 80%-90%, or from 90%-100% of the length of the reciprocating member/wire  528  which is the distal most portion is removed from or otherwise located outside of the lumen of the split conduit  593 E. 
     Another feature of the conduit splitter  605  is that when the split stem  526 A is retracted out of the artificial tube  39 , and hence moves in the proximal direction, the splitting process is reversed and the internal channels of the conduit splitter  605  act to reseal the split conduit  593 E around the reciprocating member/wire  528 . This process ensures that the reciprocating member/wire  528  is not exposed to the operator, thus preventing the chance of the provided reciprocation being impeded. This two way process of sealing and resealing also allows the operator to push and pull the split stem  526 A to supplement the reciprocation force when breaking up occlusions. 
     Proximal movement of the reciprocating member/wire  528  causes this element to be simply pulled back through the conduit splitter  605  in the proximal direction. Proximal movement of the split conduit  593 E causes this component to be first pulled back into the conduit splitter  605  through the opening in side of the conduit splitter  605  as previously discussed. The split conduit  593 E may, but does not have to, engage the outer surface of the conical guide  611 . Next, the split conduit  593 E may engage the outer surface of the hypodermic tubing  607  and be pulled through an opening between the proximal terminal end of the hypodermic tubing  607  and an inner surface of the body of the conduit splitter  605  that faces in the distal direction. Proximal movement of the split conduit  593 E at this point through this opening causes it to be located around the reciprocating member/wire  528  so that the reciprocating member/wire  528  is again located within the lumen of the split conduit  593 E. 
     Although the tube that is slit has been described as a split conduit  593 E and other components have been described as incorporating the term “conduit,” it is to be understood that the use of this term is for illustration of an exemplary embodiment and that a split tube that could be a conduit, a sheath, or other element may be present in other exemplary embodiments. As such, it is to be understood that the device includes other variations in which a conduit is not present, and although the terminology of the associated components may no longer include the term “conduit,” they may still be present and may still function in the same or similar manner. 
     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 
                 TC1 
               
