Ryoki Kawamura

Rapid long tube intubation of the jejunum —an improved technique—

This study details improvements in the intubation of a long intestinal decompression tube by use of a new flexible tip guide wire and a new intestinal decompression tube. The intubation route of the endoscope was changed from the oral to the nasal cavity. Although the guide wire formerly used (TGBD-65-345) could be inserted into the descending part of the duodenum by passing it through the biopsy channel of the endoscope, with this new method, the guide wire (TGBD-65-450) could be inserted into the upper jejunum. The endoscope could also be left in the stomach, when this method was used. The long tube was introduced along this guide wire into the upper jejunum. As a result of these improvements, the intubation rate for long intestinal decompression tubes was significantly more rapid and the time reduced. Intubation rate to the jejunum was 96 percent successful, as compared with a former success rate of 75 percent. The intubation time was decreased to 11.3±5.6 min. to the duodenum and 18.6±8.6 min. to the upper jejunum. This differs markedly from the former method which required 16.0±5.3 min. and 39.6±22.7 min, respectively.

Subclavian Vein Puncture under Ultrasonic Guidance

Ultrasonically guided subclavian venipuncture is described. Since this method permits direct tapping of the subclavian vein and control of the insertion to the innominate vein under ultrasonic guidance, complications such as pneumothorax, accidental subclavian artery puncture, and malposition of the catheter, which often accompany the conventional method, can be avoided. As a result, this technique produces no radiation damage.

Improvement of the Guide Wire in the Long Intestinal Tube Used for Endoscopic Intubation in Patients with Intestinal Obstruction

Abstract: In 1980, an endoscopic intubation method utilizing a long intestinal tube for ileus was developed. However, with this method the success rate of jejunal intubation was 89.4%, and the intubation time was 17.5±8.1 minutes (Mean±S. D.). These results were unsatisfactory as “rapid and reliable intubation” was the initial objective. Because the earliest guide wire was excessively elastic and therefore pliable, it formed a loop in the stomach. The guide wire was then improved by increasing its rigidity by approximately 20%. With this improvement, the force needed to advance the guide wire can now be effectively transmitted to its tip. As a result, the initial objective of improving the rate of jejunal intubation with the long tube (to 100%) and shortening the intubation time (to 8.9±3.9 min.) was achieved.

Evaluation of an improved ileus monitoring system for intestinal motility.

To observe the recovery of normal intestinal movement and the effects of peristalsis-promoting agents in patients with intestinal obstruction, an ileus monitoring system using the balloon method was simultaneously compared with that using the infusion method in 24 patients. To initiate the balloon ileus monitoring system, measurement was started at a setting of 0 after connecting a transducer to the balloon inflation channel of a decompression tube. The recording sensitivity was 20 mmHg/cm, and the speed of recording was 5 mm/min. The sensitivity of the infusion method was found to be 0.70±0.17 times that of the balloon method, and therefore the balloon method was considered to be more accurate. The findings of this study show how useful this ileus monitoring system is for observing the motility of intestinal obstruction.