Systems, apparatus, and methods for placing a guidewire for a gastrostomy tube

Abstract

Devices, systems, and methods for guidewire placement for a gastrostomy tube are described herein. A system can include an elongated tube, an inflatable member, and a guidewire assembly. The elongated tube can have a first end, a second end, and can define a lumen. The inflatable member can be coupled to the first end of the elongated tube and can be fluidically coupled to the lumen such that the inflatable member can receive fluid via the lumen. The guidewire assembly can include a guidewire having a first end and a second end. The first end of the guidewire assembly can include a coupling member, the coupling member configured to couple to the inflatable member such that translation of the elongated tube translates the guidewire assembly.

1 - 27 . (canceled) 
     
     
         28 . A system, comprising:
 an elongated tube having a first end, a second end, and defining a lumen;   an inflatable member coupled to the first end of the elongated tube, the inflatable member fluidically coupled to the lumen such that the inflatable member can receive fluid via the lumen; and   a guidewire assembly including a guidewire having a first end and a second end, the first end of the guidewire assembly including a coupling member, the coupling member configured to be directly coupled to a sidewall of the inflatable member such that translation of the elongated tube translates the guidewire assembly.   
     
     
         29 . The system of  claim 28 , wherein the lumen is a first lumen, and further comprising a needle defining a second lumen, the second lumen configured to receive the guidewire assembly. 
     
     
         30 . The system of  claim 28 , further comprising a fluid configured to be disposed within the inflatable member via the lumen of the elongated tube such that a location of the inflatable member can be visualized via ultrasound. 
     
     
         31 . The system of  claim 28 , further comprising a contrast medium configured to be disposed within the inflatable member via the lumen of the elongated tube such that a location of the inflatable member can be visualized via fluoroscopy. 
     
     
         32 . The system of  claim 28 , wherein the guidewire assembly includes a shape memory material. 
     
     
         33 . The system of  claim 28 , wherein the coupling member is configured to transition between a first configuration and a second configuration, the coupling member having a greater lateral extent relative to a central axis of the guidewire in the first configuration than in the second configuration, the coupling member being biased toward the first configuration. 
     
     
         34 . The system of  claim 33 , wherein the coupling member has a pigtail shape in the first configuration and an elongated shape in the second configuration. 
     
     
         35 . The system of  claim 33 , wherein the coupling member is shaped as a straight wire in the second configuration. 
     
     
         36 . The system of  claim 33 , wherein the coupling member is configured to couple to the inflatable member via being at least partially translated through the sidewall of the inflatable member within a lumen of a needle while retained within the lumen of the needle in the second configuration and transitioning to the first configuration when the needle is withdrawn relative to the coupling member. 
     
     
         37 . The system of  claim 28 , wherein the coupling member is configured to be coupled to the inflatable member such that an application of a first force on the elongated tube translates the guidewire assembly in a first direction. 
     
     
         38 . The system of  claim 37 , wherein the coupling member is configured to be coupled to the inflatable member such that an application of a second force on the guidewire assembly greater than and opposite to the first force and applied simultaneously to the first force causes the coupling member to decouple from the inflatable member. 
     
     
         39 . The system of  claim 28 , wherein the coupling member is configured to decouple from the inflatable member via at least partially transitioning from a first configuration to a second configuration, the first configuration having a greater lateral extent relative to a central axis of the guidewire than the second configuration. 
     
     
         40 . The system of  claim 28 , wherein the coupling member includes a first magnetic component and the inflatable member includes a second magnetic component, the first magnetic component configured to magnetically couple to the second magnetic component such that translation of the elongated tube translates the guidewire assembly. 
     
     
         41 . The system of  claim 28 , wherein the sidewall of the inflatable member is configured to be punctured by a needle to define a pinhole, and the coupling member is configured to be translated at least partially through the pinhole such that at least a portion of the coupling member is disposed within an interior of the inflatable member and retained by a wall surface of the inflatable member. 
     