               
                 CR 
                 Crank 
                 TC1 
               
               
                 DS 
                 Displacement Sensor 
                 TC1 
               
               
                 IS 
                 Impedance Sensor 
                 TC1 
               
               
                 NT 
                 Negative Taper Angle 
                 TC2 
               
               
                 SY 
                 Scotch Yoke 
                 TC1 
               
               
                 SS 
                 Soft Stop 
                 TC1/TC2 
               
               
                 TC1 
                 Tube Clearing Device 1 
                 TC1 
               
               
                 TC2 
                 Tube Clearing Device 2 
                 TC2 
               
               
                 TCS 
                 Tip Compression Spring 
                 TC1 
               
               
                 GL 
                 Green Light 
                 TC1 
               
               
                 YL 
                 Yellow Light 
                 TC1 
               
               
                 FT 
                 Artificial/Feeding Tube 
                 TC1/TC2 
               
               
                 R 
                 Radius of Curvature 
                 TC1 
               
               
                  1 
                 Control Box 
                 TC1 
               
               
                  2 
                 Power Switch 
                 TC1 
               
               
                  3 
                 Power Indicator 
                 TC1 
               
               
                  4 
                 Fault Indicator 
                 TC1 
               
               
                  5 
                 Power Plug 
                 TC1 
               
               
                  6 
                 Clearing Stem Connector 
                 TC1 
               
               
                  7 
                 Motor Mount 
                 TC1 
               
               
                  8 
                 Motor Mount Damper 
                 TC1 
               
               
                  9 
                 Diaphragm 
                 TC1 
               
               
                    9A 
                 Alternate Diaphragm 
                 TC1 
               
               
                  10 
                 Electronics 
                 TC1 
               
               
                  11 
                 Motor PCB 
                 TC1 
               
               
                  12 
                 Magnet 
                 TC1 
               
               
                   12A 
                 Magnet Recess 
                 TC1 
               
               
                  13 
                 Motor Magnetic Coupler 
                 TC1 
               
               
                   13A 
                 Alternate Motor Magnetic Coupler 
                 TC1 
               
               
                  14 
                 Motor 
                 TC1 
               
               
                   14A 
                 Counter Balance Mechanism 
                 TC1 
               
               
                  15 
                 Motor Shaft 
                 TC1 
               
               
                  16 
                 VCM Body 
                 TC1 
               
               
                  17 
                 Winding 
                 TC1 
               
               
                  18 
                 End Bearing 
                 TC1 
               
               
                  19 
                 Spring 
                 TC1 
               
               
                  20 
                 Magnets 
                 TC1 
               
               
                 20N-20S 
                 Magnetic Driving members 
                 TC1 
               
               
                 21A-21C 
                 Pole Pieces 
                 TC1 
               
               
                  22 
                 Tube Depth-Control collar 
                 TC1 
               
               
                   22A 
                 Fixed Tube Depth-Control collar 
                 TC1 
               
               
                  23 
                 Depth Control Collar Push Button 
                 TC1 
               
               
                   23A 
                 Central passageway of push button 
                 TC1 
               
               
                   23B 
                 Lower portion of press button 
                 TC1 
               
               
                  24 
                 Tube Depth-Control Collar Body 
                 TC1 
               
               
                   24A 
                 Central passageway of collar body 
                 TC1 
               
               
                   24B 
                 Upper portion of collar body 
                 TC1 
               
               
                  25 
                 Spring 
                 TC1 
               
               
                  26 
                 Clearing Stem 
                 TC1 
               
               
                  27 
                 Wire Stop 
                 TC1 
               
               
                   27A 
                 Alternate Wire Stop 
                 TC1 
               
               
                  28 
                 Wire 
                 TC1 
               
               
                   28A 
                 Wire Protrusion 
                 TC1 
               
               
                  29 
                 Wire Tip 
                 TC1 
               
               
                  30 
                 Sheath 
                 TC1 
               
               
                   30A 
                 Sheath length markings 
                 TC1 
               
               
                   30B 
                 Integer markings 
                 TC1 
               
               
                   30C 
                 Distal End 
                 TC1 
               
               
                   30D 
                 Proximal End 
                 TC1 
               
               
                  30E 
                 Sheath with Channels 
                 TC1 
               
               
                  31 
                 Stem Stiffener 
                 TC1 
               
               
                  32 
                 Clearing Stem Fitting 
                 TC1 
               
               
                   32A 
                 Alternate Clearing Stem Fitting 
                 TC1 
               
               
                  33 
                 Clearing Stem Magnet 
                 TC1 
               
               
                   33A 
                 Alternate Clearing Stem Magnet 
                 TC1 
               
               
                   33B 
                 Alternate Clearing Stem Magnet 
                 TC1 
               
               
                   
