US3043309A - Method of performing intestinal intubation - Google Patents

Description

July 10, 1962 H. F. M CARTHY METHOD OF PERFORMING INTESTINAL INTUBATION Filed Sept. 29, 1959 2 Sheets-Sheet l HORACE FRANK McCARTHY INVENTOR ATTORNEYS.

July 10, 1962 H. F. M CARTHY 3,

METHOD OF PERFORMING INTESTINAL INTUBATION Filed Sept. 29, 1959 2 Sheets-Sheet 2 SUCTION /as4O 44 2| 24 J 0 o L 1 23 POWER 1 43 g LINES I T r 0.0.POWER 36 SUPPLY A ORNEYS.

3,043,309 METHOD F PERFORMING INTESTINAL INTUBATION Horace Frm r McCarthy, North Andover, Mass., assignor to Ave-o Corporation, Cincinnati, Ohio, a corporation of Delaware Fiied Sept. 29, 1959, Ser. No. 843,994

6 Claims. (Cl. 128-348) A V This invention relates to an intubation procedure and more particularly an apparatus used in performing intestinal intubation.

Very frequently there Will develop in the intestines a block which prevents food and waste products from passing from the stomach and the intestines to the outside of the body. Food and waste products build up gases as a consequence of increased bacterial activity in the digestive tract behind the block. The gases distend, or expand, the digestive organs greatly, giving rise to an extremely painful and dangerous condition. While it is possible to perform surgery to remove the block with the patient in a distended condition, the operation is considered to be extremely hazardous. A preferred procedure is to decompress the digestive system by inserting a perforated tube into the digestive system, and applying a suction force at the exterior end of the tube to remove the trapped gases, the food and waste products causing the distended condition. The procedure just discussed is commonly called decompression by means of intestinal intubation. I

- It is extremely simple to insert a flexible tube into the stomach. However, if the block is in the intestinal system the tube must be made to pass from the stomach into theintestinal system. At the junction of the stomach and the entrance to the intestines, there exists a ring-like muscle surrounding a passage defined by the junction, called the pylorus. The pylorus acts as a valve for controlling the movement of food from the stomach to the duodenal portion of the intestine. Normally, the pylorus obstructs the passage between the stomach and the in testinal tract. To pass the tube fromthe stomach to the intestinal tract, the pylorus must be made to act and open the passage.

There are several ways in which the pylorus can be made to open. In the natural digestive process, the stomach produces an acid which causes the pylorus to open. Attempts have been made to insert liquids which are chemically identical and have the same concentration as the acid which is produced by the stomach during a normal digestive operation. However, these efforts have not been too successful since the pylorus is apparently able 'to discriminate between a normal digestive product and a synthetic substitute.

The practice most widely used consists of inserting a tube into the patients stomach and permitting the peristaltic and churning action of the stomach to bring the tip of the intubation tube in contact with the pylorus. It appears that the pylorus is sensitive to mechanical contact and responds to the contact by dilating, or opening the passage between the stomach and the intestines. The basic technique just described has been refined in several ways, namely: (1) weighting the tip of the intestinal tube to make use of a gravitational effect on the Weighted end for moving it into the stomach and to contact the pylorus; (2) the medical profession has also used an intubation tube which increases the peristaltic actions of the stomach by means of an inflated ballo n; and (3) water jets have also been employed for carrying the tube through the pylorus and intestinal tract. 7 V

Most of the modifications or refinements of the basic technique have not been generally successful and are not used extensively. The medical profession today relies H attests Patented July i0, 196% almost entirelyon the basic technique of permitting the normal churning action of the stomach to carry the flexible tube to the pylorus. The degree ofsuccess incident to this procedure is dependent largely, and sometimes solely, on the continuous efforts of the attending physicians and for the most part depends on a chance passage of the tube from the stomach to the pylorus.

A normal intubation operation, as generally practiced today is a time consuming operation, frequently requiring hours to days, for the tube to make a complete passage from the stomach to the region of the block inthe intestinal tract. Current methods are also not considered too reliable from several other standpoints. Natural abnormalities in the stomach construction, or abnormalities induced by the distended condition of the patient, often makes it impossible to intube the patient. Where a patient is having difiiculty intubing by the conventional natural process, a decision to operate may have to be made without waiting for decompression because of the seriousness of the patients condition. Furthermore, since the patient is frequently X-rayed to determine whether he has been intubed, prolonged exposure to hazardous radiation may occur.

It is an object of the present invention to provide an intestinal intubation method which avoids the limitations and disadvantages of prior intubation devices.

It is another object of this invention to provide an intestinal intubation method which greatly facilitates and greatly shortens an intubation operation. I

It is still another'object' of the invention to provide an intestinal intubation method which includes means for guiding the intubation tube to the pylorus for stimulating the pylorus, causing it to open the passageway between the stomach and the intestines.

