Note: Descriptions are shown in the official language in which they were submitted.
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TUBE SUPPORT
FIELD
The invention relates to supporting a portion, external to a patient, of a
tube partly
embedded in the patient.
BACKGROUND
Clinicians install tubes into the upper body of people requiring various
medical
procedures, such as percutaneous endoscopic gastrostomy (PEG) feeding tubes
and
other feeding tubes, catheters and wound drainage tubes, etc. Tubes are
surgically
installed into the patient's body and the free end of the tube is supported.
PEG feeding tubes are surgically installed into the stomach through the
abdomen wall
just below the rib cage and are typically oriented so that the portion of the
tube
external the patient projects upwardly to overlie the patient's chest.
Typically the tube portion external to the patient is a free end.
Conventionally the free
end of the tube is supported by adhesive tape attaching it to the skin of the
chest of
the recipient. When the tube is used or cleaned, the free end of the tube is
removed
from its location by removing the adhesive tape from the skin of the patient.
Once the
tube has been accessed, it is resecured using more adhesive tape.
Post-surgery complications occur from time to time. The present inventors have
recognised that some of these complications are associated with the
conventional
approach to supporting the external portion of the tube. For example, adhesive
tape is
thought to cause tearing of the skin (which tearing can result in infection)
and allergic
reaction. Adhesive tape also pulls on the skin, causing discomfort to the
recipient.
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The inventors have recognised that cancer patients are at higher risk of such
complications because some medication required to treat such patients can
cause the
skin to be sensitive and easily damaged.
Occasionally an external portion of an embedded tube is accidently snagged and
the
tube pulled out, resulting in a medical emergency which may have dire
consequences.
With the foregoing in mind, the present invention aims to provide improvements
in
and for supporting tubes, or at least to provide an alternative for those
concerned with
supporting tubes.
It is not admitted that any of the information in this patent specification is
common
general knowledge, or that the person skilled in the art could be reasonably
expected
to ascertain or understand it, regard it as relevant or combine it in any way
at the
priority date.
SUMMARY
One aspect of the invention provides a support for supporting a portion,
external to a
patient, of a tube partly embedded in the patient; the support including
a torso embracing portion, e.g. a strap, for embracing a torso of the patient;
and
one or more tube holding portions for holding the tube;
the tube holding portion(s) being fixable to, or part of, the torso embracing
portion.
Preferably the support includes a releasable fastening mechanism by which two
ends
of the straps are releasably fastenable to close the strap. The releasable
fastening
mechanism is preferably positioned to overlie the patient's chest.
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The support preferably includes a mechanism by which a circumference of the
torso
embracing portion is adjustable to suit torsos of varying size. The torso
embracing
portion may include elastic material whereby the torso embracing portion is
configured to elastically embrace the torso.
The support preferably further includes a shoulder strap, which strap
preferably
connects to the torso embracing portion in the vicinity of the patient's
spine.
The support may include a connection arrangement
by which the shoulder strap is attached or attachable to the torso embracing
portion;
and
which is laterally relocatable across the patient's back.
A releasable fastening mechanism may be positioned to releasably fasten the
shoulder strap to the torso embracing portion whilst overlying the patient's
chest.
The support is preferably configured to embrace the tube at differing
locations spaced
across the patient's chest to accommodate variation in the location and the
orientation at which the tube is at least partly embedded. By way of example,
the
support may be so configured by the inclusion of two or more of the tube
holding
portions positioned to be spaced across the patient's chest.
Preferably the torso embracing portion includes two layers of material
mutually
fastened at points of fastening; and
the points of fastening are positioned to be spaced across the patient's chest
such
that each of the tube embracing portion(s) is defined between a respective
adjacent
two of the points of fastening.
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Another aspect of the invention provides the use of the support to support the
tube,
including arranging the torso embracing portion and the tube holding portion
such that
the torso embracing portion embraces the patient's torso; and
the tube holding portion holds the tube.
Preferred forms of the support are flexible enough to allow the tube to move
with the
body movement, relieving stress to the entry wound.
