US20090030386A1 - Bowel management system and waste collection bag therefor - Google Patents

Abstract

A bowel management system includes a waste collection catheter having at least two distinct sections. The first section is patient proximal when disposed in the patient's rectum and has durometer hardness in the range of about 50 A to about 90 A. The second catheter section is connected to the first section and has durometer hardness in the range of about 5 A to about 49 A. A selectively collapsible, substantially spherical retention balloon is attached coaxially and exterior of the first catheter section such that the proximal-most end of the retention balloon is coincident to the proximal-most end of the first section of the waste collection catheter, the substantially spherical retention balloon having an inflated size so as to be sufficiently large enough to retain the patient proximal end of the catheter in the patient's rectum without being so large as to trigger a defecatory response in the patient.

Description

FIELD OF THE INVENTION
• The present invention relates generally to the field of devices for bowel maintenance, and, more particular, to a rectal catheter having multiple sections of varying durometer hardness and a retention balloon to retain the catheter within the rectum of incontinent patients.
BACKGROUND OF INVENTION
• Many circumstances can result in an individual becoming incontinent for an extended period of time. Examples of such circumstances include head or spinal cord trauma, disabling strokes, microbial caused illness, broken lower limbs or pelvic bones, digestive disorders, intensive care stays, and as side effects of administration of various pharmaceuticals. Incontinent patients and their caretakers face a great burden in the maintenance of the bowel and its functions. Such patients often suffer from constipation, but can also experience boughts of diarrhea, which impose even greater nursing problems. Constipation or stool impaction can be painful and require messy bowel irrigations and/or manual disimpaction to break up the impacted stool. Diarrhea, on the other hand, can result in perianal skin breakdown, which in turn can lead to open wounds and infections. The proper treatment of perianal wounds, whether caused by exposure to feces (i.e. diarrhea) or other etiology, can be especially difficult if the wound is continually being contaminated by feces. A great deal of time is necessary to cleanse contaminated wounds, change bedding and treat infections. Thus, there is a great need for devices and methods to improve the function of the bowel in incontinent patients. This need is particularly great in patients who are incontinent as well as being nonambulatory.
• Previously, efforts to address these problems included a variety of devices, such as bags or plugs adhered to or inserted into the anus of non-ambulatory patients. These methods are limited in their effectiveness, in part due to leakage around the devices and the resultant effluent that remains in contact with the perianal skin and, in part, due to the complexities of the anal canal anatomy that can interfere with the use of such devices. Because of the ineffectiveness of the available methods for managing fecal evacuation in bed-ridden patients, physicians are frequently forced to construct a stoma in those individuals where enough intact perianal skin does not remain or where the occurrence of an infection would be life threatening.
• Thus, it is among the advantages and features of the present invention that it can be used as a bowel maintenance system in a wide variety of incontinent patients for diversion of fecal matter to a receptacle to minimize contact of such fecal matter with patient skin. The new system (1) facilitates the collection of fecal matter for patients requiring stool management (2) provides access for colonic irrigation and (3) provides a conduit through which medications may be administered.
SUMMARY OF INVENTION
• Thus, it was with the above disadvantages and limitations in mind that the new bowel management system was developed. The new system is composed generally of a rectal catheter having three distinct portions, each with different elasticity and durometer hardness. A retention balloon mounted on the outer diameter of the patient proximal catheter maintains the catheter in a position within the rectum that provides for atraumatic sealing and anchoring. An optional intralumenal balloon mounted on the inner diameter of the catheter assists in insertion of the device into a patient's rectum and also acts as an anti-reflux valve to obstruct the catheter's evacuation lumen during periods of bowel irrigation or following medication administration for the purpose of retaining the medications in the patient's rectum. An optional faceplate that can be anchored to the patient with tape prevents migration of the retention balloon too far into the rectum. A drainage tube extends outwardly from the external retention faceplate and functions as a conduit to transport waste and irrigation fluids away from the patient to a waste collection bag. A flush/sampling port is located on the drainage tube and provides access for catheter flushing (rinsing) and stool sampling.
