Dr. Steven Briggs’ idea started brewing during his work in trauma and critical care. As a trauma surgeon, he had recently dealt with a series of severe complications involving the standard percutaneous endoscopic gastrostomy (PEG) tube.
About 300,000 PEG tubes get placed annually in the U.S. Passed into the stomach through the abdominal wall, the tube delivers nutrients when patients cannot manually feed themselves. In the intensive care unit, a gastrostomy tube is often placed for patients who require long-term mechanical ventilation.
Inadvertent dislodgment is the main cause of gastrostomy tube complications. Dr. Briggs started to wonder what could be done differently — if there were a way to prevent the issue from happening in the first place.
“It struck me that if you changed the tube in certain ways, you could make it much smaller and therefore much less likely to be dislodged,” Dr. Briggs said.
By evolving the design of the gastrostomy tube itself, Dr. Briggs hopes to make it less vulnerable to being pulled out. Nurses in the ICU often need to move patients in ways that can affect a gastrostomy tube. Many dislodgements happen inadvertently when a patient is undergoing the necessary care of someone in the unit.
“In the process of taking care of the patient, the tube itself puts the patient at risk because of everything we have to do to prevent other problems,” Dr. Briggs says. “Having fewer things hanging off the patients would make it safer for them.”
Keeping a low profile
In connection with the Sanford Health commercialization team, Dr. Briggs has developed an initial design for the investigational gastrostomy tube. It incorporates a sleeve with wings into the standard PEG tube design.
After transabdominal placement of the tube, a locking plate snaps together around the tube at the skin level. This pinches the wings and keeps the feeding tube from falling back into the stomach, allowing for excess tubing to be cut off at the locking plate.
A cap with the standard feeding ports is then inserted, which creates a low-profile feeding system. The entire process is simple to perform and falls within the established work flow of a traditional PEG tube insertion.
“The modifications to the gastrostomy tube may allow initial percutaneous placement in a low-profile configuration,” Dr. Briggs explained. “This could allow almost all of the external tube to be removed.”
Challenges of ICU care
Dr. Briggs is driven by a desire to design a modified gastrostomy tube to make the care environment safer by reducing the infection risk associated with having a gastrostomy tube.
Patients on long-term mechanical ventilation are typically in critical condition. Examples include brain injuries, multisystem traumas, chronic cardiovascular diseases and sepsis.
When a gastrostomy tube becomes dislodged, it carries great risk to an already critically ill patient. Complications from tube dislodgements include systemic infections, which can extend an ICU stay by weeks or even longer. Sometimes, by the time an infection becomes recognizable, the patient already has become so sick they might not be able to recover.
A low-profile gastrostomy tube design has the potential to help ambulatory patients as well. A modified tube could create a more comfortable and lifestyle-friendly feeding system for patients in good or reasonable health who have a gastrostomy tube on a non-hospitalized basis.
“The tube itself is the same tube we’ve been using since I’ve been in medicine, and maybe it’s time for that to change,” Dr. Briggs said. “My hope is to evolve the gastrostomy tube to better serve the 21st century ICU model of care.”
Sanford Health values the ideas and problem-solving ability of its physicians, researchers, clinical workers and support staff. Any employee with an idea for a device, therapy, software, tool or other method that helps patients is encouraged to contact the commercialization team and join the dozens of people at Sanford Health who are already inventing.
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