It is. still another object of the invention to provide an intestinal intubation method which utilizes a magnetic means in conjunction with an intubation tube for intubing a patient.

It is another object of the invention to provide an intestinal intubation method utilizing an inexpensive, reliable and an easily operated apparatus for guiding the intubation tube in its passage through the stomach to the intestinal tract.

It is yet another object of the invention to provide an electromagnetic means designed and constructed for use in intubing a patient.

It is yet another object of the invention to provide electromagnetic means for an intubation apparatus which generates an optimum magnetic field intensity in a predetermined direction for attracting a magnetic means positioned at a distance from the electromagnetic means.

Finally it is an object of the invention to provide an intubation apparatus including an electromagnetic means which includes features making it especially suitable for manual manipulation during an intubation operation.

An important aspect of this invention is to provide a method for performing intestinal intubation which comprises securing magnetic member to the tip of an elongated, X-ray opaque, flexible tube. The tip and tube are then passed through the esophagus to the stomach of a patient. Preferably, the stomach region is then illuminated by means of X-rays, and the tube is observed on fluoroscopic screen. A maneuverable magnetic field is then applied to the magnetic material to directthe tip, to which the magnetic material is secured, to the pylorus valve in the stomach.

Another aspect of this invention is to provide an intubation apparatus comprising a highly flexible intubation tube which is adapted to pass through the intestinal tract of a patient. The intubation apparatus also includes magnetic means, comprising preferably a magnet, positioned in the tip of the intubation tube. Finally, the intubation in thedigestive tract.

' preferably a soft iron elongated rod. A concentric coil is wound about the rod, and its radial build-up made large to provide substantial leakage flux,i .e., flux which does not pass through the core. The leakage flux converges or focuses the magnetic field developed by the electromagnetic means along the axis of thecore, when the coil is energized by' a rated current.

The novel features that are considered characteristic of the invention are set forth in the appended claims; the invention itself, however, both as to its organization and method of operation, together with additional objects 7 and advantages thereof, willbest be understood from the following description of a specific embodiment when read 4Volume 2, edited by Otto Glasser, Year Book Publishers, 1950, starting on page 274. It will be understood that most of the other intubation tubes shown and described in the aforementioned chapter can also be used. An intubation tube may be as long as twenty-eight feet, and includes markings along its length which indicate the position of thedistal tip 21 in the digestive tract. For

in conjunction with the accompanying drawings, in which:

FIGURE 1 is a front view of a patient showing in outline the alimentary canal and a decompression tube inserted therein; 1

, FIGURE 2 is an enlarged view of the intubed stomach region of the patient in FIGURE 1 showing the stomach in section;

FIGURE 3 is a representation of a tip of an intubation tube showing magnetic means positioned therein;

FIGURE 4 is a representation of an electromagnetic means constructed in accordance withthe principles of v the present invention; and

FIGURE is a control circuit diagram; The novel method is best described by discussing the structural features of an apparatus used to practice the method and the operation thereof.

, Referring to FIGURE 1 of the drawings where there is represented a front view of anintubed patient 10 showing the digestive tract in dash outline and an intubation tube 11 positioned therein, typically, thepatient 10 is placed face up on an X-ray table 12. The intubation operation is observed by passing X'-rays from the table through thebody 16 to afluorescent screen 13 placed over thepatient 10. The intubation tube 11, hereinafter called the tube, is passed through thenose 14 of the patient into theesophagus 16, to thestomach 17. From thestomach 17 the tube 11 passes through the pylorus 18 into the intestinal tract'19. Atip 21, commonly called the distal example, a markS indicates that the tip of the tube is just entering the stomach. A second marking, P, is located six inches beyond S and indicates that there is now suflicient tube in the stomach to allow the distal tip to pass through the pylorous.

A third marking D is placed six inches beyond P and from thereon the tube is calibrated in feet.

The intubation apparatus also includes a means for generating a magnetic field which is adapted to couple themagnet 23 in thetip 21 for developing on the magnet a force, whereby the magnet, and the tube '11, in which it is positioned, is directed towards thepylorus 18. Normally, the force developed will tend to attract themagnet 23. However, it will be shownthat a repulsive force may also be developed. FIGURE 2 of the drawings shows the tube 11 passing through thestomach 17 with the'tip21 in contact with thepylorus 18.