• The catheter of the new system preferably includes three syringe connectors. One of the connectors is in fluid communication with the retention balloon and one of the connectors is in fluid communication with the intralumenal balloon. These connectors facilitate the inflation/deflation of the respective balloons. The third connector is in fluid communication with an optional irrigation lumen that exits the catheter at the patient proximal tip and is used for bowel irrigation and administration of medication solutions.
• Accordingly, in furtherance of the above goals, the present invention is, briefly, a bowel management system for use in a patient. The new system includes a waste collection catheter having at least two distinct sections of varying durometer hardness. A first section, which is patient proximal and which is disposed in the patient's rectum in normal use position, has a first end and a second end, and a durometer hardness in the range of about 50 A to about 90 A, so that the catheter patient proximal section is stiff enough to automatically maintain an open position for free flow of bowel waste when in normal use position with a retention balloon inflated. However, the first section is soft and pliable enough to permit folding longitudinally for ease of insertion into the rectum of the patient. A second section has a first end connected to the second end of the patient proximal section, and a second end, and a durometer hardness in the range of about 5 A to about 49 A. The second section can be positioned and retained in the anal canal of the patient for extended periods without distending the sphincters or causing discomfort. The system also includes a selectively collapsible, substantially spherical retention balloon attached coaxially and exterior of the patient proximal first catheter section such that the proximal-most end of the retention balloon is coincident to the proximal-most first end of the patient proximal first section of the waste collection catheter. The substantially spherical retention balloon has an inflated size so as to be sufficiently large enough to retain the patient proximal end of the catheter in the patient's rectum without being so large as to trigger a defecatory response in the patient.
• The present invention is also, briefly, the combination of a bowel management system for use in a non-ambulatory patient and a waste collection bag. The bowel management system includes a waste collection catheter having at least two distinct sections of varying durometer hardness including a patient proximal first section, which is disposed in the patient's rectum in normal use position, having a first end and a second end. The durometer hardness of the first section is such that the catheter patient proximal section is stiff enough to automatically maintain an open position for free flow of bowel waste when in normal use position, yet is soft and pliable enough to permit folding longitudinally for ease of insertion into the rectum of a patient. A second section has a first end connected to the second end of the patient proximal first section, and a second end sufficiently spaced from the first end that the second section can be positioned and retained in the anal canal of the patient and has a durometer hardness to permit the retention of the second section in the patient for extended periods without causing discomfort or lesions in the patient. A waste collection bag is adapted for secure, leak-proof connection to the waste collection catheter and is sized sufficiently large enough to receive fecal waste from the patient for extended periods, in the range of at least four hours.
• The invention is further, briefly, a method for inserting a bowel management system into a patient, the method including:
• (a) providing a bowel management system, the system having:
• a waste collection catheter having at least two distinct sections of varying durometer hardness including:
• a first section which is patient proximal and which is disposed in the patient's rectum in normal use position, having a first end and a second end, and a durometer hardness in the range of about 50 A to about 90 A, so that the catheter patient proximal section is stiff enough to automatically maintain an open position for free flow of bowel waste when in normal use position with retention balloon inflated, yet is soft and pliable enough to permit folding longitudinally for ease of insertion into the rectum of a patient;
• a second section having a first end connected to the second end of the patient proximal section, and a second end, and a durometer hardness in the range of about 5 A to about 49 A, so that the second section can be positioned and retained in the anal canal of the patient for extended periods without distending the sphincters or causing discomfort; and
• a selectively collapsible, substantially spherical retention balloon attached coaxially and exterior of the patient proximal first catheter section such that the proximal-most end of the retention balloon is coincident to the proximal-most first end of the patient proximal first section of the waste collection catheter, the substantially spherical retention balloon having an inflated size so as to be sufficiently large enough to retain the patient proximal end of the catheter in the patient's rectum without being so large as to trigger a defecatory response in the patient;
• (b) folding the patient proximal first end of the waste collection catheter longitudinally;
• (c) inserting the folded patient proximal first end of the waste collection catheter into the patient's rectum sufficiently far that the selectively collapsible, substantially spherical retention balloon is entirely within the patient's rectum; and
