Abstract:
The present application relates to orogastric tube guides and to related systems and methods. The orogastric tube guides and systems can be used to direct an orogastric tube into the esophagus of a patient during any medical or surgical procedure where placement of an orogastric tube is indicated or used.

Description:
CROSS-REFERENCE TO RELATED APPLICATIONS 
       [0001]    This application claims the benefit of U.S. Provisional Patent Application No. 61/478,179, filed Apr. 22, 2011 and U.S. Provisional Patent Application No. 61/511,292, filed Jul. 25, 2011, both of which are incorporated herein by reference in their entirety. 
     
    
     TECHNICAL FIELD 
       [0002]    The present application relates to orogastric tube guides and to the guiding of orogastric tubes into the esophagus. 
       BACKGROUND 
       [0003]    A vast majority of patients undergoing general anesthesia require orogastric tube placement to decompress and drain gastric secretions for better surgical visualization and to minimize the risk of aspiration of gastric contents. 
         [0004]    The traditional placement technique is blind, traumatic and unhygienic as gastric secretions are a source of cross-contamination. Orogastric tubes have an inherent rigidity favoring insertion. Unsuccessful insertion attempts lead, however, to softening of the tube by the higher oral temperature compared to the ambient temperature. This leads to curling of the tube in patient&#39;s mouth rather than going down the esophagus resulting in product waste in addition to the complications resulting from multiple placement attempts. 
       SUMMARY 
       [0005]    The present application relates to orogastric tube guides and to related systems and methods. The orogastric tube guides and systems can be used to direct an orogastric tube into the esophagus of a patient during any medical or surgical procedure where placement of an orogastric tube is indicated or used. 
         [0006]    These and other features and advantages of the present invention will become more readily apparent to those skilled in the art upon consideration of the following detailed description and accompanying drawings, which describe both the preferred and alternative embodiments of the present invention. 
     
    
     
       BRIEF DESCRIPTION OF THE DRAWINGS 
         [0007]      FIG. 1  is a schematic illustration of an example orogastric tube guide and endotracheal tube. 
           [0008]      FIG. 2  is a schematic illustration of an example endotracheal tube placed in a typical patient-inserted orientation. 
           [0009]      FIG. 3  is a schematic illustration of an example orogastric tube guide and endotracheal tube positioned in a subject. 
           [0010]      FIGS. 4A-D  are schematic illustrations of an example orogastric tube guide and endotracheal tube and aspects thereof. 
       
    
    
     DETAILED DESCRIPTION 
       [0011]    The present invention now will be described more fully hereinafter with reference to specific embodiments of the invention. Indeed, the invention can be embodied in many different forms and should not be construed as limited to the embodiments set forth herein; rather, these embodiments are provided so that this disclosure will satisfy applicable legal requirements. 
         [0012]    As used in the specification, and in the appended claims, the singular forms “a,” “an,” “the,” include plural referents unless the context clearly dictates otherwise. 
         [0013]    The term “comprising” and variations thereof as used herein are used synonymously with the term “including” and variations thereof and are open, non-limiting terms. 
         [0014]    Referring to  FIGS. 1-3 , an orogastric tube guide  100  is illustrated. The orogastric tube guide  100  can be used to direct an orogastric tube  106  into the esophagus  111  of a subject. 
         [0015]    The orogastric tube guide  100  comprises a conduit  102  having a passage  104  sized to allow for the slidable advancement of an orogastric tube  106  there through the passage. For example, the passage  104  can have an opening and inner-luminal diameter along the length of the conduit that allows an operator to slide an orogastric tube through the passage. The size of the passage  104  may vary based on the size of the orogastric tube  106  that is used in a given medical procedure. 
         [0016]    For example, the passage can be sized to allow any size orogastric tube  106  to be passed through it. Optionally, the conduit passage is sized to allow the slidable passage of an orogastric tube  106  that is up to 18 french in size. 
         [0017]    Optionally, the diameter of the passage  104  is matched closely to the outside diameter of the orogastric tube used in a medical procedure. For example, the luminal diameter of the guide may in some cases be just larger than the outer diameter of the orogastric tube used in the procedure such that slidable passage is achieved while the inner luminal walls of the conduit passage are in close approximation, or even in contact, with the outside of the orogastric tube. The conduit can also vary in length. Optionally, the conduit is 9 inches long or shorter. 
