CN220309439U - Four-cavity naso-intestinal nutrition pipeline device - Google Patents
Four-cavity naso-intestinal nutrition pipeline device Download PDFInfo
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- CN220309439U CN220309439U CN202321563068.1U CN202321563068U CN220309439U CN 220309439 U CN220309439 U CN 220309439U CN 202321563068 U CN202321563068 U CN 202321563068U CN 220309439 U CN220309439 U CN 220309439U
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- Medical Preparation Storing Or Oral Administration Devices (AREA)
Abstract
The utility model relates to a four-cavity naso-intestinal nutrition pipeline device, which is characterized in that a nutrition cavity tube (1), a gastric decompression cavity tube (2), an esophageal pressure monitoring cavity tube (3), a backflow prevention cavity tube (4) and a transesophageal heart pacing electrode (5) are arranged in a cannula of the four-cavity naso-intestinal nutrition pipeline device; the utility model has the beneficial effects that: the device has simple structure and complete functions, and can select single or combined monitoring and treatment modes according to different conditions of patients; the success rate of tube placement and the position accuracy rate are improved; the comfort level of the patient is improved, and the workload of medical staff is reduced; improving the compliance of patients with long-time indwelling gastric tubes.
Description
Technical Field
The utility model relates to an integrated device for conveniently implementing enteral nutrition, gastric decompression, reflux prevention, esophageal pressure monitoring, transesophageal atrial pacing and other treatments for critically ill patients, in particular to a four-cavity nasal and intestinal nutrition pipeline.
Background
At present, the indwelling gastric tube is a widely applied basic nursing technology in clinic, and is mainly used for gastric decompression of critically ill patients, enteral nutrition and gastric lavage of toxic patients. Along with the clinical popularization of single-cavity, double-cavity and three-cavity stomach tubes, the limitation of the single-cavity, double-cavity and three-cavity stomach tubes gradually attracts attention of medical staff, and the single-cavity, double-cavity and three-cavity stomach tube is currently in existence: the feeding liquid and the nasal feeding medicine are simultaneously input to cause gastric tube blockage or secondary pollution, the feeding liquid is easy to adhere to gastric mucosa when being sucked by a central wall, gastric contents flow back through esophagus and the like, and the feeding liquid and the nasal feeding medicine are subjected to esophageal pressure monitoring and are required to be additionally arranged into an esophageal balloon, and an electrode wire is required to be additionally arranged when diagnosis and treatment are carried out through esophageal heart pacing. Therefore, research into a naso-intestinal nutrient tube which can have various therapeutic and monitoring functions and avoid the above limitations has been an interesting subject for research staff.
Disclosure of Invention
The utility model aims to solve the technical problem of providing a four-cavity nasal and intestinal nutrition pipeline which is optimized in structure, simple and convenient to operate and complete in function. Aiming at critical patients, the medicine can implement enteral nutrition and gastric tube administration separation, selectively implement intragastric decompression, esophageal pressure monitoring, transesophageal heart pacing and other monitoring and treatment, and has the functions of preventing food (poison) residues in esophagus, gastric contents from regurgitation through esophagus and the like.
The utility model relates to a four-cavity naso-intestinal nutrition pipeline device, which comprises the following technical scheme: a four-cavity naso-intestinal nutrition pipeline device is characterized in that a nutrition cavity pipe, a gastric decompression cavity pipe, an esophageal pressure monitoring cavity pipe, an anti-backflow cavity pipe and a transesophageal heart pacing electrode are arranged in a cannula of the four-cavity naso-intestinal nutrition pipeline device;
the nutrition cavity tube consists of an upper end part of a nutrition cavity and a lower end part of the nutrition cavity, wherein the upper end part of the nutrition cavity is provided with a nutrition cavity double-layer sealing cover, and enteral nutrition liquid can be infused or medicines can be injected after the first layer sealing cover of the nutrition cavity is opened; opening a second layer of sealing cover of the nutrition cavity to connect with the aspirator for small intestine decompression or sucking intestinal juice for detection; the lower end of the nutrition cavity is provided with a nutrition cavity side hole, and the tail end of the bullet head sample is provided with a guide wire outlet;
the gastric decompression cavity tube is provided with a decompression cavity upper end part and a decompression cavity lower end part, the decompression cavity upper end part is provided with a decompression cavity double-layer sealing cover, and enteral nutrient solution can be infused or medicines can be injected after the decompression cavity first layer sealing cover is opened; opening a second layer of sealing cover of the decompression cavity to connect the aspirator for decompression in the stomach or sucking gastric juice for detection and for gastric lavage in a poisoning patient; the lower end part of the pressure reducing cavity is designed with a pressure reducing cavity side hole, and the tail end of the pressure reducing cavity is designed to be a blind end without an opening;
the esophageal pressure monitoring cavity tube is provided with a monitoring cavity upper end part and a monitoring cavity lower end part, the monitoring cavity upper end part is provided with a monitoring cavity double-layer sealing cover, gas or liquid can be injected after a first layer of the monitoring cavity sealing cover is opened, and an esophageal pressure monitoring port can be connected after a second sealing cover of the monitoring cavity is opened; the lower end part of the monitoring cavity is communicated with a first air bag, and the first air bag is used for dynamic esophageal pressure monitoring after being inflated;
the anti-reflux cavity tube is provided with an upper end part of the anti-reflux cavity and a lower end part of the anti-reflux cavity, the upper end part of the anti-reflux cavity is provided with a one-way valve for positive pressure injection of gas to the second air bag, the second air bag is positioned at the lower end part of the anti-reflux cavity and communicated with the lower end part of the anti-reflux cavity, and the second air bag is used for preventing gastric contents from flowing back to the esophagus after being inflated; the first air bag is positioned above or in the second air bag;
the transesophageal heart pacing electrode is of the same pure metal integrated structure for preventing corrosion of strong acid and strong alkali, and is provided with an electrode upper end part and an electrode lower end part, wherein the electrode upper end part is provided with an insulating cap, and the transesophageal heart pacing instrument can be connected after the insulating cap is opened; the lower end of the electrode vertically penetrates out of the tube wall and forms a positive electrode plate, a negative electrode plate or a recording electrode plate with the interval of 1cm, and the electrode plates are arc-shaped and embedded on the outer wall of the four-cavity naso-intestinal nutrition tube; the lower end of the electrode can be positioned at the lower esophageal segment by ultrasonic or X-ray positioning during the tube placement.