• d) securing the waste collection catheter in the position to which it has been inserted so that the catheter does not become separated from the patient during an extended period of time, in the range of hours, while the patient's body waste is permitted to drain out of the patient's body through the waste collection catheter.
• The invention is further, briefly, a method for inserting a bowel management system into a patient, the method including:
• (a) providing a bowel management system, the system having:
• a waste collection catheter having at least two distinct sections of varying durometer hardness including:
• a first section which is patient proximal and which is disposed in the patient's rectum in normal use position, having a first end and a second end, and a durometer hardness in the range of about 50 A to about 90 A, so that the catheter patient proximal section is stiff enough to automatically maintain an open position for free flow of bowel waste when in normal use position with retention balloon inflated, yet is soft and pliable enough to permit folding longitudinally for ease of insertion into the rectum of a patient;
• a second section having a first end connected to the second end of the patient proximal section, and a second end, and a durometer hardness in the range of about 5 A to about 49 A, so that the second section can be positioned and retained in the anal canal of the patient for extended periods without distending the sphincters or causing discomfort; and
• a selectively collapsible, substantially spherical retention balloon attached coaxially and exterior of the patient proximal first catheter section such that the proximal-most end of the retention balloon is coincident to the proximal-most first end of the patient proximal first section of the waste collection catheter, the substantially spherical retention balloon having an inflated size so as to be sufficiently large enough to retain the patient proximal end of the catheter in the patient's rectum without being so large as to trigger a defecatory response in the patient;
• b) inflating an intralumenal balloon in the patient proximal end of the waste collection catheter to the extent that the intralumenal balloon extends slightly beyond the proximal-most end of the catheter, to thereby provide a curved tip for ease of introduction of the catheter into the patient's rectum
• (c) inserting the patient proximal first end of the waste collection catheter into the patient's rectum sufficiently far that the selectively collapsible, substantially spherical retention balloon is entirely within the patient's rectum; and
• (d) securing the waste collection catheter in the position to which it has been inserted so that the catheter does not become separated from the patient during an extended period of time, in the range of hours, while the patient's body waste is permitted to drain out of the patient's body through the waste collection catheter; and
• (e) deflating the intralumenal balloon in the patient proximal end of the waste collection catheter to permit free flow of body wastes from the patient.
• These and other objects and advantages will be in part apparent and in part pointed out herein below.
BRIEF DESCRIPTION OF DRAWINGS
• FIG. 1 is a schematic perspective view of a bowel management system constructed in accordance with and embodying the present invention and shown inflated in the use position.
• FIG. 2 is a schematic perspective view of the system ofFIG. 1, shown partially exploded.
• FIG. 3 is a schematic representation of the exterior of the rectal tube subassembly of the system ofFIG. 1.
• FIG. 3A is an exploded view of the subassembly ofFIG. 3.
• FIG. 4 is a side elevational view of the drainage tube assembly ofFIG. 1 with a bag connector attached thereto.
• FIG. 5 is an exploded view ofFIG. 4.
• FIG. 6 is a schematic side view of the patient proximal end of the assembled bowel management system.
• FIG. 7 is a longitudinal section, enlarged, through the patient proximal end of the system ofFIG. 1 taken on line7-7 ofFIG. 6 and further enlarged for clarity of detail.
• FIG. 8 is an enlarged schematic elevational view of the rectal tube of the assembly ofFIG. 1.
• FIG. 9 is a longitudinal sectional view taken on line9-9 ofFIG. 8.
• FIG. 10 is a transverse sectional view taken on line10-10 ofFIG. 8.
• FIG. 11 is an enlarged schematic sectional view of the tri-lumen tube of the assembly ofFIG. 1.
• FIG. 12 is an enlarged partial sectional view showing the lumens, taken fromFIG. 9.
• FIG. 13 is a left end elevational view ofFIG. 3, rotated.
• FIG. 14 is an enlarged sectional view taken fromFIG. 13 showing the connection of the tri-lumen tube to the rectal tube.
• FIG. 15 is a schematic elevational view of a waste collection bag used with the system with its various tubes and connectors.
• Throughout the drawings like elements are indicated by like element numbers.
DETAILED DESCRIPTION
• With reference to the figures, and particularlyFIGS. 1 and 2, a bowel management system, generally designated10, includes acatheter12 having a patientproximal end14 and a patientdistal end16 and threedistinct sections18,20,22 therebetween.Rectal catheter section18 is located at theproximal end14 of the catheter,section20 is a midsection andsection22 is toward the patientdistal end16. Afirst balloon24, which is inflatable, is mounted at the patientproximal end14 ofcatheter12 and a bag connector assembly26 is mounted at the patientdistal end16. These elements will be described in further detail hereafter.
