GB2534893A

GB2534893A - A teaching device for the replacement of gastronomy tubes in an already established tract

Info

Publication number: GB2534893A
Application number: GB1501808.8A
Authority: GB
Inventors: Micheal Riain Pol; Margaret McGourty Helen
Original assignee: Individual
Current assignee: Individual
Priority date: 2015-02-03
Filing date: 2015-02-03
Publication date: 2016-08-10
Also published as: GB201501808D0

Abstract

A model suitable for training purposes in the techniques of enteral feeding tube insertion into a pre-existing stoma-tract, comprising a portion 2 which represents human abdominal skin and stomach wall, comprising a plastigel portion 1 with a representation of a stoma 5. The stoma is moulded to represent the outward appearance, colour, tactile response and texture of a human abdominal section. The model may also comprises a lower section 4, which may comprise a five walled box, onto which portion 2 is fitted. Gastrostomy tubes may be inserted into the stoma in the upper portion. The lower portion may comprise a reservoir which may be filled with a liquid representing gastric contents. The model may be scaled to be enabled to be handheld for demonstration purposes.

Description

Teaching device for the reinsertion of a replacement gastrostomy tube in an already established tract The invention relates to a model of a human abdominal wall for the use in demonstrating or practicing the reinsertion of replacement gastrostomy tubes in an already established tract.

A percutaneous endoscopic gastrostomy (PEG) is a flexible polyurethane trans abdominal tube inserted endoscopically and held in position by an internal retainer bumper and externally by a skin bumper disc. A PEG tube provides direct access to the stomach for nutrients, medication and fluids, through the formation of a fistula extending from the outer abdominal wall. Although the term PEG is commonly used for all gastrostomies, it is only one type of gastrostomy; alternative types which are usually water-based balloon devices include replacement gastrostomy tubes (G tubes) and button gastrostomy or LPGDs (low profile gastrostomy devices).

PEG feeding is the most common form of enteral feeding in people requiring artificial nutritional support for longer than 4-6 weeks.

However, the procedure is not without risk, and although most patients experience few problems with their PEG tube, complications do occur. One such complication is when a PEG tube is either pulled out inadvertently or falls out. Following tube displacement an established tract will close within 12-24 hours. During this window a replacement gastrostomy or LPGD commonly referred to as a button device should be inserted to maintain the tract.

A replacement gastrostomy tube is a water filled balloon feeding device which can be placed into an existing stoma. It can either be a gastrostomy tube or a LPGD (button); both of these are water based balloon devices. These tubes come in various French sizes (Fr denotes the internal diameter of the tube) and in the case of button devices various shaft lengths which are designed to fit snugly on the patient's abdomen. At present, patients whose PEGs fall out are advised to go to their local A&E as soon as possible, where a replacement gastrostomy tube is fitted. However, it is often the case that A&E departments either do not have the correct size replacement tube or are unable to reinsert because the tract has started to close.

PEG training devices are described in patent specification numbers US 5,518,406. However, these devices do not take into account the current recommendations to obtain an aspirate of stomach contents before feeding after replacing a gastrostomy tube.

NPSA (National Patient Safety Guidelines) 2005 recommend measuring the pH of stomach aspirate using pH indicator strips/paper to ensure a feeding tube is in the stomach. This is where a healthcare professional or carer puts a syringe into the side port of the G tube or button and draws up stomach contents (aspirate) which are placed on the pH strip and is read. Gastric aspirate, pH of 5.5 or below indicates gastric placement and confirms correct tube position. This is an important technique for healthcare professionals and carers to learn because a feed can only be administered to a patient with an enteral feeding tube provided that the pH reading is between 05.5, which is considered the safe range to indicate stomach placement. It is not advised to feed above this reading as it could be fatal to the patient as the enteral feeding tube may not be in the stomach.

Replacement gastrostomy tubes or LPGDs must also be replaced every 3-6 months according to manufacturers' guidelines. Acute hospitals, nursing homes and district hospitals have developed local guidelines on the reinsertion of gastrostomy tubes and LPGDs. These policies recommend that the registered nurse/healthcare professional must have attended a training session on the replacement of a gastrostomy tube and he/she must make a judgement as to whether he/she is competent to carry out the procedure.

Competence is not static; thus the importance of skill maintenance cannot be over emphasised. Healthcare professionals and carers re-inserting gastrostomy tubes should review their practice on a regular basis, thereby maintaining a high level of skill through regular practice. Each healthcare professional is accountable for ensuring that his/her skill and competence is maintained.

In order to increase awareness of these issues and to facilitate the suitable training of physicians, nurses, patients, home care health professionals and others in the reinsertion and maintenance of gastrostomy tubes and LPGDs, the device of the present invention simulates the abdominal wall of a patient in both thickness, texture, tactile response and colour. Replacement gastrostomy tubes may be inserted through the simulated abdominal wall of the device in a manner which allows the person being trained to see and feel the gastrostomy tube without causing harm to the patient.

This improved training model enables healthcare professionals and patients or their carers to also then practice the techniques to aspirate stomach contents through the replacement gastrostomy or water based balloon devices. The model sits on a rigid see-through frame under which lies a reservoir in which suitable fluid for aspiration can be filled so that healthcare professionals or patients and their carers can learn to check the pH reading thereby reducing the risks to the patient. There is no other way to demonstrate this technique at the moment only by using the patient themselves which can lead to patient discomfort.

The invention is therefore directed towards providing an improved replacement gastrostomy training device which allows healthcare professionals to practice replacing gastrostomy tubes and LPGDs as well as learning to aspirate from such tubes without causing harm to the patient thereby maintaining their competencies.

A circular mould of plastigel which represents the thickness and depth of the abdomen and human stomach wall has also been developed. This size enables the model to be handheld for demonstration purposes.