The utility model relates to a four-cavity naso-intestinal nutrition pipeline device which is characterized in that guide wires can be inserted into a nutrition cavity pipe and a stomach decompression cavity pipe respectively, the guide wires are provided with an upper end part and a lower end part of the guide wires, the guide wires are of a metal spiral structure for preventing strong acid and strong alkali corrosion, stainless steel wires are arranged in the guide wires, and two ends of the guide wires are tightly welded with the metal spiral structure; the upper end part of the guide wire is of an annular structure, and the outer diameter of the guide wire is obviously larger than the inner diameter of the nutrition cavity; the tail end of the lower end part of the guide wire is designed into a hemispherical shape with the same diameter as the metal spiral structure.
The four-cavity naso-intestinal nutrition pipeline is mainly used for adult critical patients, has the main functions of enteral nutrition support and digestive tract drug treatment, is connected with an aspirator for gastrointestinal decompression, and is connected with a gastric lavage machine for gastric lavage of a patient suffering from poisoning; and the fourth is connected with a breathing machine for monitoring the esophageal pressure of respiratory mechanics indexes, and the fifth is connected with an esophageal heart pacing instrument for noninvasive cardiac electrophysiology diagnosis and treatment.
The use state of the four-cavity naso-intestinal nutrition pipeline device of the utility model is different according to different diagnosis and treatment requirements of different patients, and comprises a single mode or a combined mode:
first mode: single mode, enteral nutrition, suitable for critically ill patients who cannot eat orally;
second mode: the single mode, gastrointestinal decompression, is suitable for patients with acute pancreatitis, intestinal obstruction, chest and abdomen operation perioperative period and the like;
third mode: gastric lavage is suitable for patients with poisoning due to pesticides, medicines, food, etc.;
single mode esophageal pressure monitoring, suitable for invasive mechanical ventilation patients;
fourth mode: the single mode, transesophageal heart pacing therapy is suitable for temporary pacing of patients with III-degree atrioventricular block and cardiac arrest, and patients with paroxysmal supraventricular tachycardia, implicit pre-excitation, multi-bypass pre-excitation, pre-excitation syndrome complicated with arrhythmia and the like.
Fifth mode: combination modes, such as enteral nutrition + intragastric decompression, enteral nutrition + pacing through the esophageal heart, enteral nutrition + intragastric decompression + pacing through the esophageal heart, and the like.
The four-cavity naso-intestinal nutrition pipeline device has the beneficial effects that:
firstly, the device has simple structure and complete functions, and can select single or combined treatment modes according to different conditions of patients;
secondly, the electrode wire can be used for ultrasonic, X-ray or digital subtraction angiography machine perspective lower tube setting, so that the tube setting success rate and the position accuracy are improved;
thirdly, the patient suffering from arrhythmia does not need to put in a transesophageal heart pacing electrode, so that the comfort level of the patient is improved, and the workload of medical staff is reduced;
fourth, mechanical ventilation patient need not to put into esophagus sacculus separately and monitors respiratory mechanics, improves patient and breathing machine's synchronism, improves patient's comfort level, improves mechanical ventilation's security, reduces medical personnel's work load.
Fifth, prevent the stomach content from flowing back upward the design, reduce patient's mistake and inhale the suffocation risk, reduce the relative pneumonia incidence of breathing machine, improve medical quality, lighten patient's burden.
Sixthly, the pipeline is made of TPU (polyurethane) materials, and compared with the traditional materials such as polyvinyl chloride (PVC), silica gel, rubber and the like, the biocompatibility is better, the ultra-smooth coating or the hydrophilic coating is adopted, the pain of a patient is reduced, the comfort is improved, and the compliance of the patient with the gastric tube left for a long time is improved.
Seventh, the electrode for regulating the heart of the transesophageal nerve and the spiral structure of the guide wire are made of pure metal silver or copper, so that the electrode has stable physicochemical property, soft quality, less corrosion by gastric acid (hydrochloric acid) or other strong acid and alkali, and has small resistance compared with metals such as gold, aluminum, magnesium, zinc, nickel, cadmium, cobalt, iron, platinum, tin, lead, antimony and the like, and better conductivity.