• Rectal catheter section18 has a patient proximal opening that, when positioned for normal use, opens into the rectum of a patient and a second end or distal opening which connects to thesecond catheter section20. First catheter section18 (shown enlarged inFIGS. 8,9,10 and12) is formed of a material having a durometer hard enough to maintain a sufficient opening at the first end of the tube, in order to avoid collapse and subsequent blocking of fecal outflow from the patient. An example of a suitable material is silicone rubber, 80 SH polydimethylsiloxane and fumed silica. The optimal durometer range is between 50 A and 90 A shore hardness. The proximal opening must be kept open, in order to effectively receive stool entering thefirst catheter section18. A relatively large lumen which runs longitudinally within the cylindrical wall oftube section18 is indicated atnumber30 inFIGS. 8,9,10 and12.Smaller lumens32,34 are located adjacent and parallel to lumen30 on opposite sides thereof.Reference numeral36 denotes an annular shoulder at the proximal end ofcatheter section18. The proximal end of bolster (“retention”)balloon24 rests againstshoulder36 when in expanded, inflated use position.
• FIGS. 6 and 7 show enlargements ofretention balloon24 mounted totube section18 and show that the proximal end of theballoon24 is adjacent to and tapers toward the proximal end oftube18.Retention balloon24 is formed of a selectively collapsible and inflatable material and is mounted coaxially around the proximal end ofsection18 so that the extreme ends of each element are substantially flush (or at least closely adjacent to) with one another.
• FIG. 7 is a longitudinal section ofFIG. 6, which illustrates internally oftube section18 anoptional intralumenal balloon38 in a collapsed state. When inflated theintralumenal balloon38 acts as a anti-reflex valve (ARV) and if inflated sufficiently so that the patient proximal end ofballoon38 protrudes slightly (as shown in phantom inFIG. 7) beyond the proximal end oftube section18, the intralumenal balloon also acts as an aid to insertion of the bowel management assembly into the patient's rectum. This optional embodiment of the system includes an irrigation lumen30 (described further herein), which exits the patient proximal end of thecatheter section18 and can be connected to an irrigation supply for inputting irrigant (such as saline) into the patient's rectum.
• FIGS. 3 and 3A illustrate assembled and unassembled, respectively, the sub-assembly of the indwelling portion of thenew system10. From the lower left to the upper right ofFIG. 3 there is seen the patientproximal catheter section18 extending just slightly beyond theretention balloon24 and then thesecond catheter section20.Catheter section20 is a cylindrical tube when completely open. It is formed with a very thin wall from a soft elastic material which results in a collapsible tube that when collapsed, such as by the anal sphincter muscles, creates a very small profile. As this section of the catheter is left in place for very extended periods of time in the patient's anal region this collapsibility is important to prevent loss of the patient's sphincter tone, as could result over time if a large diameter rigid tube where in such place. The optimal durometer range forsection20 is between 5 A to 49 A shore hardness. A first, proximal, end of thesecond catheter section20 is connected to the distal or second end of thefirst catheter section18.Catheter section20 may be constructed as one unitary tube of singular durometer hardness, thickness and diameter. An example of a suitable material for making trans-sphincter catheter section20 is silicone rubber, 30 SH polydimethylsiloxane and fumed silica.
• Toward the patient distal end ofcatheter section20 there is mounted anoptional faceplate41 which mounts surrounding thetube20 and has preferably at least twosections42 extending therefrom. Eachextension42 can have loops orother connectors44 thereon to facilitate attachment of thefaceplate strap40 to the patient to keep it in place. Finally, inFIG. 3, at the patient distal end ofcatheter section20 there is connected an extruded multi-lumen member46 (shown in enlarged perspective, inFIG. 11) for permitting inflation/deflation of the balloons and flushing of the rectum, if desired. An end view ofassembly10 is provided inFIG. 13, showing the relative positions of thestrap40 and the multi-lumen catheter. An enlarged sectional view (rotated) inFIG. 14 better illustrates the connection of themulti-lumen member46 with the assembly atcatheter section18. An example of a suitable material for formingmulti-lumen member46 is silicone rubber, 57SH polydimethylsiloxane and fumed silica.
• In the exploded view,FIG. 3A, further elements of the subassembly are seen which are hidden or not clear inFIG. 3. This view illustratesretention balloon24 in its expanded state before application tocatheter section18. The extensions24A of the symmetrical balloon on each end are annular. InFIG. 7 it is seen more clearly how extensions24A are folded under and inwardly so as to seal flat against the exterior wall at opposite ends ofcatheter section18.