         [0018]    The conduit  102  of the orogastric tube guide  100  is secured or securable to an endotracheal tube  108 . When secured to the endotracheal tube  108 , the conduit  102  is optionally oriented such that the passage  104  is posterior to the endotracheal tube  108  when the endotracheal tube is in its patient-inserted orientation. Patient-inserted orientation refers to an endotracheal tube inserted and/or positioned into the trachea of subject as typical for use in medical and surgical procedures. 
         [0019]    The conduit  102  is configured to guide an orogastric tube into the esophagus of a subject when the conduit  102  is secured to the endotracheal tube  108  and when the endotracheal tube or a portion thereof is located in the trachea of the subject. The orogastric tube guide  100  can therefore be used to direct an orogastric tube into the esophagus  111  while an endotracheal tube is positioned in the trachea  113 . 
         [0020]    When the conduit  102  is placed in a subject, at least a portion of the conduit  102  can be located in the pharyngeal cavity  112  of the subject. For example, the distal end  105  of the conduit  102  can be located in the pharyngeal cavity  112  of the subject. The distal end  105  comprises an opening that allows the passage of the distal end of the orogastric tube  106  out of the conduit and into the esophagus  111 . The pharyngeal cavity includes, for example, the oropharynx or laryngopharynx. 
         [0021]    At least a portion  114  of the conduit  102  can also be located outside of the pharyngeal cavity and, optionally, outside of the oral cavity of the subject. This portion  114  also has an opening for insertion of the orogastric tube  106  into the conduit passage  104 . 
         [0022]    The conduit  102  is optionally secured to the endotracheal tube  108  by at least one connector  116 . Optionally, the conduit  102  is releaseably secured or securable to the endotracheal tube  108 . For example, the at least one connector  116  can be used to attach the conduit  102  to the endotracheal tube  108  and the at least one connector can also release the attachment to allow the separation of the endotracheal tube  108  from the conduit  102 . The conduit is optionally flexible. In some examples, the connector is a clamp, such as a snap-on clamp that can snap onto the guide  100  and/or endotracheal tube using a friction fit or other attachment mechanism. The guide  100  and other portions of the devices and systems described herein can optionally comprise material used in medical applications such as medical tubing applications. For example, the guide can be made of the same or similar material to the endotracheal tube. The guide optionally comprises medically compatible plastic or polymeric material. Optionally, the guide is left in the subject over a period of time, for example, for the duration of a medical or surgical procedure. Optionally, the conduit  102  is spaced from the endotracheal tube  108  when the conduit is secured to the endotracheal tube. 
         [0023]    Still referring to  FIGS. 1-3 , further provided is a system that comprises an endotracheal tube  108  and an orogastric tube guide  100 . The orogastric tube guide  100  comprises a conduit  102  configured for attachment to the endotracheal tube  108  and the conduit  102  has a passage that is sized to allow for slidable advancement of an orogastric tube there through the passage. 
         [0024]    The system optionally further comprises an orogastric tube  106  wherein the orogastric tube is configured to be slidably advanced through the passage  104  of the conduit  102 . As described above, the conduit  102  can be attached to the endotracheal tube  108  such that its passage is posterior to the endotracheal tube when the endotracheal tube is in its patient-inserted orientation. The conduit  102  is configured, and can be used, to guide an orogastric tube into the esophagus  111  of a subject when the conduit is attached to the endotracheal tube  108  and when the endotracheal tube, or a portion thereof, is located in the trachea of the subject. 
         [0025]    Also provided are methods for placing an orogastric tube  106  into the esophagus  111  of a subject. The methods include providing an endotracheal tube  108  and an orogastric tube guide  100 . The orogastric tube guide  100  comprises a conduit  102  having a passage that is sized to allow the slidable passage of an orogastric tube  106  there through the passage. 
         [0026]    An end  115  of the endotracheal tube and an end  105  of the conduit can be inserted into the oral cavity of the subject and positioned such that the end  115  of the endotracheal tube is located in the trachea of the subject and the end  105  of the conduit is located in the pharyngeal cavity of the subject. The pharyngeal cavity includes, for example, the oropharynx or laryngopharynx. 