Drawings
FIG. 1 is a schematic cross-sectional view of a nutrition chamber, a gastric decompression chamber, an esophageal pressure monitoring chamber, an anti-reflux chamber, and an esophageal heart pacing electrode of a four-chamber naso-intestinal nutrition tube according to the utility model: taking 4 electrode plates as an example;
FIG. 2 is a sagittal view of a four-chamber naso-intestinal nutrition line device of the present utility model: a nutrition cavity, an esophageal pressure monitoring cavity and an esophageal heart pacing electrode;
FIG. 3 is a schematic coronal view of a four-lumen naso-intestinal nutrient line according to the utility model: a gastric decompression cavity, an esophageal pressure monitoring cavity and an esophageal heart pacing electrode;
FIG. 4 is a schematic diagram of an anti-reflux lumen, esophageal pressure monitoring lumen and esophageal heart pacing electrode of a four-lumen naso-intestinal nutrition tube of the present utility model;
fig. 4-1 is a schematic diagram of an anti-reflux lumen, esophageal pressure monitoring lumen and esophageal heart pacing electrode of a four-lumen naso-intestinal nutritional circuit of the utility model: the first air bag and the second air bag are in a concentric circle or an up-down relation;
FIG. 5 is a schematic cross-sectional view of a nutrition chamber and gastric decompression chamber of a four-chamber naso-intestinal nutrition tube of the present utility model;
fig. 6 is a schematic diagram of an esophageal cardiac pacing electrode of a four-lumen naso-intestinal nutrition tube according to the utility model:
fig. 6-1 is a schematic diagram of an esophageal heart pacing electrode of a four-lumen naso-intestinal nutrition tube of the present utility model: taking 4 electrode plates as an example;
fig. 6-2 is a schematic diagram of an esophageal heart pacing electrode of a four-lumen naso-intestinal nutrition tube of the present utility model: taking 2 electrode plates as an example;
FIG. 7 is a schematic diagram of the overall structure and cross section of a guide wire of a four-lumen naso-intestinal nutrition tube according to the present utility model;
FIG. 7-1 is a schematic illustration of the overall cross-sectional configuration of a guidewire for a four lumen naso-intestinal nutrition tube in accordance with the present utility model;
FIG. 8 is a schematic view of the length scale of the lower end of a four-lumen naso-intestinal nutrient circuit according to the utility model;
fig. 8-1 is a schematic cross-sectional view of the lower end of a four-lumen naso-intestinal nutrient circuit according to the utility model.
In the accompanying drawings: 1-is a nutrition lumen; 2-is a gastric decompression lumen; 3-is an esophageal pressure monitoring lumen; 4-is a backflow preventing cavity tube; 5-an electrode tube for esophagus heart pacing; 6-is a guide wire; 7-is the upper end part of the nutrition cavity; 8-is the lower end part of the nutrition cavity; 9-is the upper end part of the decompression cavity; 10-is the lower end part of the decompression cavity; 11-is the upper end of the monitoring cavity; 12-is the lower end of the monitoring cavity; 13-is the upper end part of the anti-backflow cavity; 14-is the lower end part of the anti-backflow cavity; 15-is the upper end of the electrode; 16-is the lower end of the electrode; 17-is the upper end of the guide wire; 18-is the lower end of the guide wire; 19-is a first layer of sealing cover of the nutrition cavity; 20-is a second layer of sealing cover of the nutrition cavity; 21-is a nutrition cavity side hole; 22-is a guide wire outlet; 23-is a first layer sealing cover of the decompression chamber; 24-is a second layer sealing cover of the decompression chamber; 25-is a side hole of the decompression chamber; 26-a first layer of sealing cover of the monitoring cavity; 27-a second layer sealing cover of the monitoring cavity; 28-is a first balloon; 29-is a one-way valve; 30-is a second balloon; 31-is an insulating cap; 32-is a positive electrode plate; 33-negative electrode sheet; 34-is a metal spiral structure; 35-is stainless steel wire; 36-is a recording electrode sheet.
Detailed Description
The following description of the embodiments of the present utility model will be made clearly and completely with reference to the accompanying drawings, in which it is apparent that the embodiments described are only some embodiments of the present utility model, but not all embodiments. All other embodiments, which can be made by those skilled in the art based on the embodiments of the utility model without making any inventive effort, are intended to be within the scope of the utility model.
In the description of the present utility model, it should be noted that the directions or positional relationships indicated by the terms "upper", "lower", "inner", "outer", "front", "rear", "both ends", "one end", "the other end", etc. are based on the directions or positional relationships shown in the drawings, are merely for convenience of describing the present utility model and simplifying the description, and do not indicate or imply that the devices or elements referred to must have a specific direction, be configured and operated in the specific direction, and thus should not be construed as limiting the present utility model. Furthermore, the terms "first," "second," and the like, are used for descriptive purposes only and are not to be construed as indicating or implying relative importance.
In the description of the present utility model, it should be noted that, unless explicitly specified and limited otherwise, the terms "mounted," "provided," "connected," and the like are to be construed broadly, and may be fixedly connected, detachably connected, or integrally connected, for example; can be mechanically or electrically connected; can be directly connected or indirectly connected through an intermediate medium, and can be communication between two elements. The specific meaning of the above terms in the present utility model will be understood in specific cases by those of ordinary skill in the art.