• The figures also show the substantially spherical shape ofretention balloon24. This shape is important because it seats naturally in the patient's rectum to prevent leaking around the retention balloon. The shape of the balloon is important to prevent damage to the rectal wall and to achieve optimum sealing to prevent leakage and to effectively funnel fecal matter into the proximal opening ofcatheter section18. Thus, the shape needs to be substantially spherical, not elliptical or torrodial.
• The size of the balloon when inflated is not only critical to prevent leakage but also to prevent migration of thenew system10 out of the rectum. The optimal size forballoon24 for the normal adult patient is between 44 cc and 69 cc. It has been shown in the literature that a volume of 90 cc is sufficient to trigger a defecatory response and thus the retention balloon should not be sized to reach this volume. The minimum of 44 cc is critical in order to prevent leakage and outward migration from the rectum of the patient. The size of the balloon as expressed by a length to diameter ratio is 0.75 at the low end of the inflation range, 44 cc, (i.e., the balloon length is 1.35 inches and the balloon diameter would then be 1.8 inches) and 0.61 at the upper end, 69 cc (i.e., a balloon length of 1.35 inches and a balloon diameter of 2.32 inches). It is to be understood that all sizes given herein are for an average adult patient and can be adjusted proportionally for other non-average patients. Theretention balloon24 is inflated via alumen34, which opens into the balloon. The lumen is connected via amulti-lumen member46 to an inflation device, such as a syringe, filled with air or saline or some other biocompatible fluid. The inflation device limits the volume of inflation medium infused to a volume that results in the inflation of the balloon to the desired range of 44 to 69 cc.
• An example of a suitable material from which to formretention balloon24, in order to achieve the desired results is silicone rubber, 30SH polydimethylsiloxane and fumed silica. Alternatively, the retention balloon material itself could limit the size if a material or structure was used that would only expand to the optimum size. An example of such material would be polyimide. An example of such a structure would be a stiff mesh impregnated into an otherwise elastic material such as silicone that would mechanically limit the retention balloon size when inflated. In turning toFIG. 3A, to the right of theretention balloon24 is shown asecond balloon38 which is illustrated in its collapsed position.Balloon38 is also illustrated inFIG. 7 collapsed in solid lines and inflated in broken lines. When inflated,balloon38 fills the lumen ofcatheter section18 to block reflux and facilitates insertion of the system into a patient.
• Further with reference toFIG. 3A,catheter section18 is shown then to the right ofballoon38. To the right ofcatheter section18 are shown twosmall TEFLON tubes48 which interconnect paired small lumen in themulti-lumen catheter46 to corresponding openings to paired lumen inrectal catheter section18. An optionalradiopaque marker50 is preferably annular and is useful for accurately determining the location of and position of the assembly portion within the rectum of the patient.Marker50 is formed for example of material such as a tungsten silicone mixture, which is biocompatible, but easily detected by radiograph. To the right ofradiopaque marker50 inFIG. 3A is shown the trans-sphincter catheter section20, the midsection ofcatheter12.FIGS. 3 and 3A also illustrate the positioning of thefaceplate40 as it is mounted by a through hole onto the patient distal end ofmid-catheter section20. A bridge section or draintube connector band52 is illustrated to the right ofelement40 inFIG. 3A and also is visible inFIG. 3.Bridge section52 permits the third, patient distal segment ofcatheter12,segment22 to be connected in abutting relationship withmidsection20, by a slip fit of thesections20,22 over (or optionally, under) thesegment52. Extrudedmulti-lumen member46 is illustrated at the right ofFIG. 3A and is shown in part, enlarged inFIG. 11 for clarity. In this embodiment, themulti-lumen member46 is relatively flat and elongated and bears a largecentral lumen30 flanked by twosmaller lumen32,34 on opposite sides oflumen30, as previously discussed.
• FIGS. 1 and 2 illustrate three ports (for example, luer-style connectors), which are connectable to the various lumens inmulti-lumen member46. The largercentral port54 attaches to large lumen30A in the multi-lumen member and is used for connection of a syringe or other infusion device in order to infuse irrigants or medications. Anoptional port56 connects to one of the small optional lumens (e.g.,32a) in themulti-lumen member46 for inflation and deflation of theoptional intralumenal balloon38 with a syringe or other appropriate device. The other smalloptional port58 connects tosmall lumen34a, in themulti-lumen member46 in order to inflate and deflate the retention balloon with a syringe or other appropriate device.
• FIGS. 4 and 5 illustrate the subassembly of thethird catheter segment22.Segment22 connects at a patient proximal end22A to the distal end of the trans-sphincter mid-segment20 and the opposite, patient distal end22B to aconnector66, which is adapted for connection to a collection bag for example as illustrated at60 inFIG. 15. Thethird catheter section22 is formed of a non-collapsible tube constructed of a material that is stiff enough to maintain its shape to minimize kinking and facilitate drainage of the tube, but soft enough to be “milked” by a care professional to force through fecal material. Optional application of a coating to the exterior of section2 can facilitate milking thereof and optional internal coating ofsection22 facilitates flow-through of feces by decreasing friction against the internal side wall.