Another aspect of the invention provides a support, for supporting a PEG
feeding
tube, formed
from
two 20mm plastic side release buckles;
two 20mm plastic tri-slides; and
2.95m of 19mm soft elastic; and
by
to make a chest strap, cutting 1.7m of the elastic and sliding a female side
of
one of the buckles 250mm in from an end of the 1.7m of elastic to define a
250mm end portion of the elastic;
folding the 250mm end portion back along the elastic and bar tacking the end
of
the 250mm end portion;
bar tacking every 50mm back towards the buckle, to make pockets for the PEG,
leaving the last bar tack;
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cutting 50mm of the elastic;
threading the 50mm of elastic through the female side of another of the
buckles;
sewing the 50mm of elastic, via bar tack, at right angles to and next to the
first
buckle to give an attachment point for a shoulder strap;
5 sliding the other end of the 1.7m of elastic through one of the tri-
slides and the
male side of one of the buckles and back through the one of the tri-slides;
folding and bar tacking the other end of the 1.7m of elastic to stop it
fraying;
to make the shoulder strap, cutting 1.2m of the elastic;
sewing an end of the shoulder strap to the chest strap 600mm from the first
buckle and on the same side of the chest strap; and
sliding the other end of the shoulder strap through the other of the tri-
slides and
the male side of the other of the buckles and back through the other of the
tri-
slides.
Another aspect of the invention provides a support, for supporting a PEG
feeding
tube, formed
from
two 20mm plastic side release buckles;
three 20mm plastic tri-slides; and
2.31m of 19mm soft elastic; and
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by
to make a chest strap, cutting 1.5m of the elastic and sliding the female side
of
one of the buckles, 250mm in from an end of the 1.5m of elastic to define a
250mm end portion of the elastic;
folding the 250mm end portion back along the elastic and bar tacking the end
of
the 250mm end portion;
bar tacking every 25mm back towards the buckle, to make pockets for the PEG,
leaving the last bar tack;
to make a shoulder strap, cutting 700mm of the elastic and sewing a 25mm loop
in one end of the 700mm of the elastic;
cutting 110mm of the elastic;
threading the 110mm of the elastic through the female side of the other buckle
to form a loop and bar tacking to form a 20mm loop;
sliding the other end of the 1.5m of elastic through
the 20mm loop, then
one side of one of the tri-slides, then
the 25mm loop of the shoulder strap, then
the other side of the one of the tri-slides;
fitting another of the tri-slides to the 1.5m of the elastic; then
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sliding the other end of the 1.5m of elastic
through the male side of one of the buckles from the underside and back
through from above, then
back through the other of the tri-slides; and
fitting a further of the tri-slides to the 700mm of the elastic; then
sliding the other end of the 700mm of elastic
through the male side of one of the buckles from the underside and back
through from above, then
back through the further of the tri-slides.
BRIEF DESCRIPTION OF DRAWINGS
An embodiment of the apparatus will now be described by way of example only
with
reference to the accompanying drawings in which:
Figure 1 is a plan view of an embodiment of the invention laid flat;
Figure 2 is a plan view of a portion of the embodiment of Figure 1;
Figure 3 is a plan view of the embodiment of Figure 1 partially disassembled;
Figure 4 is a front view of a patient wearing the embodiment of Figure 1;
Figure 5 is a rear view of a patient wearing the embodiment of Figure 1;
Figure 6 is a plan view of a tri-slide;
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Figure 7 is a plan view of a male portion of a buckle;
Figure 8 is a plan view of a female portion of a buckle;
Figure 9 is a cross-section view of an end portion of a torso embracing
portion;
Figure 10 is cross-section view of the relocatable connection mechanism; and
Figure 11 is another cross-section view of the relocatable connection
mechanism.
DESCRIPTION OF EMBODIMENTS
Disclosed herein are apparatus and methods that can be used to comfortably and
detachably secure the free end of a tube (e.g., a feeding tube, catheter, etc)
to the
body of a patient without using adhesive tape. At least preferred forms of
these
apparatus and methods comfortably support the tube and reduce the risk of
infection.
