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