Summary of the invention

There is therefore provided, according to the present invention, a teaching aid for training purposes in the techniques of enteral feeding tube insertion into a pre-existing stoma tract, consisting of a model comprising an upper portion representing human abdominal skin and stomach wall comprising a Plastigel portion with a stoma which is moulded to represent the outward appearance, colour, tactile response and texture of a human abdominal section and a lower portion comprising of a see-through two tier box onto which the upper portion fits.

In another embodiment, the training model of claim 1, wherein the lower frame portion comprises five walls of a box and wherein the upper portion comprises a hole into which gastrostomy tubes of various sizes may be inserted to gain access to the chamber below and which fits into an upward facing aperture of the frame so as to form a seal.

In another embodiment, the training model of claims 1 or 2 wherein the frame comprises a reservoir which may be filled with a liquid representing gastric contents so the user can aspirate the contents and test them.

In another embodiment, a model for training purposes in the techniques of enteral feeding tube insertion into a pre-existing stoma tract according to any of claims 1 to 3, wherein the lower chamber can be separated from the top section for cleaning and also acts as a storage space for gastrostomy tubes for demonstration purposes.

In another embodiment, a model for training purposes in the techniques of enteral feeding tube insertion into a pre-existing stoma tract according to any preceding claim wherein the model is scales to be enabled to be handheld for demonstration purposes.

In another embodiment, a model for training purposes in the techniques of enteral feeding tube insertion into an already established stoma tract according to any previous claim, wherein the model can be covered with a plastic lid and the entire model and two tier box frame can be sealed together making the teaching device portable.

In another embodiment, a model for training purposes in the techniques of enteral feeding tube insertion into a pre-existing stoma tract wherein the odel only comprises the upper portion of the model of claim 1.

Brief description of the Drawings

Figure 1 is a perspective view of a replica abdomen for the teaching device.

Figure 2 is a perspective view of the teaching device for the reinsertion of gastrostomy tubes comprising a 2 tier transparent box (4) which sits one on top of the other which contains an airtight seal, the function of which allows the lower box to be filled with liquid that will represent stomach aspirate.

Figure 3 is a perspective view of the teaching device for the reinsertion of gastrostomy tubes illustrating the top tier of the box which has an opening(5) which allows various sizes of gastrostomy tubes to be inserted through the stomach model and into the lower chamber(6) below which will contain liquid that will represent gastric contents.

Figure 4 is a perspective view of the teaching device for the reinsertion of gastrostomy tubes illustrating a circular mould of plastigel(7) which represents the thickness and depth of the abdomen and human stomach wall. It resembles the tactile response of human skin and has a stoma tract to enable replacement gastrostomy and LPGDs (water filled balloons) to be inserted for training purposes. This size enables the model to be handheld for demonstration purposes.

Detailed description of the invention

Referring now to the drawings, figure 1 shows a perspective view of a model of the human abdomen of the teaching device, for the reinsertion of a replacement gastrostomy tube in an already established tract. It comprises a one layer rectangle of Plastigel(1) which represents the thickness and depth of the abdomen(2) and human stomach wall. It resembles the tactile response of human skin and has a stoma tract(3) to enable replacement gastrostomy and LPGDs to be inserted for training purposes.

Referring to Figure 2 now, this is a perspective view of the teaching device for the reinsertion of gastrostomy tubes which comprises a 2 tier transparent box (4) which sits one on top of the other which contains an airtight seal, the function of which allows the lower box to be filled with liquid that will represent stomach aspirate.

Referring now to Figure 3 this is a perspective view of the teaching device for the reinsertion of gastrostomy tubes illustrating the top tier of the box which has an opening(5) which allows various sizes of gastrostomy tubes to be inserted through the stomach model and into the lower chamber(6) below which will contain liquid that will represent gastric contents.

Illustrated by Figure 4 is a perspective view of the teaching device for the reinsertion of gastrostomy tubes illustrating a circular mould of plastigel(7) which represents the thickness and depth of the abdomen and human stomach wall. It resembles the tactile response of human skin and has a stoma tract to enable replacement gastrostomy and LPGDs (water filled balloons) to be inserted for training purposes. This size enables the model to be handheld for demonstration purposes

Claims

Claims 1. A model for training purposes in the techniques of enteral feeding tube insertion into a preexisting stoma tract, comprising an upper portion representing human abdominal skin and stomach wall comprising a Plastigel portion with a stoma which is moulded to represent the outward appearance, colour, tactile response and texture of a human abdominal section and a lower portion comprising of a see-through two tier box onto which the upper portion fits.
2. The training model of claim 1, wherein the lower frame portion comprises five walls of a box and wherein the upper portion comprises a hole into which gastrostomy tubes of various sizes may be inserted to gain access to the chamber below and which fits into an upward facing aperture of the frame so as to form a seal.
3. The training model of claims 1 or 2 wherein the frame comprises a reservoir which may be filled with a liquid representing gastric contents so the user can aspirate the contents and test them.
4. A model for training purposes in the techniques of enteral feeding tube insertion into a pre-existing stoma tract according to any of claims 1 to 3, wherein the lower chamber can be separated from the top section for cleaning and also acts as a storage space for gastrostomy tubes for demonstration purposes.
5. A model for training purposes in the techniques of enteral feeding tube insertion into a preexisting stoma tract according to any preceding claim wherein the model is scaled to be enabled to be handheld for demonstration purposes.
6. A model for training purposes in the techniques of enteral feeding tube insertion into an already established stoma tract according to any previous claim, wherein the model can be covered with a plastic lid and the entire model and two tier box frame can be sealed together making the teaching device portable.
7. A model for training purposes in the techniques of enteral feeding tube insertion into a pre-existing stoma tract wherein the model only comprises the upper portion of the model of claim 1.