The electromagnetic means comprises preferably anelectromagnet 26 which is designed and constructed for manual manipulationand control. It is often difiicult to pinpoint the precise location of the pylorus 18, but in all cases, it is' possible to ascertain its approximate location and'to direct the tube 11 to its immediate vicinity. As

, seen in FIGURE .2, themagnet 26, with the aid of the X- tip, of the tube 11 is shown adjacent to an intestinal lock. The region of theintestinal tract 19 immediately in back of the intestinal block is shown distended as a result'of the pile-up of food; waste products and gases Referring briefly to FIGURE 3 of the drawings there is frepresented therein thedistal tip 21, in a partial sectional view. It will be noted that there is positioned within the' tube amagnetic means 23, which may be a piece of ''ferromagnetic material or an electromagnet, but preferlably comprises a permanent magnet; .The tube 11 extends integrally from thedistal tip 21 and includesnumerous holes 24 distributed over its surface. When a suctionforce is applied to the external or proximal end of /2 of, an inch long.

The most widely-used int bation tube .11 is a long tube is shown and described in the chapter on decompression of'the digestivetractfoundin Medical Physics,

rays and fluoroscopic screen, is positioned opposite the approximate position ofpylorus 18 on the outside of thepatient 10; As .will be seen hereinafter, the maximum magnetic field intensity willbe developed along the axis of the core 27 to forcibly attract themagnet 23.

It is well to point out, at this time, that the peristaltic and churning action of the stomach provide partly: the motivating force for drawing the tube 11, into the intestinal tract and intestinal peristalsis'provides, the primary force for drawing the tube 11 through the intestines. Thepylorus 18, when it 'is open, also exhibits a peristaltic action which draws the tube through the passageway from thestomach 17 to theintestine 19. Accordingly, the first function of the intestinal intubation apparatus is to make contact between the tube 11 and thepylorus 18, to stimulate thepylorus 18, causing it to. open the passageway a Referring to FIGURES 3 and 4 of the drawings there Levin tube called the gastro-duodenal tube. The Levin are represented therein a preferred construction of theelectromagnet 26. Theelectromagnet 26 comprises amagnetic core 27 formed from a rod of magnetic material, preferably soft iron. The rod is approximately six inches long and one and one-quarter inches in diameter. Aconcentric coil 29 covers approximately five inches of rod'27 and comprises a pair of end pieces31 and 32, the latter including ahandle 33 extending integrally therefrom. The electrical conductors making up thecoil 2? are wound in the space between theend pieces 31 and 32. In order to maintain a reasonable size and weight,

thecoil 29 comprises, in this instance, a plurality ofwindings 34, each of which comprises a plurality of concentric turns made upofanodized aluminum strip 35. As is well known, the aluminum surface formed in an anodizing process can be made nonconductive and for the voltages normally used to energize theelectromagnet 26, an anodized surface provides adequate insulation between the turns of thewindings 34. V

Current is suppliedto the windings through a pair of As seen in FIGURE 2 thehandle 33 and 41 are coupled. The leads '40 and 41, as will be seen hereinafter, are in the control circuit of theelectromagnet 26.

The number of turns used in making up thecoil 29 is a function of the space allocated for the coil, the current available to energize the'coil and the material used in the magnetic core 28. A design which has been found suitable comprises fivewindings 34 having 140 turns per winding of 0.015 inch thick aluminum strip. The total resistance of thecoil 29 was found to be 0.6- ohm and a current of 40 amperes was found to develop a magnetic field intensity of 150 gauss, at 4 inches from the core face. Clinical tests of this design of an intestinal intubation apparatus have shown it to be satisfactory. Under normal clinical conditions the above described electromagnet was used in intubing a patient in about ten to fifteen minutes total time. It is estimated that the initial separation between themagnet 23 in the intubation tube 11 and the face of the core 27, on the outside of the patient, will vary from six to eight inches.

It is clear from FIGURE 2. that it is desirable to construct a magnetic field having a maximum intensity parallel to the axis of thecore 27. Accordingly, there is provided means for converging, or focusing the magnetic flux lines along a desired direction. The focusing means makes use of a leakage field surrounding, but not within thecore 27, for directing the flux lines produced in the core along its axis. The leakage field is produced in the following manner. It is well known that the magnitude of flux produced in a magnetic field is proportional to the product of the number of turns in the energizingcoil 29 and the current flowing in the coil. Accordingly, the number of ampere turns developed in thecoil 29 is of sufiicient magnitude to fully saturate thecoil 27 and to create flux lines outside of thecore 27. The flux lines which do not couple the core 27 make up a leakage field.

- It is also well known that the ability of a flux line developed in any particular turn of a coil to couple themagnetic core 27 is related to the distance between the turn in question and the core. Accordingly, thecoil 29 has been constructed to have a substantial radial build-up, thus assuring that a substantial leakage field will be developed after themagnetic core 27 has been fully saturated.

The over-all magnetic field developed by theelectro magnet 26 is depicted in FIGURE 4. It will be noted that there is a higher density of flux directed along the axis of the core 27 than at distances radially remote from the core 28. The flux lines are more widely separated laterally of thecore 27.