The preferred form of the apparatus is a harness from which the free end of
the tube
is detachable when the harness is accidently snagged during normal activities,
to
reduce the risk of the tube being dislodged from its attachment in the
patient's body.
The disclosed support 100 takes the form of a harness consisting of a chest
strap 10
and a shoulder strap 20. The chest strap 10 is an example of a torso embracing
portion. The shoulder strap 20 is an example of a shoulder overlying portion.
The chest strap 10 includes:
= a length of elastic which is preferably slighter longer than is required
to encircle
the torso of a large patient and is preferably about 1" (25mm) wide;
= a pair of tri-slides 30a, 30c;
= a buckle made up of a male portion 41a and a female portion 40a; and
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= an extension 11 including the female buckle portion 40b.
Preferably each of the tri-slides and buckle portions is a respective integral
plastic
molding (see Figures 6 to 8).
The tri-slide 30a includes a trio of spaced parallel bars 130a, 230a, 330a,
the ends of
which are connected by a pair of parallel rails.
The male buckle portion 41a includes a pair of spaced parallel bars 141a,
241a. A
prong 341a and a pair of resilient barbs 441a extend perpendicularly away from
the
bars 141a, 241a. The prong 341a sits centrally between the barbs 441a.
The female buckle portion 40a is a hollow body having an open end 140a to
receive
the prong 341a and barbs 441a. The body further includes a pair of side
openings
240a and a bar 340a.
The barbs 441a are:
= outwardly biased to engage the openings 240a to resist removal of the
male
portion 41a from the female portion 40a; and
= pressed inwardly via the openings 240a to disengage and allow the removal of
the male portion 41a from the female portion 40a.
The buckle 40a, 41a is thus one example of a releasable fastening mechanism.
Other
possible examples include hook and loop fastening (such as VelcroTm), press
studs,
hooks and eyes, etc.
At one end of the strap 10, the elastic is wrapped around the bar 340a of the
female
buckle portion 40a and is stitched back on to itself to define a permanently
closed
loop capturing the female buckle portion 40a.
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At the other end of the strap 10 (Figure 9), the elastic is laced through the
tri-slide
30a, around the bar 241a then back through the tri-slide 30a, such that the
second
pass of the elastic through the tri-slide 30a sits between the bar 230a and
the elastic
of the first pass through the tri-slide. The buckle portion 41a is thus
captured at the
5 end of the elastic.
The layers of elastic through the tri-slide 30a frictionally engage each other
sufficiently
to resist inadvertent reversal. On the other hand, with careful hand
manipulation,
elastic can be fed through the tri-slide to adjust length of the strap 10. In
use, the
length of the strap 10 corresponds to the circumference of the patient's
torso. Thus
10 the arrangement of Figure 9 constitutes a mechanism for adjusting the
circumference
of the strap 10.
The shoulder strap 20 includes a length of elastic, one end of which is looped
back
on, and stitched to, itself to define a loop 21. The other end of the elastic
is fitted with
a tri-slide 30b and a male buckle portion 41b, whereby the shoulder strap is a
length
adjustable shoulder strap.
The shoulder strap maintains the support at a consistent level around the
torso. This
substantially overcomes any vertical movement that may dislodge any tubes that
have been secured to the support and prevent spillage and assists with wound
management.
The tri-slide 30c is the major component of a connection arrangement by which
the
shoulder strap 20 is connected to the back of the chest strap 10 (see Figures
10 and
11). To form this connection:
= prior to the fitment of components 30a, 41a, an end of the elastic of the
strap
10 is passed through the gap defined by the bars 130c, 230c;
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= the loop 21 at the end of the shoulder strap 20 is then passed over the
tri-slide
30c;
= the end of the elastic of the strap 10 is passed through the gap defined
by the
bars 230c, 330c (or more precisely by an edge of the loop 21 and the bar
330c, since the loop 21 partly covers the gap defined by the bars 230c, 330c)
to define a loop 14 in the elastic of the strap 10.