         [0027]    The orogastric tube  106  is inserted into the passage of the conduit and advanced through the passage into the esophagus  111  of the subject. The conduit  102  can be secured to the endotracheal tube  108  prior to inserting the end of the endotracheal tube and conduit into the oral cavity. Optionally, the conduit is secured to the endotracheal tube in a position posterior to the endotracheal tube. Optionally, a second end  114  of the conduit is positioned outside of the oral cavity. The end  114  of the conduit positioned outside of the oral cavity has an opening where the orogastric tube is inserted into the conduit. 
         [0028]    Referring now to  FIG. 4 , an orogastric tube guide  400  comprises a conduit  102  having a passage  104 . At least a portion of the passage  104  is moveable between a first collapsed state shown in  FIG. 4B  and a second expanded state shown in  FIG. 4C . The second expanded state is configured to allow for slidable advancement of an orogastric tube there through the passage  104 . Thus, in the expanded state, the lumen of the passage is sufficiently open to allow slidable passage of the orogastric tube. 
         [0029]    The conduit  102  is secured or securable to an endotracheal tube  108 . Optionally, the conduit  102  comprises a pliable or flexible material that tends to a collapsed state when not held or actuated into the expanded state. Such materials may include, for example, rubber or another elastic material, such as an elastic polymer. 
         [0030]    The passage  104  optionally maintains the collapsed state prior to slideable advancement of the orogastric tube. Thus, the passage can be expanded to the expanded state on insertion and advancement of an orogastric tube and the passage can return to the collapsed state on removal of the orogastric tube. Optionally, the collapsed state prevents or impedes substantial fluid flow there through the passage. 
         [0031]    Also provided are systems, comprising an endotracheal tube and an orogastric tube guide  400 , wherein the orogastric tube guide  400  comprises a conduit  102  having a passage  104 . At least a portion of the passage  104  is optionally moveable between a first collapsed state ( FIG. 4B ) and a second expanded state ( FIG. 4C ). The second expanded state is configured to allow for slidable advancement of an orogastric tube there through the passage. 
         [0032]    The orogastric tube guide  400  comprises a conduit  102  having a passage  104  sized, in its expanded state, to allow for the slidable advancement of an orogastric tube  106  there through the passage. For example, the expanded passage  104  can have an opening and inner-luminal diameter along the length of the conduit that allows an operator to slide an orogastric tube through the passage. The size of the expanded passage  104  may vary based on the size of the orogastric tube  106  that is used in a given medical procedure. 
         [0033]    For example, the expanded passage can be sized to allow any size orogastric tube  106  to be passed through it. Optionally, the conduit expanded passage is sized to allow the slidable passage of an orogastric tube  106  that is up to 18 french in size. 
         [0034]    Optionally, the diameter of the expanded passage  104  is matched closely to the outside diameter of the orogastric tube used in a medical procedure. For example, the luminal diameter of the guide may in some cases be just larger than the outer diameter of the orogastric tube used in the procedure such that slidable passage is achieved while the inner luminal walls of the conduit passage are in close approximation, or even in contact, with the outside of the orogastric tube. The conduit can also vary in length. Optionally, the conduit is 9 inches long or shorter. 
         [0035]    As described with reference to  FIGS. 1-3 , the conduit  102  of the orogastric tube guide  400  is secured or securable to an endotracheal tube  108 . When secured to the endotracheal tube  108 , the conduit  102  is optionally oriented such that the passage  104  is posterior to the endotracheal tube  108  when the endotracheal tube is in its patient-inserted orientation. Patient-inserted orientation refers to an endotracheal tube inserted and/or positioned into the trachea of subject as typical for use in medical and surgical procedures. 
         [0036]    The conduit  102  is configured to guide an orogastric tube into the esophagus of a subject when the conduit  102  is secured to the endotracheal tube  108  and when the endotracheal tube or a portion thereof is located in the trachea of the subject. The orogastric tube guide  400  can therefore be used to direct an orogastric tube into the esophagus  111  while an endotracheal tube is positioned in the trachea  113 . 