Referring to FIGURE of the drawings, there is depicted therein a current supply means comprising a DC.power supply 43 which generates a unidirectional current. The output terminals of the DC.power supply 43 are coupled through a current reversingswitch 42 to theelectromagnet 26 by means ofconductors 36 and 37. The polarity of theelectromagnet 26, as is conventional, is controlled by the direction of current in itscoil 29. Its polarity further determines whether themagnet 23 will be attracted or repelled.Witch 42 is a conventional double pole double throw current reversing switch. Interposed between the power lines and the input terminals of the DC.power supply 43 is thepush button 39 which lies in the energizing path of anelectromagnetic relay 44. The electromagnetic relay includes a pair ofcontacts 45 which lie in the current path of the energizing circuit of the DC.power supply 43. Thepush button 39 is shown in a normally open position. When it is depressed, current from the power lines flows through thecoil 46 of therelay 44 thus closing thecontacts 45. When thecontacts 45 are closed current is drawn from the power lines by the DC.power supply 43 for energizing theelectromagnet 26.

While the operation of the intubation apparatus is ob- 6 vious, a brief summary will be given. Initially thedistal tip 21 of the intubation tube 11 is inserted in the nose of thepatient 10 and directed by the physician into. thestomach 17 of the patient. When thedistal tip 21 is observed, through thefluoroscope screen 13, entering thestomach 17, theelectromagnet 26 is positioned against the body of the patient opposite the pylorus 18 as shown in FIGURE 2. Thepush button 39 is depressed and theelectromagnet 26 is energized producing a magnetic field which is generally directed along the axis of thecore 27.

The magnetic field interacts with the magnetic field of the tive force tending to-pull the distal end of the intubation tube 11 toward the pylorus.

This attractive force cooperates to bring thedistal end 21 into contact with the pylorus. As described herebefore, thepylorus 13 is stimulated by the contact of the tube and opens the passageway between thestomach 17 and theintestine 19. With the passage open, the magnetic force aided by the peristalsis of the stomach, the pylorus, and the intestine when the tube 11 finally enters the intestine, moves the tube 11 through the intestine. A suction force is applied to the proximal end of the tube that lies outside of the patient and the food, waste products and gases found in the digestive tract are sucked into the tube and carried outside of the patients body. The suction force may be applied while the patient is being intubed since it has been found that it will have no adverse effect on the intubation procedure. 7

On occasion, thetip 21 may become wedged in the stomach wall so that movement toward the pylorus is prevented. An assist in freeing thetip 21 can be obtained by reversing the current in the electromagnet, by means ofswitch 42, to repel themagnet 23andconsequently tip 21.

The various features and advantages of the invention are thought to be clear from the foregoing description. Various other features and advantages not specifically enumerated will undoubtedly occur to those versed in the art, as likewise will many variations and modifications of the preferred embodiment illustrated, all of which may be achieved without departing from the spirit and scope of the invention as defined by the following claims.

I claim:

1. An intestinal intubation method comprising:

(a) securing a magnetic member to the tip of an elongated flexible tube;

(b) passing the tip and the tube through the esophagus to the stomach of a patient; and

(c) applying a maneuverable magnetic field to the magnetic material and directing said tip to the pylorus valve in the stomach,

2. The method as described in claim 1 in which said magnetic member is a permanent magnet.

3. An intestinal intubation method comprising:

(a) inserting a magnetic member in the tip of an elongated flexible tube, said magnetic member being dimensioned to engage the walls of said tube to be secured thereby;

(b) passing the tip and the tube through the esophagus to the stomach of a patient; and

(c) applying a maneuverable magnetic field to the magnetic material and directing said tip to the pylorus valve in the stomach.

4. An intestinal intubation method comprising:

(a) securing a magnetic material to the tip of an elongated flexible tube;

(b) passing the tip and the tube through the nose and through the esophagus to the stomach of apatient; and

(c) applying a maneuverable magnetic field to the magnetic material and directing said tip to the pylorus valve in the stomach.

magnetic material and directing said tip to' t he' pylorus valve in the'stomach. I

6; An intestinal intubation method comprising:

(a) securing a magneticmember to the tip of an elongated flexible tube;

to the stomach of a patient; and

I (12) passing the tip and thetube through the esophagus 5 a '(c) applyingan' electrically reversible and maneuverable magnetic field to-the'magnetic material for attracting and repelling said tip for directing said tip to the pylorns valve in the stomach. 5

References Cited infthe file of this patent.

' UNITED STATES PATENTS 1,736,182 Wilkins Nov; 19, 1929 2,184,152 Saflir V e. 19, 1959 2,863g458 5 Modnyet a1. Dec. 9; 1958 2,897,411 Brown et a1 July 28, 1959 V FOREIGN PATENTS 281,869 Germany Feb. 3, 1915

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