With careful hand manipulation, the elastic of the strap 10 can be fed through
the tri-
slide 30c so as to move the tri-slide 30c (and in turn the loop 21 and the end
of the
shoulder strap 20) along the strap 10. Thus Figures 10 and 11 describe one
example
of a relocatable connection arrangement by which an end of the shoulder strap
can
be relocated across the patient's back 61.
The extension 11 including the female buckle portion 40b includes a short
length of
elastic. The short length of elastic encircles the bar of the buckle portion
40b and is
stitched to the elastic of the strap 10 at a location adjacent the buckle
portion 40a so
that in use the buckle 40b opens upwardly to receive the buckle portion 41b of
the
shoulder strap 20.
The front run of the elastic of the strap 10 (i.e. the portion that sits on
the patient's
chest 60) is formed as a double layer of elastic. These layers are stitched to
each
other at stitching points 13 spaced at a pitch of about 50mm along the
elastic. Here,
and elsewhere in the harness 100, the stitching preferably takes the form of
bar tacks
such as short zig-zag stitching.
Each pair of adjacent stitching points 13 defines a respective open ended
pocket 13a
though which a tube (e.g. a feeding tube or a catheter) may be passed. These
pockets embrace the tube to hold it in place.
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Stitching is but one means of mutually fastening the two layers.
Alternatively, by way
example, buttons or press studs could be used. Plastic welding is also
contemplated.
In the illustrated example, the tube 50 is a "Y" tube having two branches 51.
Each of
the two branches 51 is respectively received in a respective one of the
pockets 13a.
A preferred form of the support for two or more tube holding portions at pre-
defined
points. The support can also be maneuvered to allow tubes positioned for left
or right
attachment and does not interfere with, or inhibit other medical treatment or
devices
that may need to be worn.
For the avoidance of doubt, "embrace" and "hold" and similar terms as used
herein do
not require compression or continuous conformal contact. That said, in the
described
support 100, the length of the strap 10 is preferably adjusted to gently
compress the
patient's torso. When the support 100 is so adjusted, the tension in the strap
gently
compresses the tube by urging the pocket in which the tube is received to
close in the
fore-aft direction (i.e. normal to the patient's chest).
In the described example, the tube holding pockets are formed as part of the
strap 10.
In other variants, the tube holding portion could take the form of a clip
carried by the
tube and attachable to the strap 10 at a preferred location along the strap.
Alternatively, loops of fabric may be stitched to the front run of the elastic
of the strap
10.
The support could be formed from a variety of materials. That said, it is
preferably
formed of soft elastic materials and plastic (e.g. nylon) fittings that are
freely available
and well known in the context of clothing and bags, etc. These materials are
comfortable to the patient, suited to routine washing (thus making the support
conveniently and economically reusable) and suited to routine medical
procedures
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such as x-rays, Magnetic Resonance Imaging (MRI), radiation therapy and
chemotherapy.
To fit the support 100:
= The support is obtained in (or first assembled to) the condition
illustrated in
Figure 1 in which the buckles 40a, 41a and 40b, 41b are released.
= The strap 10 is placed around and as high as possible on the patient's
chest.
= The buckle portions 40a, 41a are mutually engaged.
= The elastic of the strap 10 and the tri-slide 30a are manipulated to
adjust the
length of the strap 10 so that it gently compresses the patient's chest to
stay
firmly in place.
= The elastic of the strap 10 and the tri-slide 30c are manipulated to
position tri-
slide 30c substantially at the centre of the patient's back.
= The shoulder strap 20 is passed over the patient's shoulder and the
buckle
portions 40b, 41b are mutually engaged.
= The elastic of the shoulder strap and the tri-slide 30b are manipulated to
adjust
the length of the strap until the shoulder strap is firm.
= Insert the tube to be supported into a suitably positioned one of the
pockets
13a.
= Trim each of the chest and shoulder straps at an angle of about 45 as
required to leave about 100mm to about 150mm free elastic.
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Trimming the straps at an oblique angle, such as 45 , reduces fraying.
