Consideration of alternative designs for a Percutaneous Endoscopic Gastrostomy feeding tube
Yerrabolu, Santosh Rohit
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The inability of some people to chew or swallow foods (but can digest foods) due to problems associated with various diseases and complications leads them to insufficient nutritional intake and loss of quality of life. These individuals are generally provided with nutritional support by means of injecting or infusing food directly into their stomachs or small intestines via feeding tubes. Gastrostomy feeding tubes (G-tubes) are used when such nutritional support is required for over 3-6 weeks. Percutaneous Endoscopic Gastrostomy (PEG) tubes are one of the most widely used G- Tubes and devices which are inserted via an incision through the abdominal wall either through a pull or push method. This investigation proposes conceptual alternative Percutaneous Endoscopy Gastrostomy (PEG) feeding tube designs with optimized materials selection to be used for their construction. The candidate materials were chosen from 18 commercial catheters, 2 reference grade polymers and a commercial polymer; using tissue-catheter-friction testing and surface chemistry characterization (Infrared spectroscopy and Critical Surface Tension approximation). The main objectives considered were to minimize slipping/dislodgement of gastrostomy tube/seal, to reduce peristomal leakage, and to attain size variability of PEG tubes while maintaining a low profile. Scanning Electron Microscope- Energy Dispersive X-ray Spectroscopy was employed to further determine the filler materials used in the samples. Nylon coated with fatty ester and filled with Barium sulphate was determined as the optimum material for the construction of the tube part of the feeding tubes to reduce slipping/dislodgment of gastrostomy tube/seal and to minimize peristomal leakage. Nylon coated with fatty ester and filled with Silica is the suggested as a candidate material for construction of the bumper/mushroom sections of the feeding tubes to avoid the Buried Bumper Syndrome. Fused Deposition Modeling, Selective Laser Sintering and/or 3-D printing are proposed for manufacturing of the product. Radio Frequency Glow Discharge Treatment is proposed as a sterilizing technique. Further investigations suggested are pilot Finite Element Analysis of the biomechanics involved and the subsequent validation and optimization of the conceptual designs apart from pursuing materials performance evaluation with stomach tissue-skin composites and long-term placement of tubes/ catheters at variable surface roughness profiles, filler materials, modulus of rigidities, tube-pull-through speeds and tissue stretch ratios.