• Catheter22 as shown has an optional sampling/flushing port62 (shown most clearly inFIG. 5) to provide access to the lumen ofsection22 for taking fecal samples or for flushing to clean the catheter. In order to prevent bacterial contamination of the catheter and to also aid in reduction of odor to fecal build up in the catheter, frequent flushing through the optional sampling/flushingport62 is preferred. A cover forport62,63 of any suitable variety is also desirable.
• Theconnector assembly66 illustrated at end22B ofcatheter22 includes asleeve64 spacedly along the length ofcatheter22 to receive and retain the connector assembly, which attaches22B tocollection bag60. It may be a heat-shrinkable band or other suitable retention means as desired. As shown inFIG. 5connector assembly66 fits into the end22B and then is adapted, also with an optional O-ring (e.g. 67), to connect in a sealing manner to the bag. Aclosure portion68 is also desirable for closing off theconnector assembly64 preventing leakage when the bag is separated fromcatheter portion22. If desired, theclosure portion68 may be connected by a string, strip, cord orother piece70 to end26.
• System10catheter section22 empties into acollection bag60, which can be hung by the bedside to collect fecal waste matter.FIG. 15 illustrateswaste collection bag60, which is considerably larger than what would ordinarily be used for a colostomy or urinary bag and the bag may be left in place for long periods of time without having to be emptied. It is expected thatbag60 will have approximately a three liter capacity, and be provided with ahook72 for hanging on the bed or chair and of course aconnector73 for connection to thecatheter connector assembly64 in a sealing manner. Thewaste bag60 also optionally carries adrain tube holster74, such as the U-shaped connector illustrated, for example, and aclamp76 for sealing off the collectionbag drain tube82.Clamp76 desirably carries abutton78 or other connector, which slips intoholster74 or otherwise attaches to bag60.Closure portion75 is also desirable for preventing leakage from thebag connector73 when the bag is not connected to thecatheter portion22 of thebowel management system10. Anoutlet tube82 is also provided for draining out the contents of the bag. It is preferred that thebag60 be suitable for folding up because it is rather long; in order to prevent it from dragging on the floor.Clamp76 carrying thebutton holster connector78 is useful for sealing off collectionbag drain tube82 by pinching it. Also,Cap80, which is preferably attached to the.holster74 is useful for blocking the open tip (not shown) ofbag drain tube82.
• Another optional feature of the new bowel management system is the provision of a faceplate which would serve as a retention mechanism to prevent internal migration of thebowel management system10, as well as to prevent rotation of the trans-sphincter catheter section20 of the device. Such afaceplate41 can be mounted on thebridge section52 as illustrated, inFIGS. 1 and 2, as one useful example. The faceplate can take the form of a strap, wedge, donut, etc. and would preferably be made of silicone, foam or other soft material to avoid irritation of the patient's skin.
• FIGS. 1 and 2 also illustrate aclip assembly21 for attachment of theassembly10 to a sheet, bedclothes, etc. It is to be understood that the illustrated embodiment is merely one useful assembly for accomplishing this task. As shown, an elastomeric band surrounds a simple pinch clip for gripping fabric or other thin material for the purpose of holding the assembly in position. Other useful stabilizing devices are conceived.
• Use of the New Bowel Management System:
• For insertion ofbowel management system10 into a non-ambulatory patient it is preferred that the patient be in the left side down position, if possible, although other positions may be utilized if necessary due to the patient's clinical condition. The procedure for insertion is performed using recognized aseptic techniques as appropriate.
• A device is selected with the appropriate trans-sphincter catheter section length, usually 4 cm for a female patient, or 6 cm for a male patient. And the rectum of the patient is examined to confirm no rectal impaction and to be sure that no lesions or strictures exist which would preclude use of the device. A 60 cc syringe is filled with 35 cc-40 cc water and a 30 cc syringe is filled with 20 cc water. The 30 cc syringe is attached to the intralumenal balloon connector and theintralumenal balloon38 is filled with the 20 cc's of fluid.
• Lubricant is applied to patient proximal end of the device including the protrudingintralumenal balloon38, the deflatedretention balloon24 and the patient's anus. Using the protruding end of the intralumenal balloon as an introducer, the patient proximal end ofcatheter section18 is guided through the anus and into the distal rectum.
• The 60 cc syringe is attached to theretention balloon connector58 and theretention balloon24 is inflated with the syringe contents (in this example, 35 cc-40 cc water). Thecatheter connector assembly66 is connected to the wastecollection bag connector73 andbag60 is positioned at bedside so that thecatheter drainage tube22 is not twisted or kinked. This allows for unobstructed fecal matter flow from thecatheter22 intobag60.