     
         42 . The system of  claim 28 , wherein the sidewall of the inflatable member is configured to be punctured by a needle to define a pinhole, the coupling member is configured to transition between a first configuration and a second configuration, the coupling member having a greater lateral extent relative to a central axis of the guidewire in the first configuration than in the second configuration, the coupling member configured to be translated through the pinhole in the second configuration, the coupling member configured to transition from the second configuration to the first configuration within an interior of the inflatable member such that the coupling member can be retained within the interior of the inflatable member by an inner surface of the sidewall of the inflatable member such that translation of the elongated tube translates the guidewire assembly. 
     
     
         43 . A method, comprising:
 translating an inflatable member of an elongated tube through an orifice of a patient, through an esophagus of the patient, and into a stomach of the patient;   inflating the inflatable member via a lumen of the elongated tube such that the inflatable member transitions from an uninflated configuration to an inflated configuration;   translating a coupling member of a guidewire assembly through a stomach wall of the stomach, the guidewire assembly including a guidewire having a first end coupled to the coupling member and a second end disposed outside the patient, the guidewire extending through the stomach wall;   directly coupling the coupling member to a sidewall of the inflatable member; and   withdrawing the elongated tube through the orifice such that the coupling member and the first end of the guidewire are withdrawn from the orifice and such that the guidewire extends through the esophagus, stomach, and stomach wall of the patient and the second end of the guidewire is disposed outside of the patient.   
     
     
         44 . The method of  claim 43 , further comprising visualizing a location of the inflatable member via ultrasound. 
     
     
         45 . The method of  claim 43 , wherein inflating the inflatable member includes providing a fluid including a contrast medium to the inflatable member, and further comprising visualizing a location of the inflatable member via fluoroscopy. 
     
     
         46 . The method of  claim 43 , wherein directly coupling the coupling member includes translating at least a portion of the coupling member through the sidewall of the inflatable member. 
     
     
         47 . The method of  claim 46 , wherein the sidewall comprises a first sidewall portion and a second sidewall portion, and wherein directly coupling the coupling member further includes translating at least a portion of the coupling member through the second sidewall portion of the inflatable member such that the coupling member is disposed outside of the inflatable member and the guidewire extends from the coupling member through the first sidewall portion, through the second sidewall portion, and through the stomach wall. 
     
     
         48 . The method of  claim 46 , wherein the coupling member is configured to transition between a first configuration in which the coupling member is pigtail-shaped and a second configuration in which the coupling member is straight, the coupling member being biased toward the first configuration, the coupling member configured to be at least partially translated through the sidewall of the inflatable member in the second configuration and to be retained by the sidewall of the inflatable member in the first configuration. 
     
     
         49 . The method of  claim 43 , wherein the inflatable member includes a first magnetic component and the coupling member includes a second magnetic component, the first magnetic component configured to magnetically couple to the second magnetic component such that translation of the elongated tube translates the guidewire assembly. 
     
     
         50 . The method of  claim 43 , further comprising deflating the inflatable member after coupling the coupling member to the inflatable member. 
     
     
         51 . The method of  claim 43 , wherein the orifice of the patient is a nasal orifice. 
     
     
         52 . The method of  claim 43 , wherein the orifice of the patient is an oral orifice. 
     
     
         53 . The method of  claim 43 , further comprising, after withdrawing the elongated tube through the orifice such that the coupling member and the first end of the guidewire are withdrawn from the orifice, decoupling the coupling member and the inflatable member. 
     
     
         54 . A method, comprising:
 translating an inflatable member of an elongated tube through an orifice of a patient and to a first location within the patient;   inflating the inflatable member via a lumen of the elongated tube such that the inflatable member transitions from an uninflated configuration to an inflated configuration;   translating a coupling member of a guidewire assembly through a tissue wall of the patient to a second location within the patient near the first location, the guidewire assembly including a guidewire having a first end coupled to the coupling member and a second end disposed outside the patient, the guidewire extending through the tissue wall;   directly coupling the coupling member to a sidewall of the inflatable member; and   withdrawing the elongated tube through the orifice such that the coupling member and the first end of the guidewire are withdrawn from the orifice and such that the guidewire extends through the orifice, the first location, and the tissue wall of the patient and the second end of the guidewire is disposed outside of the patient.