Example 1: a four-cavity naso-intestinal nutrition pipeline device is characterized in that a nutrition cavity tube 1, a gastric decompression cavity tube 2, an esophageal pressure monitoring cavity tube 3, a backflow prevention cavity tube 4 and a transesophageal heart pacing electrode 5 are arranged in a cannula of the four-cavity naso-intestinal nutrition pipeline device; the nutrition cavity tube 1 consists of a nutrition cavity upper end 7 and a nutrition cavity lower end 8, wherein the nutrition cavity upper end 7 is provided with a nutrition cavity double-layer sealing cover, and enteral nutrition liquid can be infused or medicines can be injected after a first layer sealing cover 19 of the nutrition cavity is opened; opening a second layer sealing cover 20 of the nutrition cavity to connect an aspirator for small intestine decompression or sucking intestinal juice for detection; the lower end part 8 of the nutrition cavity is provided with a nutrition cavity side hole 21, and the tail end of the bullet head sample is provided with a guide wire outlet 22; the gastric decompression cavity tube 2 is provided with a decompression cavity upper end part 9 and a decompression cavity lower end part 10, the decompression cavity upper end part 9 is provided with a decompression cavity double-layer sealing cover, and the intestinal nutrient solution can be infused or the medicine can be injected after the decompression cavity first layer sealing cover 23 is opened; opening the second seal cap 24 of the decompression chamber to connect the aspirator for decompression in the stomach, or to aspirate gastric juice for detection, and for lavage in a patient with poisoning; the lower end part 10 of the decompression cavity is designed with a side hole 25 of the decompression cavity, and the tail end is designed to be a blind end without an opening; the esophageal pressure monitoring cavity tube 3 is provided with a monitoring cavity upper end part 11 and a monitoring cavity lower end part 12, the monitoring cavity upper end part 11 is provided with a monitoring cavity double-layer sealing cover, gas or liquid can be injected after a first layer of the monitoring cavity sealing cover 26 is opened, and an esophageal pressure monitoring port can be connected after a second sealing cover 27 of the monitoring cavity is opened; the lower end 12 of the monitoring cavity is communicated with a first air bag 28, and the first air bag is used for dynamic esophageal pressure monitoring after being inflated; the anti-reflux cavity tube 4 is provided with an anti-reflux cavity upper end part 13 and an anti-reflux cavity lower end part 14, the anti-reflux cavity upper end part 13 is provided with a one-way valve 29 for positive pressure injection of gas to a second air bag 30, the second air bag 30 is positioned at the anti-reflux cavity lower end part 14 and communicated with the anti-reflux cavity lower end part, and the second air bag 30 is used for preventing gastric contents from flowing back to esophagus after being inflated; the first bladder 28 is positioned above or within the second bladder 30; the transesophageal heart pacing electrode 5 is of the same pure metal integrated structure for preventing corrosion of strong acid and strong alkali, and is provided with an electrode upper end 15 and an electrode lower end 16, wherein the electrode upper end 15 is provided with an insulating cap 31, and the transesophageal heart pacing instrument can be connected after the insulating cap is opened; the lower end 16 of the electrode vertically passes through the tube wall and forms a positive electrode plate 32, a negative electrode plate 33 and a recording electrode plate 36 with the spacing of 1cm, and 1-6 electrode plates are all arc-shaped and embedded on the outer wall of the four-cavity naso-intestinal nutrition pipeline; the lower end of the electrode can be positioned at the lower esophageal segment by ultrasonic or X-ray positioning during the tube placement.
Guide wires 6 can be inserted into the nutrition lumen 1 and the gastric decompression lumen 2 respectively, the guide wires 6 are provided with guide wire upper end parts 17 and guide wire lower end parts 18, the guide wires 6 are metal spiral structures 34 for preventing strong acid and strong alkali corrosion, stainless steel wires 35 are arranged in the guide wires, and two ends of the guide wires are tightly welded with the metal spiral structures 34; the upper end 17 of the guide wire is of an annular structure and the outer diameter is obviously larger than the inner diameter of the nutrition cavity; the distal end of the guide wire lower end 18 is designed as a hemisphere of the same diameter as the metal helix 34.
Example 2: the utility model relates to a four-cavity naso-intestinal nutrition pipeline with the outer diameter of 8.67mm, which consists of a nutrition cavity pipe 1, a gastric decompression cavity pipe 2, an esophageal pressure monitoring cavity pipe 3, an anti-reflux cavity pipe 4, a transesophageal heart pacing electrode 5 and a guide wire 6;
the inner diameter of the nutrition cavity tube 1 is 2mm, the length of the nutrition cavity tube is 150cm, scales are marked by taking centimeters as units, a nutrition cavity double-layer sealing cover is designed at the upper end part 7 of the nutrition cavity, and enteral nutrition liquid can be infused or medicines can be injected after the first layer sealing cover 19 of the nutrition cavity is opened; opening a second layer sealing cover 20 of the nutrition cavity to connect an aspirator for small intestine decompression or sucking intestinal juice for detection; the lower end part 8 of the nutrition cavity is provided with a nutrition cavity side hole 21, and the tail end of the bullet head sample is provided with a guide wire outlet 22 which is convenient for guiding and placing a tube;
the inner diameter of the gastric decompression cavity tube 2 is 2.5mm, the length of the gastric decompression cavity tube is 100cm, scales are marked by taking centimeters as a unit, the upper end part 9 of the decompression cavity is provided with a decompression cavity double-layer sealing cover, and enteral nutrient solution can be infused or medicines can be injected after the first layer sealing cover 23 of the decompression cavity is opened; opening the second seal cap 24 of the decompression chamber to connect the aspirator for decompression in the stomach, or to aspirate gastric juice for detection, and for lavage in a patient with poisoning; the lower end part 10 of the decompression cavity is designed with a side hole 25 of the decompression cavity, and the tail end is designed to be a blind end without an opening;
the inner diameter of the esophageal pressure monitoring cavity tube 3 is 2mm, the length of the esophageal pressure monitoring cavity tube is 90cm, scales are marked by taking centimeters as units, a double-layer sealing cover of the monitoring cavity is designed at the upper end part 11 of the monitoring cavity, the monitoring cavity can be inflated by a syringe after the first layer sealing cover 26 of the monitoring cavity is opened, and an esophageal pressure monitoring port can be connected after the second sealing cover 27 of the monitoring cavity is opened; the lower end part 12 of the monitoring cavity is communicated with a first air bag 28, the first air bag 28 is cylindrical and has the height of 1cm, and the monitoring cavity is used for dynamic esophageal pressure monitoring after being inflated;
the inner diameter of the anti-reflux cavity tube 4 is 1.5mm, the length of the anti-reflux cavity tube is 90cm, scales are marked by taking centimeters as a unit, the upper end part 13 of the anti-reflux cavity is designed with a one-way valve 29, the second air bag 30 is positioned at the lower end part 14 of the anti-reflux cavity and communicated with the one-way valve 29, the second air bag 30 is cylindrical and has the height of 1cm, and the air bag is used for preventing gastric contents from flowing back to esophagus and preventing the tube from being pulled out after being inflated; the second bladder 30 is positioned below the first bladder 28;
the transesophageal heart pacing electrode 5 is cylindrical, has a diameter of 1mm, is provided with an insulating cap 31 at the upper end 15 of the electrode, and can be connected with an transesophageal heart pacing instrument after the insulating cap is opened; the positive electrode plate 32 and the negative electrode plate 33 are respectively 1, 1mm wide and are embedded on the outer wall of the four-cavity naso-intestinal nutrition pipeline in an arc shape, and the arc length is 1.5cm; the positive electrode plate 32 is positioned 1cm below the second air bag 30, and the positive electrode plate 32 and the negative electrode plate 33 are spaced 1cm up and down;
the metal spiral structure 34 of the guide wire 6 is silver, the outer diameter is 1.5mm, the length is 160cm, a stainless steel wire 35 is arranged in the guide wire, two ends of the guide wire are tightly welded with the metal spiral structure 34, the metal spiral structure 34 at the upper end 17 of the guide wire is designed to be a ring-shaped structure with the diameter of 2cm, and the tail end of the lower end 18 of the guide wire is designed to be a hemispherical shape with the diameter of 1.5 mm.