         [0037]    As described with reference to  FIG. 3 , when the conduit  102  is placed in a subject, at least a portion of the conduit  102  can be located in the pharyngeal cavity  112  of the subject. For example, the distal end  105  of the conduit  102  can be located in the pharyngeal cavity  112  of the subject. The distal end  105  comprises an opening that allows the passage of the distal end of the orogastric tube  106  out of the conduit and into the esophagus  111 . The pharyngeal cavity includes, for example, the oropharynx or laryngopharynx. 
         [0038]    At least a portion  114  of the conduit  102  can also be located outside of the pharyngeal cavity and, optionally, outside of the oral cavity of the subject. This portion  114  also has an opening for insertion of the orogastric tube  106  into the conduit passage  104 . 
         [0039]    Referring to  FIG. 4D , the conduit  102  is optionally secured to the endotracheal tube  108  by at least one connector  406 . Optionally, the conduit  102  is releaseably secured or securable to the endotracheal tube  108  using, for example the connector  402 . For example, the at least one connector  406  can be used to attach the conduit  102  to the endotracheal tube  108  and the at least one connector can also release the attachment to allow the separation of the endotracheal tube  108  from the conduit  102 . 
         [0040]    The connector can extend along the length, or a portion of the length, of the conduit  102 . For example, the connector  406  can extend along the length of the conduit  102  and can include a first side  404  and second side  402 , which are separated by a slot. The endotracheal tube may be forcibly pushed into the connector through the slot such that the slot expands to receive the endotracheal tube. Because the slot is narrower than the diameter within the connector  406 , and because the slot is resilient, it can snap back to its original width once the endotracheal tube is positioned in the connector  406 . Moreover, the connector  406  optionally has an inner diameter that is less than the outer diameter of the endotracheal tube  108 . In this case, the force of the connector trying to regain its original dimensions following the insertion of the endotracheal tube optionally functions to secure the endotracheal tube within the connector  406 . 
         [0041]    The conduit is optionally flexible. In some examples, as with the connector  406 , the connector is a clamp, such as a snap-on clamp that can snap onto the conduit  102  and/or endotracheal tube using a friction fit or other attachment mechanism. The conduit  102  and other portions of the devices and systems described herein can optionally comprise material used in medical applications such as medical tubing applications. For example, the guide can be made of the same or similar material to the endotracheal tube. The guide optionally comprises medically compatible plastic or polymeric material. Optionally, the guide is left in the subject over a period of time, for example, for the duration of a medical or surgical procedure. Optionally, the conduit  102  is spaced from the endotracheal tube  108  when the conduit is secured to the endotracheal tube. 
         [0042]    The device shown in  FIG. 4  and the systems described above can be used to place an orogastric tube into the esophagus of a subject. For example, an endotracheal tube may be provided and the orogastric tube guide may be provided. An end of the endotracheal tube and the conduit are inserted into the oral cavity of the subject such that the end of the endotracheal tube is located in the trachea of the subject and the end of the conduit is located in the pharyngeal cavity of the subject. An orogastric tube is inserted into the passage of the conduit, expanding the passage, and advancing the orogastric tube through the passage and into the esophagus of the subject. 
         [0043]    The orogastric tube guides, systems, and methods described herein can optionally take advantage of an endotracheal tube placed in a subject for general anesthesia. The endotracheal tube acts as a guide for orogastric tube placement. As described throughout, the orogastric tube guides comprise a hollow conduit with the internal diameter wide enough to channel the orogastric tube through it. This orogastric tube guides may be attached to the backside of the endotracheal tube, prior to intubation. After intubation, the orogastric tube is inserted through an open end of the orogastric tube guide and since the esophagus is behind and follows the same curvature as the trachea, the tube slides through the esophagus into the stomach. 
         [0044]    Many modifications and other embodiments of the invention set forth herein will come to mind to one skilled in the art to which this invention pertains having the benefit of the teachings presented in the foregoing description. Therefore, it is to be understood that the invention is not to be limited to the specific embodiments disclosed and that modifications and other embodiments are intended to be included within the scope of the appended claims. Although specific terms are employed herein, they are used in a generic and descriptive sense only and not for purposes of limitation.