The present disclosure relates to pH indicators, and more specifically, to pH indicators for aspirated fluids.
Nasogastric medical tubes are typically placed to decompress the stomach or to deliver liquid enteral nutrition formula into the stomach. During proper intubation, the distal tip of the tube enters the esophagus and is pushed down into the stomach. Due to erroneous intubation, on the other hand, the distal tip of the tube may veer off into the airway bronchus. In such a case, liquids or enteral formula may be sent into the lungs, causing catastrophic consequences for the patient. As such, before the administration of any liquid medication or enteral formula through the nasogastric tube, most hospital or critical care protocols require verification that the distal end of the tube is actually in the stomach.
A few methods have previously been used to verify placement of the nasogastric tube into the stomach. These methods include x-ray verification, stethoscope, auscultation, and pH testing of syringe aspirated stomach fluid. The x-ray verification uses an x-ray of the torso of the patient to determine the location of the already inserted tube. While the x-ray method can be accurate, it may not be feasible, economic, or harmless. Bedside x-ray is not always readily available. Moreover, exposing the patient to the x-ray radiation can be harmful.
A more feasible method for confirming gastric placement of nasogastric tubes endorsed by the American Association of Critical Care Nurses is the pH testing of aspirated stomach fluid. Stomach fluid, or gastric fluid, is generally agreed to have a pH of 4.5 or less, which falls in the acidic range. The blue litmus paper is a convenient tool for detecting this pH, because, upon contact with a liquid with a pH of 4.5 or less, the paper changes colors from blue to red.
The standard pH testing procedure, however, requires considerable time, work and effort to gather all the necessary supplies. Moreover, the pH testing procedure is often messy and potentially exposes the user or clinician to potentially infectious aspirated contents. The procedure requires the clinician to acquire litmus pH indicator paper, a medicine cup, and a 60 cc piston syringe having a catheter tip. The clinical then has to aspirate stomach fluid from the tube using a 60 cc piston-syringe, transfer this fluid to the medicine cup, and then manually dip the litmus paper into the cup and accordingly determining the pH. An acidic pH usually indicates that the distal tip of the tube is properly placed in the stomach. To reduce the steps of the manual procedure, US patent application publication 2011/0077495 by Gilbert discloses a housing that is inserted at the end of a nasogastric tube. The housing includes a detection indicator 5504 that changes between two visual indications upon contact with a fluid.
An object of the invention is to provide an efficient, cost effective, and simple to use apparatus for determining the pH of the aspirated gastric fluid.
In various embodiments, a pH indicator module configured to attach on a proximal module end to a suction mechanism and on a distal module end to a proximal tube end of an aspiration tube, and configured to be used during aspirating an aspirated fluid drawn by the suction mechanism from a location of a distal tube end of the aspiration tube, the pH indicator module comprising: a barrel connector configured to attach to the aspiration tube, wherein the barrel connector forms an inner passageway and wherein the passageway is located in a direct flow path of the aspirated fluid when the pH indicator module is used, and wherein the barrel connector is configured to receive a pH indicator material placed in the passageway, wherein the pH indicator material is configured to come into contact with a direct flow of the aspirated fluid drawn into the passageway to determine a pH value of the aspirated fluid; and a cap portion configured to attach on a proximal cap end to the suction mechanism and to attach on a distal cap end to the barrel connector.
In some embodiments, the pH indicator material is a pH indicating strip of material. In some embodiments, the pH indicator material is shaped in a rectangle and is folded in a V shape cross section before being placed in the passageway. In some embodiments, the pH indicating strip is fixed inside the passageway, at least in part, by contacting an inner surface of the passageway. In some embodiments, the barrel connector is made of a transparent material, and wherein the pH indicator material is visible from a viewing angle greater than or equal to 180° around the pH indicator module. In some embodiments, the barrel connector is sized such that during the aspirating less than 0.5 ml of the aspirated fluid is required to enter the pH indicator module for the aspirated fluid to come into contact with the pH indicator material.
In some embodiments, a slot is formed in the passageway and wherein the pH indicating strip of material is inserted in the slot and held in place, at least in part, by contacting internal walls of the slot. In some embodiments, the pH indicator module further comprises a label including a label color that matches an indicator color of the pH indicator material when during the aspirating the pH indicator material comes into contact with the aspirated fluid and when the aspirated fluid has a pH value in a specific range. In some embodiments, the cap portion includes at the proximal cap end a bushing section configured to attach to the suction mechanism and further includes at the distal cap end a cap section configured to attach to the barrel connector. In some embodiments, the pH indicator material is configured to determine that the pH value falls into one of more than two pH value ranges. In some embodiments, the proximal cap end is configured to be connected to a syringe.