The selected materials include several parts: the metal spiral structure 34 of the guide wire 6 and the transesophageal heart pacing electrode 5 are made of metal silver, the first air bag 28, the second air bag 30, the one-way valve 29 and the insulating cap 31 are made of PVC, and the rest is made of TPU (polyurethane).
The method for placing the four-cavity naso-intestinal nutrition pipeline comprises the following steps: including but not limited to bedside blind insertion, under-guide catheterization under X-ray or digital subtraction angiography, post-gastrointestinal implantation, under-guide catheterization under B-ultrasound, etc. Taking a double-person collaborative catheterization method under the guidance of B ultrasonic as an example, a nurse A performs catheterization operation, and a nurse B performs ultrasonic operation.
The first step is preparation: including ultrasound, saline, 20ml and 50ml syringes, therapeutic towel, sterile glove, stethoscope, ruler, PH paper, label, fixation patch, etc., the guidewire 6 is pushed to the feeding lumen 1 flush with the guidewire outlet 22 and labeled at the second seal cap 20 of the flat feeding lumen, and then withdrawn from the guidewire 6 for use.
Second step of esophagus positioning (tube depth 25-30 cm): the patient takes a recumbent position or a semi-recumbent position, a nurse A measures the distance from the nasal tip to the earlobe and then to the sternum xiphoid process (generally 45-55 cm), a tube is placed at the lower end 8 of a nutrition cavity of the four-cavity naso-intestinal nutrition pipeline, a tube placing path can be selected from the left nasal cavity, the right nasal cavity and the oral cavity, a linear array probe is placed on the left lobe of the thyroid gland of the patient to scan vertically towards the central area, ultrasound of the transverse section of the esophagus of the cervical segment is in a regular circle or ellipse, and the nurse A places the lower end 8 of the nutrition cavity into the central area of about 25 cm. At this time, the first sealing cover 19 of the nutrition cavity is opened, 10-20 ML of air is rapidly injected, the high-brightness 'inflation sign' in the esophagus is visible, and the high-brightness lower end 8 of the nutrition cavity is visible in the esophagus to develop 'equal sign'. The transverse section of the esophagus is taken as the midpoint, the probe is rotated 90 degrees clockwise, the position of the probe is adjusted by moving left and right, the longitudinal section of the esophagus is found to be in a long strip shape, and the lower end part 8 of the nutrition cavity is in double track in the esophagus. When the lower end 8 of the nutrition cavity is not found by ultrasonic scanning of the esophagus and the lower end 8 of the nutrition cavity is retracted after advancing, the lower end 8 of the nutrition cavity is determined not to enter the esophagus.
Thirdly, positioning in the stomach (the depth of the tube is 50-60 cm): the nurse A lifts the patient's recumbent bed head by at least 30 degrees, the nurse B places the ultrasonic convex array probe mark point towards the patient's head, and is perpendicular to the abdomen under the xiphoid process, the superior mesenteric vein, the left hepatic lobe and the abdominal aorta are taken as the antrum marks, an oval antrum cross section image is obtained, then the nurse A places the lower end 8 of the nutrition cavity into the first standard antrum (the tube placing depth is about 50 cm), at this time, the ultrasonic probe detects the linear strong echo which moves rapidly in the stomach cavity, and the appearance of double-track marks indicates that the lower end 8 of the nutrition cavity is in the stomach. Then the first sealing cover 19 of the nutrition cavity is opened again, 40ML of warm boiled water and 10ML of air are rapidly injected, and contrast-enhanced echoes appear at the side holes 21 of the nutrition cavity and the guide wire outlet 22 in the stomach cavity by ultrasonic, so that cloud signs are shown.