• After the catheter system is inserted into the patient's rectum and connected to the drainage bag, the 30 cc syringe is used to completely aspirate the 20 cc of water (or air) fromintralumenal balloon38. The 30 cc syringe is disconnected from the intralumenal balloon connector.
• Catheter/bowel lumenal patency is confirmed by performing the following procedure:
• The patient is placed in a slight head up position to promote drainage, the gravity irrigation or enteral feeding bag is filled with one liter of warm tap water and hung from an IV pole two to three feed above the height of patient's anus. The irrigation bag administration set is connected to thecatheter irrigation port54. After the caretaker verifies the connection to the correct catheter port, gravity irrigation is begun. Large stool pieces are broken up by a combination of irrigating and manual douching (i.e. constricting outflow and squeezing the drainage tube repeatedly). Irrigation is discontinued when stool pieces are no longer present in the effluent.
• Irrigation of the patient's rectum can be performed using a gravity bag or by using a syringe. In the gravity bag method it is necessary to provide a waste collection bag with at least two liters of available volume. A standard gravity irrigation or enteral feeding bag with pre-attached administration set is used to infuse about a liter of warm tap water into the patient's anus at a flow rate of about one liter in six to ten minutes. The irrigation bag administration set is connected to the catheter system irrigation port and the 30 cc syringe (filled with 20 cc of fluid) is attached to the intralumenal balloon connector and theintralumenal balloon38 is filled with the 20 cc's of fluid.
• With the patient in a slight head down position the flow control valve on the irrigation bag set is opened and fluid is allowed to drain by gravity into the rectum and colon. If leakage occurs past the retention balloon during irrigation more water is injected into the retention balloon up to a maximum inflation volume of 50 cc.
• The infused irrigant is permitted to remain as long as prescribed by physician. Then the 20 cc volume of fluid with which the intralumenal balloon was inflated is removed via syringe and the mixed fluid and feces are allowed to drain out of the rectum and colon. If necessary, the patient's position is modified to slight head up. Once irrigation is complete the administration set is disconnected from the catheter irrigation port. Any additional fluid that was injected into the retention balloon is removed by syringe via the retention balloon connector. If necessary the retention balloon may be completely aspirated and refilled to normal use volume (about 35 to about 40 cc).
• If irrigation is performed using a syringe instead of a gravity bag preparations are similar, ensuring that sufficient space is available in the waste collection bag, and then a syringe is prepared with about 60 cc of warm tap water. A 30 cc syringe is prepared with about 20 cc of air or water and attached to the intralumenal balloon connector and the intralumenal balloon is inflated. The syringe is connected to the catheter irrigation port. With the patient in a slight head down position the irrigant is slowly injected into the rectum and colon. As with the gravity bag irrigation method, any leakage can be handled by further inflating the retention balloon. Similarly, irrigant is permitted to dwell for a prescribed time and then the fluid is aspirated from the intralumenal balloon with a syringe to allow drainage of fluid and feces out of the rectum and colon. If necessary the patient's position can be modified. Again, if extra fluid was introduced into the retention balloon it can now be released and the waste bag emptied if necessary.
• The system irrigation port can be useful for administering medications or enema solutions. In this case, the port is preferably flushed first with about 10 cc to about 20 cc of water before and after administration of enema/medication solution. A syringe is filled with the desired solution to be introduced and a 30 cc syringe is filled with about 20 cc of air or water. After inflating the intralumenal balloon, the solution is injected and the catheter irrigation lumen is flushed as indicated. The syringe is then disconnected from the irrigation port and the solution is permitted to dwell for the prescribed time. The intralumenal balloon is then deflated, preferably by use of a 30 cc syringe, as previously described.
• The flush/sampling port of the system can also be used to draw samples of fecal mater by use of a catheter tip syringe attached to the flush/sampling port. This can be very useful for monitoring a patient's progress and for testing purposes.
• In view of the foregoing, it will be seen that the several objects of the invention are achieved and other advantages are attained. Although the foregoing includes a description of the best mode contemplated for carrying out the invention various modifications are conceivable.
• As various modifications could be made in the constructions herein described and illustrated without departing from the scope of the invention it is intended that all matter contained in the foregoing description or shown in the accompanying drawings shall be interpreted as illustrative rather than limiting.