In some embodiments, the pH value is used to determine whether a distal tube end of a gastric tube has been properly placed within a patient's stomach. In some embodiments, the pH indicator material is placed in a center of the passageway. In some embodiments, the passageway is cylindrical. In some embodiments, the pH indicator module further comprises the pH indicator material, wherein the pH indicator material is inserted and held in place in the passageway, such that the pH indicator material is configured to come into contact with the direct flow of the aspirated fluid drawn into the passageway. In some embodiments, the proximal cap end includes a luer fitting configured to be connected to a luer syringe.
In various embodiments, a method is disclosed of using a pH indicator module to measure a pH value of an aspirated fluid, wherein the pH indicator module is configured to attach on a proximal module end to a suction mechanism and on a distal module end to a proximal tube end of an aspiration tube, and to be used during aspirating the aspirated fluid drawn by the suction mechanism from a location of a distal tube end of the aspiration tube. The method comprises providing a barrel connector included in the pH indicator module, the barrel connector configured to attach to the aspiration tube, wherein the barrel connector forms an inner passageway, and wherein the passageway is located in a direct flow path of the aspirated fluid when the pH indicator module is used; providing a pH indicator material inserted in the passageway, wherein the pH indicator material is configured to come into contact with a direct flow of the aspirated fluid drawn into the passageway to determine a pH value of the aspirated fluid; and providing a cap portion included in the pH indicator module, wherein the cap portion is configured to attach to the suction mechanism on a proximal cap end and to attach to a proximal barrel end of the barrel connector on a distal cap end; attaching a distal barrel end of the barrel connector to the aspiration tube; drawing a fluid into the passageway using the suction mechanism; and observing a color of the pH indicator material after contacting the fluid.
In some embodiments, the pH indicator material is a pH indicating strip of material, and the pH value is used to determine whether a distal tube end of a gastric tube has been properly placed within a patient's stomach.
In some embodiments, the method further comprises providing a label including a label color that matches an indicator color of the pH indicator material when during the aspirating the pH indicator material comes into contact with the aspirated fluid and when the aspirated fluid has a pH value in a specific range. In some embodiments, the cap portion includes at the proximal cap end a bushing section configured to attach to the suction mechanism and further includes at the distal cap end a cap section configured to attach to the barrel connector.
The drawings are not necessarily to scale. Instead, emphasis is generally placed upon illustrating the principles of the inventions described herein. It is to be understood that the following detailed description is exemplary and explanatory only and is not restrictive of any invention, as claimed. The accompanying drawings, which are incorporated in and constitute a part of this specification, illustrate several embodiments consistent with the inventions and together with the description, serve to explain the principles of the inventions. In the drawings:
The following detailed description refers to the accompanying drawings. Wherever possible, the same reference numbers may be used in the drawings and the following description to refer to the same or similar parts. Also, similarly-named elements may perform similar functions and may be similarly designed. Numerous details are set forth to provide an understanding of the embodiments described herein. In some cases, the embodiments may be practiced without these details. In other instances, well-known techniques and/or components may not be described in detail to avoid obscuring described embodiments. While several exemplary embodiments and features are described herein, modifications, adaptations, and other implementations are possible, without departing from the spirit and scope of the invention. Accordingly, the following detailed description does not limit the invention. Instead, the proper scope of the invention is defined by the appended claims.
Indicator strip 120, located inside barrel connector 110, comes into contact with the aspirated fluid and changes color if the pH of the aspirated fluid is in specific pH range. Label 128 shows one or more colors as guides for comparison with the color of the indicator strip 120 and for determining the pH of the aspirated fluid. In some embodiments, cap 130 and bushing 140 are molded as a once piece cap portion, which connects to a syringe on its proximal end and to barrel connector 110 on its distal end.