Fourthly, pylorus and duodenal bulbar positioning (the depth of the pylorus catheter is 65-75 cm and the duodenal bulbar is 85-95 cm): the nurse B moves down the ultrasonic convex array probe from the xiphoid process of the patient to the right rib so as to probe the position of the pylorus canal (the tube placement depth is about 70 cm), when the probe is parallel to the pylorus canal, the pylorus symptom like an inverted 8 at the position near the gall bladder is visible, the nurse A pushes the lower end part 8 of the nutrition cavity in time when the pylorus expands under the guidance of ultrasonic waves, and the pylorus portal can see that the lower end part 8 of the nutrition cavity enters in a straightening position. At this time, the first layer sealing cover 19 of the nutrition cavity is opened again, 40ML of warm boiled water is injected rapidly, and the ultrasonic probe scans the pylorus of the patient to show cloud and fog signs and spread to the left, so that the guide wire outlet 22 is prompted to pass through the pylorus. The nurse A continues to slowly send the tube, the ultrasonic visible nutrition cavity side hole 21 and the guide wire outlet 22 move forward smoothly, and if the ultrasonic visible double-rail sign in the duodenum indicates that the nutrition cavity side hole 21 and the guide wire outlet 22 enter the duodenum (the tube placement depth is about 90). If necessary, nurse a opens the first seal cap 19 of the nutrition chamber and inserts the guide wire 6 to guide the lower end 8 of the nutrition chamber from the pylorus into the duodenum, and nurse B holds the ultrasonic visible metal hyperecho.
Fifth step, the duodenum horizontal part is positioned (the tube placement depth is 95cm to 105 cm): the patient takes the bed head to lift by 30 degrees and the right lateral position is about 30-45 degrees. The nurse B places the probe under the xiphoid process, the Mark point faces the right side of the patient, and moves the probe downwards along the transverse section of the abdominal aorta to probe and treat the superior mesenteric artery, superior mesenteric vein, abdominal aorta and inferior vena cava. The nurse a again opened the first sealed cap 19 of the nutrition chamber and injected Wen Shuibian slowly (about 100cm in depth). At this time, the superior mesenteric artery, superior mesenteric vein, abdominal aorta and inferior vena cava are in "double-track" form, that is, the nutrition lumen side hole 21 and the guide wire outlet 22 reach the duodenal horizontal portion. At this time, nurse a again opened the first seal cap 19 of the nutrition chamber and pulse 40ML of warm boiled water, and could detect the "cloud syndrome" sound image in the duodenum level, proving that the guide wire outlet 22 reached the duodenum level. Patients suffering from pancreatitis, vomiting and easy reflux often need to be placed in the jejunum, and may need to be sent to about 110-120 cm.
Sixth step gastric decompression lumen 2, esophageal pressure monitoring cavity 3, anti-reflux cavity 4 and positioning via esophageal heart pacing electrode 5: after being placed at the lower end part of the nutrition cavity by 50cm, the gastric decompression cavity tube 2 is placed in the patient; after placement of the lower end 8 of the feeding lumen by about 60cm, the esophageal pressure monitoring lumen 3 and the anti-reflux lumen 4 begin to be placed into the patient. In the tube placing process, a nurse A opens the first layer sealing cover 23 of the decompression cavity and rapidly injects 40ML of warm boiled water and 10ML of air, and a nurse B holds the convex array probe to see that contrast-enhanced echoes appear at the side holes 25 of the decompression cavity in the stomach cavity, so that cloud and fog signs are presented. The nurse A opens the first layer sealing cover 26 of the monitoring cavity and rapidly injects 1-2 ML of air, and the nurse B holds the convex array probe to move towards the head side to see the 'inflation sign' of the highlight of the first air bag 28 in the esophagus. The second balloon 30 was similarly verified to be in the middle of the esophagus. The balloon inflation or deflation is maintained after the first balloon 28, second balloon 30 position is verified, as needed for the condition. The nurse B holds the convex array probe to move towards the head side, and sequentially sees the negative electrode 33 and the positive electrode sheet 32 positioned at the lower esophageal segment and strongly echos.
And a seventh step of fixing well.
The clinical use state of the four-cavity nasal and intestinal nutrition pipeline at least comprises the following schemes, and is mainly suitable for adult critical patients:
first mode: the first layer sealing cover 19 of the nutrition cavity is opened to be connected with an enteral nutrition night infusion tube, so that the nutrition cavity is suitable for patients who cannot tolerate gastric nutrition, gastric retention, gastroesophageal fistula, pancreatitis, severe burn, craniocerebral trauma and the like;
second mode: the second layer sealing cover 24 of the decompression cavity is opened to be connected with an aspirator for decompression in the stomach, and the decompression cavity is suitable for patients with acute pancreatitis, intestinal obstruction, chest and abdomen operation perioperative period and the like; secondly, gastric juice can be sucked for detecting occult blood test and measuring gastric juice pH; when in need, the crushed solid medicine is given through the gastric decompression cavity tube 2 while the nutrition in the intestines is carried out, so that the blockage of the nutrition cavity tube 1 is avoided; in addition, the medicine can also be used for gastric lavage of patients with empty stomach after pesticide or drug poisoning;
third mode: after the first air bag 28 is inflated and the second air bag 30 is emptied, the second sealing cover 27 of the monitoring cavity is opened, and an additional pressure measuring port integrated by the breathing machine is connected, so that the esophageal pressure can be monitored, and the device is suitable for patients with invasive mechanical ventilation;
fourth mode: after confirming that the second balloon 30 is inflated, it can prevent the gastric contents from flowing back to the esophagus, and is suitable for spinal trauma, shock and other patients who cannot perform elevation of the head of the bed;
fifth mode: the insulating cap 31 is opened, and the electrode wire at the upper end 15 of the electrode is connected with an esophagus heart pacing instrument, so that the esophagus electrocardiogram can be monitored, and arrhythmia which is difficult to distinguish by some body surface electrocardiograms can be identified; or terminate supraventricular tachycardia, atrial flutter, temporary pacing therapy;
sixth mode: combination modes such as enteral nutrition + intragastric decompression + anti-reflux, enteral nutrition + pacing through the esophageal heart, enteral nutrition + esophageal pressure monitoring, enteral nutrition + intragastric decompression + pacing through the esophageal heart, etc.