                 Fitting 
               
               
                  34 
                 Plastic Wire Tip 
                 TC1 
               
               
                   34A 
                 Alternate Tubing Tip 
                 TC1/TC2 
               
               
                   34B 
                 Fixed Member 
                 TC1/TC2 
               
               
                   34C 
                 Gripping/Chopping Mechanism 
                 TC1 
               
               
                   34D 
                 Pivot Point 
                 TC1 
               
               
                   34E 
                 Ball Tip 
                 TC1/TC2 
               
               
                  35 
                 Wire Tip Brush 
                 TC1 
               
               
                  36 
                 Sheath Tip Brush 
                 TC1 
               
               
                  37 
                 Forward Swept Sheath Tip Brush 
                 TC1 
               
               
                  38 
                 Nursing Cart 
                 TC1 
               
               
                   38A 
                 Pole 
                 TC1 
               
               
                  39 
                 Artificial Tube 
                 TC1 
               
               
                  40 
                 Clog 
                 TC1 
               
               
                  41 
                 Tube Inner Lumen 
                 TC1 
               
               
                  42 
                 Pneumatic Motor 
                 TC1 
               
               
                  43 
                 Pneumatic Motor Housing 
                 TC1 
               
               
                  44 
                 Pneumatic Motor Shaft 
                 TC1 
               
               
                  46 
                 Pneumatic Motor Diaphragm 
                 TC1 
               
               
                  47 
                 Internal Tubing 
                 TC1 
               
               
                  48 
                 Scotch Yoke Motor 
                 TC1 
               
               
                  49 
                 DC Motor 
                 TC1 
               
               
                  50 
                 Scotch Yoke Slider 
                 TC1 
               
               
                   50A 
                 Scotch Yoke Forward Displacement 
                 TC1 
               
               
                   
                 direction 
               
               
                   50B 
                 Scotch Yoke Rearward Displacement 
                 TC1 
               
               
                   
                 direction 
               
               
                  51 
                 Adapter 
                 TC1 
               
               
                  52 
                 Scotch Yoke Shaft 
                 TC1 
               
               
                  53 
                 Wires 
                 TC1 
               
               
                  54 
                 Air Supply Inlet 
                 TC1 
               
               
                  55 
                 Solenoid Motor 
                 TC1 
               
               
                  56 
                 Solenoid 
                 TC1 
               
               
                  57 
                 Solenoid Shaft 
                 TC1 
               
               
                  58 
                 Return Spring 
                 TC1 
               
               
                  59 
                 APA Motor 
                 TC1 
               
               
                  60 
                 Actuator 
                 TC1 
               
               
                  61 
                 Actuator Mount 
                 TC1 
               
               
                  62 
                 Actuator Shaft 
                 TC1 
               
               
                  63 
                 Electronic System 
                 TC1 
               
               
                  66 
                 Fuse 
                 TC1 
               
               
                  67 
                 Power 
                 TC1 
               
               
                  69 
                 Micro Processor Power Unit (MPU) 
                 TC1 
               
               
                  70 
                 +3.3 VDC 
                 TC1 
               
               
                  71 
                 Microprocessor 
                 TC1 
               
               
                  72 
                 Enable Switch 
                 TC1 
               
               
                  73 
                 Power Electronics 
                 TC1 
               
               
                  75 
                 Clearing Status Indicator 
                 TC1 
               
               
                   75A 
                 Indicator 
                 TC1 
               
               
                  76 
                 power signal to motor 
                 TC1 
               
               
                  77 
                 Langevin Transducer motor 
                 TC1 
               
               
                  78 
                 Piezoelectric elements 
                 TC1 
               
               
                  79 
                 Pre-stress bolt 
                 TC1 
               
               
                  80 
                 Tail Mass 
                 TC1 
               
               
                  81 
                 Horn 
                 TC1 
               
               
                  82 
                 Clearing Stem Attachment 
                 TC1 
               
               
                  83 
                 Sheath Attachment Bracket 
                 TC1 
               
               
                  84 
                 Diaphragm Sealing Ring 
                 TC1 
               
               
                  85 
                 Power Up 
                 TC1 
               
               
                  86 
                 Initialization 
                 TC1 
               
               
                  87 
                 Disabled 
                 TC1 
               
               
                  88 
                 Enabled 
                 TC1 
               
               
                  89 
                 Enable Button Pressed 
                 TC1 
               
               
                  90 
                 Fault Detected 
                 TC1 
               
               
                  91 
                 Fault 
                 TC1 
               
               
                  92 
                 Power Cycle 
                 TC1 
               
               
                  93 
                 Time Interval 
                 TC1 
               
               
                 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 
               
               
                   105A 
                 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 
               
               
                   127A 
                 Maximum Desired Displacement 
                 TC2 
               
               
                   127B 
                 Undesirable Displacement 
                 TC2 
               
               
                 128 
                 Distance between nodal points 
                 TC2 
               
               
                 129 
                 Tube depth-control collar housing 
                 TC2 
               
               
                   129A 
                 Undesired Profile of Rotating Stem 
                 TC2 
               
               
                 130 
                 Tube Depth-Control Collar Push 
                 TC2 
               
               
                   