To assemble fluid aspiration system 200, piston syringe 210 is attached to the proximal end of pH indicator module 100 by inserting tip 212 of piston syringe 210 into bushing 140 of pH indicator module 100. Further, nozzle type tip 113 of barrel connector 110, at the distal end of pH indicator module 100, is inserted into tube terminal 222 of aspiration tube 220. In some embodiments, aspiration tube 220 is a stomach tube, a distal end of which is configured to enter a patient's stomach. Using plunger 214, a user can aspirate fluid from the location of the distal end of aspiration tube 220 into barrel connector 110.
In various embodiments, tube connector portion 112 is configured to enable connection to a wide variety of tubes or catheters, for example, stomach tubes such as nasogastric tubes and gastrostomy tubes. In some embodiments, enlarged tapered portion 114 matches the tapered angle of most 60 cc catheter tip piston syringes. In some embodiment, enlarged tapered portion 114 thereby enables a wedge lock angled leakproof engagement for the pH indicator module 100 to Dale® Medical Products, Inc. ACE Connector enteral connector syringe port seal. In some embodiments, flared portion 115 enables connection to the funnel end of balloon replacement gastrostomy tubes. In some embodiments, tube connector portion 112 is about 1¼ inches long with a beginning tip outside diameter of 0.185 inches. These dimensions provide a safety measure, preventing tube connector portion 112 from connecting to any female I.V. luer. In some embodiments, barrel connector 110 is about 2¼ inches long with an outside diameter of about 0.430 inches.
In some embodiments, the total length of indicator module 100 is about 3½ inches. Such a size provides a compact assembly that is about the size of a disposable 5 cc syringe.
In some embodiments, cap 130 is made by injection molding from rigid polycarbonate clear transparent plastic. In the embodiment shown in
In various embodiments, cap 130 is a plastic injection molded component incorporating a molded in barb portion 136. Barb portion 136 enables a press on engagement with flexible molded or extruded bushing 140, permitting attachment to various standard catheter tip or generic tip syringe. In some embodiments, cap 130 is molded with a terminal end having a uniform dimensioned female luer portion instead of the barb portion 136. In some embodiments, female luer portion is molded in conformance with ISO/ANSI 1986 standard for luer fittings. In some embodiments, use of a female luer configuration enables a direct attachment of cap 130 with a variety of male luers or male luer lock aspiration syringes, thus eliminating the need for bushing 140. In some embodiments, module 100 is pre-connected and assembled with a luer or luer lock syringe, providing a ready to use pH indicator.
In some embodiments, bushing 140 has a cylindrical shape and is made of flexible PVC or flexible synthetic rubber. In the embodiment shown in
In various embodiments, indicator strip 120 is configured to indicate, by its color, a pH of the aspirated fluid that contacts the strip. In some embodiments, strip 120 is a blue litmus paper, which changes color based on a pH of the fluid. In various embodiments, strip 120 is a coated paper pH indicator strip or a plastic strip. In various embodiments, strip 120 can provide a multitude of clinical information, such as the pH of the aspirated fluid through a wide range of pH values. In various embodiments, when assembling pH indicator module 100, strip 120 is inserted inside barrel connector 110.
Returning to
In the view shown in
In some embodiments, indicator strip 120 is configured to fit and remain inside barrel passageway 117.
In various embodiments, strip 120 is inserted into barrel passageway and is held in place without use of any adhesives.
In some embodiments, top edges 126, on the other hand, are in contact with and press against the walls of barrel passageway 117 due to a spring force, shown by double arrow 129. In some embodiments, this contact produces a friction between top edges 126 and the walls, generating a mechanism for holding strip 120 in place.
In some embodiments, strip 120 is held in place by static friction forces between its various parts and the walls of barrel passageway 117. In some embodiments, strip 120 has a width 125 that is equal or slightly larger than a diameter of barrel passageway 117. Before being inserted into barrel passageway 120, in some embodiments strip 120 is folded and in some other embodiments strip 120 is not folded. Once inserted into barrel passageway 117, strip 120 will contact the inner walls of barrel passageway by its various parts, such as edges, 127. In some embodiments, because width 125 is slightly larger than the diameter of barrel passageway 117, edges 127 or other contacting surfaces exert a slight pressure against the inner wall of barrel passageway 117, providing for a friction force that holds strip 120 in place.
In some embodiments, one or more of the above mechanisms hold top edges 126 in place. The above mechanisms thus hold top edges 126 aligned with or close to a proximal end of barrel passageway 117, which abuts cap 130. The mechanisms further hold lower portion 124 aligned with or close to a distal end of barrel passageway 117, which abuts connector passageway 111.