Example 3: the utility model relates to a four-cavity naso-intestinal nutrition pipeline with the outer diameter of 9.33mm, which is characterized by comprising a nutrition cavity pipe 1, a gastric decompression cavity pipe 2, an esophageal pressure monitoring cavity pipe 3, a backflow prevention cavity pipe 4, a transesophageal heart pacing electrode 5 and a guide wire 6;
the inner diameter of the nutrition cavity tube 1 is 2mm, the length of the nutrition cavity tube is 155cm, scales are marked by taking centimeters as a unit, a nutrition cavity double-layer sealing cover is arranged at the upper end part 7 of the nutrition cavity, and enteral nutrition liquid can be infused or medicines can be injected after the first layer sealing cover 19 of the nutrition cavity is opened; opening a second layer sealing cover 20 of the nutrition cavity to connect an aspirator for small intestine decompression or sucking intestinal juice for detection; the lower end part 8 of the nutrition cavity is provided with a nutrition cavity side hole 21, and the tail end of the bullet head sample is provided with a guide wire outlet 22 which is convenient for guiding and placing a tube;
the inner diameter of the gastric decompression cavity tube 2 is 3mm, the length is 105cm, scales are marked by taking centimeters as a unit, the upper end part 9 of the decompression cavity is provided with a decompression cavity double-layer sealing cover, and enteral nutrient solution can be infused or medicines can be injected after the first layer sealing cover 23 of the decompression cavity is opened; opening the second seal cap 24 of the decompression chamber to connect the aspirator for decompression in the stomach, or to aspirate gastric juice for detection, and for lavage in a patient with poisoning; the lower end part 10 of the decompression cavity is designed with a side hole 25 of the decompression cavity, and the tail end is designed to be a blind end without an opening;
the inner diameter of the esophageal pressure monitoring cavity tube 3 is 2mm, the length of the esophageal pressure monitoring cavity tube is 90cm, scales are marked by taking centimeters as units, a double-layer sealing cover of the monitoring cavity is designed at the upper end part 11 of the monitoring cavity, the monitoring cavity can be inflated by a syringe after the first layer sealing cover 26 of the monitoring cavity is opened, and an esophageal pressure monitoring port can be connected after the second sealing cover 27 of the monitoring cavity is opened; the lower end part 12 of the monitoring cavity is communicated with a first air bag 28, the first air bag 28 is cylindrical and has the height of 1cm, and the monitoring cavity is used for dynamic esophageal pressure monitoring after being inflated;
the inner diameter of the anti-reflux cavity tube 4 is 1.5mm, the length is 90cm, scales are marked by taking centimeters as units, the upper end part 13 of the anti-reflux cavity is designed with a one-way valve 29 for injecting gas into the second air bag 30 in a positive pressure way, the second air bag 30 is positioned at the lower end part 14 of the anti-reflux cavity and communicated with the second air bag, and the second air bag 30 is cylindrical and has the height of 1cm, and is used for preventing gastric contents from flowing back to esophagus and preventing tube drawing after inflation; the first bladder 28 is located inside the second bladder 30;
the transesophageal heart pacing electrode 5 is cylindrical, has a diameter of 1mm, is provided with an insulating cap 31 at the upper end 15 of the electrode, and can be connected with an transesophageal heart pacing instrument after the insulating cap is opened; the positive electrode plate 32 and the negative electrode plate 33 are 1 respectively, have a width of 1mm and an up-down interval of 1cm, are embedded on the outer wall of the four-cavity naso-intestinal nutrition pipeline in an arc shape, and have an arc length of 1.5cm; the negative electrode plate 33 is positioned 1cm below the second air bag 30, 3 electrode plates below the negative electrode plate are vertically spaced 1cm apart, the positive electrode plate 32 is positioned 4cm below the second air bag 30, and 2 recording electrode plates 36 are respectively positioned above the negative electrode plate 33 and the positive electrode plate 32;
the metal spiral structure 34 of the guide wire 6 is silver, the outer diameter is 1.6mm, the length is 165cm, a stainless steel wire 35 is arranged in the guide wire, two ends of the guide wire are tightly welded with the metal spiral structure 34, the metal spiral structure 34 at the upper end 17 of the guide wire is designed to be a ring-shaped structure with the diameter of 2cm, and the tail end of the lower end 18 of the guide wire is designed to be a hemispherical shape with the diameter of 1.6 mm.
The selected materials include several parts: pure metal copper is selected as the transesophageal heart pacing electrode 5, PVC is selected as the first air bag 28, the second air bag 30, the one-way valve 29 and the insulating cap 31, and TPU (polyurethane) is selected as the rest.
The method for placing the four-cavity naso-intestinal nutrition pipeline comprises the following steps: taking a double-person collaborative tube placing method under the guidance of B ultrasonic as an example, a nurse A performs tube placing operation, and a nurse B performs ultrasonic operation, which is similar to the seven-step method of example 2.
The clinical use state of the four-cavity nasal and intestinal nutrition pipeline at least comprises the following schemes, and is mainly suitable for adult critical patients:
first mode: as in example 2.
Second mode: as in example 2.
Third mode: as in example 2.
Fourth mode: after confirming that the second balloon 30 is inflated, it is possible to prevent the backflow of the stomach contents to the esophagus, and the advantage over example 1 is that the risk of mucosa compression ischemia in patients with esophageal stenosis can be reduced.