                 Button 
               
               
                 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 
                 TC1/TC2 
               
               
                 402 
                 Port 
                 TC1/TC2 
               
               
                 403 
                 Hollow Lumen or Wire 
                 TC1/TC2 
               
               
                 500 
                 Clearing and Irrigation Device 
                 TC1′ 
               
               
                 501 
                 Controller (Control Box) 
                 TC1′ 
               
               
                   509A 
                 Separator 
                 TC1′ 
               
               
                 512 
                   
                 TC1′ 
               
               
                   513A 
                 Shaft Magnetic Adaptor 
                 TC1′ 
               
               
                 515 
                 Shaft 
                 TC1′ 
               
               
                 526 
                 Stem 
                 TC1′ 
               
               
                   527A 
                 Deformable Reservoir (Pliant Wire 
                 TC1′ 
               
               
                   
                 Stop) 
               
               
                 528 
                 Reciprocating Member/Wire 
                 TC1′ 
               
               
                   528A 
                 Reciprocating Member Distal Tip 
                 TC1′ 
               
               
                 529 
                 Reciprocating Member Distal Portion 
                 TC1′ 
               
               
                   529A 
                 Distal Portion Coiled Section 
                 TC1′ 
               
               
                   529B 
                 Distal Portion Core Section 
                 TC1′ 
               
               
                 530 
                 Reciprocating Member Proximal 
                 TC1′ 
               
               
                   
                 Portion 
               
               
                 531 
                 Interdisposed Connecting Member 
                 TC1′ 
               
               
                   532A 
                 Fixed Adaptor 
                 TC1′ 
               
               
                   533B 
                 Displaceable Adaptor 
                 TC1′ 
               
               
                 583 
                 Fixed Support Arm 
                 TC1′ 
               
               
                 592 
                 Narrow Tube Depth Control Collar 
                 TC1′ 
               
               
                 593 
                 Conduit 
                 TC1′ 
               
               
                   593A 
                 Conduit First Portion 
                 TC1′ 
               
               
                   593B 
                 Interdisposed Tubing Member 
                 TC1′ 
               
               
                   593C 
                 Conduit Second Portion 
                 TC1′ 
               
               
                  593′ 
                 Conduit Deformable Distal End 
                 TC1′ 
               
               
                 594 
                 External Flowable-Medium Source 
                 TC1′ 
               
               
                 595 
                 Port 
                 TC1′ 
               
               
                 596 
                 Valve 
                 TC1′ 
               
               
                   599A 
                 Displaceable End 
                 TC1′ 
               
               
                   599B 
                 Fixed End 
                 TC1′ 
               
               
                 600 
                 Distal End Portion 
                 TC1′ 
               
               
                   526A 
                 Split Stem 
               
               
                 528 
                 Reciprocating Member/Wire 
               
               
                   528A 
                 Reciprocating Member Distal Tip 
               
               
                 593 
                 Conduit 
               
               
                  593E 
                 Split Conduit 
               
               
                 601 
                 Conduit Cutter 
               
               
                 602 
                 No. 15 Scalpel Blade 
               
               
                 603 
                 Scalpel Blade Channel 
               
               
                 604 
                 Conduit Channel 
               
               
                 605 
                 Conduit Splitter 
               
               
                 606 
                 Spike 
               
               
                   606A 
                 Spike Exit port 
               
               
                 607 
                 Hypodermic Tubing 
               
               
                 608 
                 Hypodermic Tubing Channel 
               
               
                 609 
                 Stem Channel 
               
               
                 610 
                 Wire Channel 
               
               
                 611 
                 Conical Conduit Guide 
               
               
                   
               
            
           
         
       
     
     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.