Thus, when indicator module is used, fluid bypass area 121 permits aspirated fluid 123 (shown in
As seen in
In various embodiments, pH indicator module 100 also minimizes the required amount of aspirated fluid. In some embodiments, the required volume of aspirated stomach fluid 123 needed to cause a color change in strip 120 is less than 0.5 ml. pH indicator module 100 places indicator strip 120 in the direct fluid flow path of the aspirated fluid and thus requires aspiration of an amount of fluid that is enough to reach barrel connector 110. In some embodiments, pH indicator module 100 only requires aspirating around 0.1 ml of fluid for the fluid to contact indicator strip 120. Such a mechanism avoids shortcomings of a pH indicator system in which a pH indicator is placed in a separate chamber away from the main flow path. This separate chamber design requires aspirating an additional amount of fluid to reach the separate chamber. pH indicator module 100 is thus usable in situations in which the separate chamber design will not be convenient or usable; e.g., situations where only a small amount of fluid can be aspirated. These cases include using pH indicator module 100 with small bore neonate and pediatric stomach tubes of 3.5fr and 5fr., which usually deliver gastric aspirate of less than 1 ml.
In some embodiments, connector passageway 111 has a flow path of about 0.090 inches (2.3 mm) in diameter and a length of 1¼ inches. With these dimensions, connector passageway 111 provides an adequate flow path with a very low volume of fluid of about 0.2 ml. The indicator strip 120 is positioned in barrel passageway 117 right after connector passageway 111 and in the direct path of the flow of the aspirated fluid. Therefore, the amount of fluid that a user should aspirate for the fluid to reach strip 120 is only slightly more than the amount of fluid needed to fill connector passageway 111. As a result, in some embodiments the total volume of stomach fluid 123 that a user should aspirate for the fluid to reach contact strip 120 is about 0.4 ml. In some embodiments, this property enables the pH indicator module to be used with smaller French sized nasoenteric tubes such as models 5, 6, and 8, which only yield an aspirated volume of 1 ml to 3 ml.
In some embodiments, not one, but two color change panels 522 are attached to indicator strip 520. In this manner, when strip 520 is folded and inserted into barrel passageway 517, the two color change panels 522 can be seen from either side of pH indicator module 500, providing for a viewing angle of about 360°. In some embodiments, folded strip 520 is inserted into barrel passageway 517 not in the inverted V orientation of
Barrel connector 610 includes molded retention bars 613 and 614, which together form a central molded slot groove 615. Retention bars 613 and 614 respectively have tapered or rounded entrance guide edges 618 and 619. Edges 618 and 619 facilitate insertion of indicator strip 620 into slot groove 615. Barrel connector 610 also forms barrel passageway 617 through which aspirated fluid flows.
In various embodiments, strip 620 is made from a high density plastic polymer that is flexible and also firm. As such, strip 620 can be inserted into slot grooves 615 and 616, and held in place with no need for adhesives, glues, or other strip retention components. Such a mechanism reduces the cost of material and labor in manufacturing pH indicator module 600. In some embodiments, strip 620 is about 0.010 inches (0.24 mm) in thickness, and can thus be easily inserted into slightly wider slot grooves 615 and 616.
In some embodiments, inner wall 624 of barrel connector 610 is dimensioned slightly below the nominal width of strip 620. For example, in some embodiments, this nominal width is typically about 0.265 inches and the inner wall 624 is dimensioned to about 0.255 inch J.D. In some embodiments, the oversized strip width generates a slight interference fit, eliminating the need for slot grooves 615 or 616.
It will be apparent to those skilled in the art that additional various modifications and variations can be made consistent with the present disclosure. Other embodiments consistent with the tube holder will be apparent to those skilled in the art from consideration of the specification and practice of the disclosure. It is intended that the specification and examples be considered as exemplary only, with a true scope and spirit of the disclosure being indicated by the following claims.
This application claims priority under 35 U.S.C. §119 to U.S. Provisional Patent Application No. 61/627,951, filed on Oct. 21, 2011; and U.S. Provisional Patent Application No. 61/686,275, filed on Apr. 3, 2012, both of which are herein incorporated by reference.
Number | Date | Country | |
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61627951 | Oct 2011 | US | |
61686275 | Apr 2012 | US |