Claims (11)

1-20. (canceled)

21. The combination of a bowel management system for use in a non-ambulatory patient and a waste collection bag, the bowel management system comprising: a waste collection catheter having at least two distinct sections including: a patient proximal first section, which is disposed in the patient's rectum in a normal use position, having a first end and a second end, and a durometer hardness so that the patient proximal first section is stiff enough to automatically maintain an open position for free flow of bowel waste when in the normal use position, yet is soft and pliable enough to permit folding longitudinally for ease of insertion into the rectum of a patient; a second section having a first end connected to the second end of the patient proximal first section, and a second end sufficiently spaced from the first end that the second section can be positioned and retained in the anal canal of the patient and having a durometer hardness to permit the retention of the second section in the patient for extended periods; and a waste collection bag adapted for secure, leak-proof connection to the waste collection catheter and which is sized sufficiently large enough to receive fecal waste from the patient for extended periods.

22. The combination ofclaim 21, and further comprising a patient distal third section having a first end connected to the second end of the second section, and a second end, which is patient distal-most when in use, the patient distal third section being flexible enough to remain open for flow-through of waste through the catheter to a waste collection bag and being adapted for secure, leak-proof connection to the waste collection bag.

23. The combination ofclaim 22, the system further comprising a selectively collapsible retention balloon attached around the patient proximal first section such that a proximal-most end of the retention balloon is coincident to a proximal-most first end of the patient proximal section of the waste collection catheter, the retention balloon having a size when not collapsed sufficiently large to retain the patient proximal end of the catheter in the patient's rectum without being so large as to trigger a defecatory response in the patient.

24. The combination ofclaim 23, the system further comprising a lumened member which is substantially smaller in diameter than the waste collection catheter and which has a first end and a second end, the first end of the lumened member being connected to the patient proximal first section of the waste collection catheter and being in fluid communication with the selectively collapsible retention balloon.

25. The combination ofclaim 22, the system further comprising a connector at the second end of the patient distal third section of the waste collection catheter, to thereby permit removable connection of the system to the waste collection bag.

26-27. (canceled)

28. The combination ofclaim 21, wherein the waste collection bag has attached a closeable drainage hose and a closure member for sealing a free end of the drainage hose when the drainage hose is not in use.

29. A waste collection bag for use with a patient bowel management system, the waste collection bag comprising: a body portion having a volume of approximately three liters, the body portion having an end which is positioned upwardly when connected to the system for use, the upper end defining an opening adapted for releasable connection to an end of a patient waste collection catheter; an attachment mechanism for removably attaching the waste collection bag to a support device for the patient; a retention mechanism for permitting the waste collection bag to be folded against itself and releasably retained in such position in order to prevent the bag from dragging on the ground or other support surface; a closeable drainage hose; and a closure member for sealing a free end of the drainage hose when the drainage hose is not in use for emptying waste from the waste collection bag.

30. The waste collection bag ofclaim 29, wherein the bag is provided on an external surface thereof with indicia for indicating the approximate volume of patient body waste material in the waste collection bag.

31-42. (canceled)

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