Dual-Purpose

Tube

Nasoenteric

for

B

D. T. Maglinte, MD H. Stevens, MD Robert C Hall, MD Frederick M. Kelvin, MD Larry T. Micon, MD

clarify

teroclysis

has

A catheter designed for the dual purpose of nasogastric-nasoenteric decompression and enteroclysis is described. The catheter facilitates direct decompression of the obstructed small bowel and, if necessary, subsequent performance of enteroclysis. The use of this tube obviates dual intubation and its accompanying discomfort.

Radiology

1992;

recommended

5,015,232)

as the

lion (2). We describe a nasogastric tube designed for decompression of the obstructed

are shown

examination

medium-enhanced

in small

small

bowel

of the performance such

intestinal

and

obstruc-

simplification

of enteroclysis

in

patients.

#{149} Intestines,

School

the Departments F.M.K.) and

ofMedicine,

already

of Radiology Surgery (L.H.S.,

adapted

suction

devices

in use in hospitals in North It is a 14-F, 155-cm-long disposable catheter made of polvinyl chloride. The deconstruction of the catheter

in the Figure.

for enteroclysis

a nasogastric

for enteroclysis,

(D.D.T.M., by the Department of Medi-

Hospital

referred

have

may

or other

de-

compression tube in place. Because these tubes are not easy to position the small bowel and are not designed

R.C.H.,

Indianapolis

F.M.K.). Supported cal Research, Methodist

clysis

through

Although

of Indiana,

performance these

tubes

an enteroclysis

in

of enterois suboptimal.

catheter

can

be introduced through the opposite nostril, this results in additional patient discomfort (2).

Indianapolis. Received April 21, 1992; accepted May 14. Address reprint requests to D.D.T.M. C RSNA, 1992

185:281-282

and

Cook, no.

Discussion

L.T.M.), Methodist Hospital oflndiana, 1701 N Senate Blvd, Indianapolis, IN 46206, and the Department of Radiology, Indiana University

and catheterization,

designed

existing

Patients 1 From

(MDEC-1400, md, u.s. patent

was

for use with currently America. closed-end radiopaque sign and

(D.D.T.M.,

Catheters

been

of contrast

and Methods

The catheter Bloomington,

of obstruction of the small intestine (1). Because of its ability to challenge the distensibility of the intestinal wall, enmethod

technology #{149} Enteroclysis, 72.1272 stenosis or obstruction, 74.72

Materials

studies are frequently used to the site, severity, and cause

ARIUM

Larry

terms:

Nasogastric-

Decompression’

Dean

Index

and

Enteroclysis

or

(_

b

a

B

S

a. Design

and construction

of decompression

enteroclysis

b. (a) Diagram

catheter.

of internal

construction.

The uppermost

drawing

shows

the distal

end of the cathetr, the middle drawing shows the proximal end, and the bottom diagrams are cross sections at level of distal side ports (1) and at level of balloon attachment (2). The distal side ports (a) in the uppermost drawing connect the intestinal lumen with the sump lumen (s), which in turn communicates with the decompression (suction) lumen (d). The most distal side ports (a) are diagrammed to show the longitudinal communication between the sump and decompression (suction) lumina. The side ports communicating with the sump and suction lumina allow flushing from proximal attachment S to clear any blockage of the side ports during decompression. The staggered position of the side

ports

also

helps

prevent

tissue

blockage

of the

ports

during

suction.

The

tapered

end

results

in less

nasal

mucosal

irritation

during

tion. The sump lumen (s) is connected externally at S. and the suction lumen is connected at D. The balloon lumen (b), which is provided a one-way check valve proximally (B), communicates with the circularly disposed silicone balloon (arrow) at level 2. (b) Construction ter. The rubber adapter (1) allows connection of decompression lumen (D) to existing suction devices. A small plastic cap (2) prevents from leaking out of the sump port (S) when suction is disconnected. The small external connection to the sump port is labeled “distal balloon (b) is inflated by first pressing in the balloon inflation opening attachment (B) by the straight tip of a plastic syringe to release way valve in the assembly. The black marker (arrow) indicates the tube tip position in the body of the stomach, which allows the tube positioned

at bedside,

torquable

guide

Volume

185

wire

#{149} Number

without

fluoroscopic

introduced

into

1

guidance.

the suction

Torque

lumen

and

directional

of the catheter

prior

control

is provided

to transnasal

by a Teflon-coated

stainless

steel

intubawith

of cathefluid

air.” The

the oneto be braided

intubation.

Radiology

281

#{149}

The catheter described is recommended for use in patients with small bowel obstruction or severe small bowel ileus, as an alternative to the standard 18-F nasogastric tube. Introduction of the catheter should be performed in adherence with guidelines and precaulions similar to those used with the standard balloon enterodysis catheter (3). It can be introduced by either the attending physician or by the radiologist. A fluid-filled distended stomach should be decompressed over a period of several hours before the catheter tip is advanced into ternal landmark

282

#{149} Radiology

the jejunum. 59 cm from

the

The excatheter

tip facilitates recognition of this initial position without fluoroscopy so that clinicians can position the tube at bed-

side for immediate sion. The patient

gastric decompresthen be sent to the radiology facility for fluoroscopic positioning of the tube in the proximaijejunum, for small bowel decompression, or for enterodysis, if desired. Our

preliminary

ACknowledgments: We thank Richard Graffis, MD, James Crossin, MD, and Steve Waslawski, MD, for reviewing the manuscript and for their comments;Jerry Williams for artworlc and Fran Shaul for her secretarial assistance.

can

experience

with

this bettube.

catheter suggests that it is tolerated ter than the usual 18-F nasogastric It can be readily positioned in the jejunum to provide direct decompression of the obstructed small intestine and simplifies the performance of enterodysis in such patients. #{149}

References 1.

Nelson

SW,

barium

sulfate

Christoforides

suspensions

The use of in the diagnosis

AJ.

of acute diseases of the 2.

small intestine. AJR 1968; 104:505-528. Herlinger H, Maglinte DDT. Small bowel obstruction. In: CliniCal radiology of the

small intestine. 3.

Philadelphia:

Saunders,

1989; 479-507. Maglinte DDT, Herlinger H. Enterodysis catheters, intubation, and infusion. In: Clinical radiology of the small intestine. Philadelphia: Saunders, 1989; 85-105.

October1992

Dual-purpose tube for enteroclysis and nasogastric-nasoenteric decompression.

A catheter designed for the dual purpose of nasogastric-nasoenteric decompression and enteroclysis is described. The catheter facilitates direct decom...
273KB Sizes 0 Downloads 0 Views