Fifth mode: the insulating cap 31 is opened, the electrode wire at the upper end 15 of the electrode is connected with an esophagus heart pacer, the positive electrode plate 32 and the negative electrode plate 33 are 1 group and are used for inducing and treating arrhythmia, the 2 recording electrode plates 36 are 1 group, and the occurrence and termination of esophagus electrocardiograms, such as the temporary pacing of patients suffering from III-degree atrioventricular block and cardiac arrest, the monitoring and treatment of patients suffering from paroxysmal supraventricular tachycardia, pre-excitation syndrome and arrhythmia and the like are synchronously recorded.
Sixth mode: the joint pattern is the same as in example 1.
While the basic principles and main features of the present utility model and advantages of the present utility model have been shown and described, it will be apparent to those skilled in the art that the present utility model is not limited to the details of the above-described exemplary embodiments, and that the present utility model may be embodied in other specific forms without departing from the spirit or essential features thereof. The present embodiments are, therefore, to be considered in all respects as illustrative and not restrictive, the scope of the utility model being indicated by the appended claims rather than by the foregoing description, and all changes which come within the meaning and range of equivalency of the claims are therefore intended to be embraced therein. Any reference sign in a claim should not be construed as limiting the claim concerned.
Furthermore, it should be understood that although the present disclosure describes embodiments, not every embodiment is provided with a separate embodiment, and that this description is provided for clarity only, and that the disclosure is not limited to the embodiments described in detail below, and that the embodiments described in the examples may be combined as appropriate to form other embodiments that will be apparent to those skilled in the art.
Claims (2)
1. A four-cavity naso-intestinal nutrition pipeline device is characterized in that a nutrition cavity pipe (1), a gastric decompression cavity pipe (2), an esophageal pressure monitoring cavity pipe (3), a backflow prevention cavity pipe (4) and a transesophageal heart pacing electrode (5) are arranged in a cannula of the four-cavity naso-intestinal nutrition pipeline device;
the nutrition cavity tube (1) consists of a nutrition cavity upper end part (7) and a nutrition cavity lower end part (8), wherein the nutrition cavity upper end part (7) is provided with a nutrition cavity double-layer sealing cover, and enteral nutrition liquid can be infused or medicines can be injected after a first layer sealing cover (19) of the nutrition cavity is opened; opening a second layer of sealing cover (20) of the nutrition cavity to connect with an aspirator for small intestine decompression or sucking intestinal juice for detection; the lower end part (8) of the nutrition cavity is provided with a nutrition cavity side hole (21), and the tail end of the bullet head sample is provided with a guide wire outlet (22);
the gastric decompression cavity tube (2) is provided with a decompression cavity upper end part (9) and a decompression cavity lower end part (10), the decompression cavity upper end part (9) is provided with a decompression cavity double-layer sealing cover, and enteral nutrient solution can be infused or medicines can be injected after the decompression cavity first-layer sealing cover (23) is opened; opening a second layer of sealing cover (24) of the decompression cavity to connect with an aspirator for decompression in the stomach or sucking gastric juice for detection and for gastric lavage in a poisoning patient; the lower end part (10) of the pressure reducing cavity is provided with a pressure reducing cavity side hole (25), and the tail end is provided with a blind end without an opening;
the esophageal pressure monitoring cavity tube (3) is provided with a monitoring cavity upper end part (11) and a monitoring cavity lower end part (12), the monitoring cavity upper end part (11) is provided with a monitoring cavity double-layer sealing cover, gas or liquid can be injected after a first layer of the monitoring cavity sealing cover (26) is opened, and an esophageal pressure monitoring port can be connected after a second monitoring cavity sealing cover (27) is opened; the lower end part (12) of the monitoring cavity is communicated with a first air bag (28), and the first air bag is used for dynamic esophageal pressure monitoring after being inflated;
the anti-reflux cavity tube (4) is provided with an anti-reflux cavity upper end part (13) and an anti-reflux cavity lower end part (14), the anti-reflux cavity upper end part (13) is provided with a one-way valve (29) for positive pressure injection of gas to a second air bag (30), the second air bag (30) is positioned at and communicated with the anti-reflux cavity lower end part (14), and the second air bag (30) is used for preventing gastric contents from being refluxed to the esophagus after being inflated; the first balloon (28) is positioned above or inside the second balloon (30);
the transesophageal heart pacing electrode (5) is of the same pure metal integrated structure for preventing corrosion of strong acid and strong alkali, and is provided with an electrode upper end (15) and an electrode lower end (16), wherein the electrode upper end (15) is provided with an insulating cap (31), and the transesophageal heart pacing instrument can be connected after the insulating cap is opened; the lower end part (16) of the electrode vertically penetrates out of the tube wall and forms a positive electrode plate (32), a negative electrode plate (33) and a recording electrode plate (36) with the spacing of 1cm, wherein 1-6 electrode plates are arc-shaped and embedded on the outer wall of the four-cavity naso-intestinal nutrition tube; the lower end of the electrode can be positioned at the lower esophageal segment by ultrasonic or X-ray positioning during the tube placement.
2. The four-cavity naso-intestinal nutrition pipeline device according to claim 1, wherein guide wires (6) can be inserted into the nutrition cavity tube (1) and the stomach decompression cavity tube (2) respectively, the guide wires (6) are provided with guide wire upper end parts (17) and guide wire lower end parts (18), the guide wires (6) are of metal spiral structures (34) for preventing strong acid and alkali corrosion, stainless steel wires (35) are arranged in the guide wires, and two ends of the guide wires are tightly welded with the metal spiral structures (34); the upper end part (17) of the guide wire is of an annular structure, and the outer diameter of the guide wire is obviously larger than the inner diameter of the nutrition cavity; the tip of the lower end (18) of the guide wire is designed as a hemispherical shape with the same diameter as the metal spiral structure (34).
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