Positioning the tri-side 30c at the centre of the patient's back stably
positions the
support 100 on the patient's body. It also comfortably locates the tri-side
(and
connection arrangement generally) in the hollow of the patient's back.
In the illustrated example, the strap 20 is passed over the patient's right
shoulder.
Alternatively, it may be passed over the left shoulder.
Preferred forms of the support 100 do away with the need for adhesive tape to
secure
the free end of the tube, and with various of the problems associated with
adhesive
tape. These preferred forms are comfortable for patients. They also provide a
degree
of resilience, thus reducing the risk of the tube being pulled out when the
tube is
inadvertently snagged. They also allow the tube to separate from the support,
thus
reducing the risk of the tube being pulled out when the harness is
inadvertently
snagged.
The tube embracing portions are configured to slidingly engage the tube so
that the
tube, if pulled, slides through tube embracing portion. Thus the tube is
allowed to
move with the natural movement of the body. If the feeding (or other) tube is
interfered with (e.g. accidentally pulled or snagged), the support flexes with
the
pressure, releasing the tube from the support thereby ensuring that the
tube(s) does
not become displaced or unattached from the inserted location on the patient.
Desirably the force required to dislodge the tube from the patient is greater
than the
force required to dislodge the tube from the retention loops of the harness.
One example of the disclosed support is a feeding tube support brace that is a
cost
effective and comfortable alternative to adhesive tape. This support brace is
made
using the following materials and in accordance with the following the
instructions.
Materials:
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= 2 x 20mm plastic side release buckles
= 2 x 20mm plastic tri-slides
= 2.95mtr 19mm soft elastic
Instructions:
5 1. To make the chest strap, cut 1.7mtr elastic and slide the female
side of one
buckle, 250mm in from the end of the elastic
2. Fold the 250mm end back along the elastic and bar tack the end
3. Bar tack every 50mm back towards the buckle, to make pockets for the
PEG,
leaving the last bar tack
10 4. Cut 50mm length of elastic and thread it through the female side
of the other
buckle and sew it, via bar tack, at right angles to and next to the first
buckle to
give attachment of shoulder strap
5. Slide the free end of the chest strap through a tri-slide and the male
side of the
buckle and back through the tri-slide
15 6. Fold and bar tack the end of the elastic to stop it fraying
7. To make the shoulder strap, cut 1.2mtr elastic
8. Sew shoulder strap to chest strap 600mm from the shoulder strap buckle
and on
the same side
9. Install the tri-slide and the male side of the buckle using the same
method as the
chest strap
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To fit this support brace:
A. Place the chest strap around the chest and insert the PEG through the
pocket in
the chest strap that is the most comfortable, adjust the strap via the side
release
buckle then take up the excess strap using the tri-slide
B. Fasten the shoulder strap and adjust in the same way as the chest
C. This item can be used as right hand or left hand
Another example of the disclosed support is a feeding tube support brace that
is a
cost effective and comfortable alternative to adhesive tape. This support
brace is
made using the following materials and in accordance with the following the
instructions.
Materials:
= 2 x 20mm plastic side release buckles
= 3 x 20mm plastic tri-slides
= 2.31m of 19mm soft elastic
Instructions:
1. To make the chest strap, cut 1.5m elastic and slide the female side of
one
buckle, 250mm in from the end of the elastic
2. Fold the 250mm end back along the elastic and bar tack the end
3. Bar tack every 25mm back towards the buckle, to make pockets for the
PEG,
leaving the last bar tack
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4. To make the shoulder strap, cut 700mm elastic and sew 25mm loop in one
end
5. Cut 110mm length of elastic and thread it through the female side of the
other
buckle to form a loop and bar tack to form a 20mm loop
6. Slide the free end of the chest strap through the 20mm loop in step 5
then
through one side of a tri-slide and the 20mm loop of the shoulder strap then
through the other side of the tri-slide
7. Fit a tri-slide to the chest strap then through the male side of the
buckle from the
underside and back through from above then back through the tri-slide
8. Install the tri-slide and the male side of the buckle using the same
method as the
chest strap
