referring to the attached drawings , and initially to fig1 the disposable enema nozzle of the present invention is shown at 1 and comprises a flexible plastic tip or tube 10 , a self - adhesive positioning collar 24 disposed about tube 10 , and a rigid plastic conduit connector or adaptor 30 for connecting to a fluid source such as tubing leading from an enema bag . tube 10 generally comprises a first end 15 ( being the initial contact point for placement of the tube 10 into a patient &# 39 ; s rectum ), a shaft 11 having central longitudinal throughbore 9 ( shown in fig6 ), an expanded or flared portion 19 , a second end 13 . tube 10 may be a conventionally known flexible plastic enema tip available from a number of commercial suppliers , for example , such as lafayette pharmaceuticals incorporated , lafayette , ind . tube 10 may be a standard adult size tip having any of a variety of suitable head shapes , it may include an inflatable balloon at the end , or it may be a shorter pediatric size tip . in one embodiment of the present invention the region between shaft first end 12 and first end 15 of tube 10 comprises a bulbous area , terminus 14 , in the shape of a truncated ovoid having a central cavity 17 and end 15 , 16 openings compatible in diameter with that of shaft 11 . the first end 15 of terminus 14 is the same as first end 13 of tube 10 . the second end 16 of terminus 14 is joined end - to - end with the first end 12 of shaft 11 to provide for continuation of fluid flow from the tube shaft 11 through the terminus 14 and out into the patient &# 39 ; s rectum through auxiliary outlets 18 and end 15 . the end - to - end junction between end 16 and end 12 is permanently joined . alternatively , shaft 11 and terminus 14 may be molded as one unit , thereby eliminating the last mentioned joint . of course , it is possible to fixed by any suitable glue . tube shaft second end 8 is joined to and integral with an expanded portion 19 of the tube 10 , as best shown in fig5 and 6 . in one embodiment of the invention disclosed herein ( shown in fig6 ) tube 10 is about 7 cm in length ; shaft 11 is about 22 mm in length and has a central throughbore 9 that is about 3 mm in diameter ; expanded portion 19 is about 2 . 8 cm in length , and has an increasing external diameter of about 4 to 6 mm from first end 12 to second end 13 of tube 10 and a correspondingly increasing internal bore diameter 6 of about 2 to 5 mm , which larger diameter accommodates first end 31 of adapter 30 . in the same embodiment terminus 14 is about 9 mm in length and its diameter varies from about 3 mm at either end 15 , 16 to about 4 . 5 mm at a point about midway along the length of terminus 14 . the central cavity 17 of terminus 14 likewise varies in diameter from about 2 to 3 . 5 mm from either end 15 , 16 to about midway on the length of terminus 14 . in this embodiment , the auxiliary outlets 18 are pairs of axially opposing openings in terminus 14 that are in communication with the central cavity 17 . each of the auxiliary outlets 18 are about 1 mm in diameter , and one pair of which is positioned at about 1 . 5 mm from end 15 of tube 10 and the other pair are positioned at about 4 mm from end 15 and are placed at about 180 degrees about the axis of tube 10 relative to the location of the first pair . the expanded portion 19 of tube 10 may be stretched to accommodate first end 31 of a conduit connector or adapter 30 , as depicted in fig2 . the dimensions of the expanded portion 19 are not critical so long as the expanded portion can join first end 31 of a suitable adapter 30 and provide a stop for positioning collar 20 , as described below . the second end 32 of adapter 30 is shown unattached to a fluid source , which can be conventional flexible tubing leading to an enema bag . the adapter used in this invention can be obtained from any of a number of commercial sources that are well known by those of skill in the art . referring to fig1 and 5 , the disclosed invention further comprises a positioning collar 20 annularly attached to tube 10 at least by friction fit in orifice 22 of frustoconical nipple 21 of the positioning collar 20 . the exact manner of attachment is described in more detail below . in one embodiment the positioning collar 20 is fixedly attached at a predetermined distance from end 7 along expanded portion 19 of tube 10 . positioning collar 20 is permanently joined to expanded portion 19 . alternatively , tube 19 and nipple 21 may be molded as one unit thereby eliminating the joint . in an alternative embodiment , expanded portion 19 provides a backstop for controlling the most distal position along tube 10 the positioning collar 20 can reach . in this embodiment positioning collar 24 is slidably attached to tube 10 at any point along shaft 11 thereby permitting the technologist to adjust the tube length which can be inserted into the rectum . the slidable disposition of collar 24 is accomplished by the annular attachment about shaft 11 of frustoconical nipple 21 at its orifice 22 ; said attachment having sufficient resistance to incidental sliding to maintain a manually preset position while being resilient enough to permit the desired movement . as shown in fig1 - 5 , tube 10 extends through nipple orifice 22 of frustoconical nipple 21 of positioning collar 20 . end 13 , therefore , protrudes into and through frustoconical recess 24 , the same being the interior or reverse side of frustoconical nipple 21 , best shown in fig2 and 4 . in one embodiment of the disclosed invention , frustoconical nipple 21 is about 0 . 8 inches ( 8 mm ) in length , and has an increasing external diameter of about 0 . 55 to 0 . 9 inches ( 5 . 5 to 9 mm ) from orifice 22 to base 23 and frustoconical recess 25 has a correspondingly increasing internal diameter of about 3 . 5 mm to 2 . 5 cm from orifice 22 to base 26 . orifice 22 of frustoconical nipple 21 has a diameter of about 11 mm and nipple 21 has a base 23 diameter of about 12 mm . although the embodiments of the invention disclosed herein describe the positioning collar 24 as having a nipple 21 and recess 25 which are frustoconical in shape , they may be shaped otherwise so long as the nipple 21 , recess 25 , orifice 22 and bases 22 , 23 together constitute sufficient support for the flat collar extension 24 , provide adequate frictional contact surface around shaft 11 and provide an attachable surface in fixed collar embodiments of the present invention . referring now to fig3 and 4 , joined to and integral with frustoconical nipple base 3 is flat collar extension 24 which comprises a flat base extension 24 extending axially outward from the respective bases 23 , 26 of frustoconical nipple 21 and frustoconical recess 25 . the flat collar extension 24 of one embodiment of the present invention has an inner diameter of about 11 mm at the nipple base 23 , an outer diameter of about 18 mm , and is about 1 mm thick . the tube 10 , nipple 21 , recess 25 and flat collar extension 24 are made of any suitable flexible plastic material , such as polyvinylchloride , and may all be made of the same or different plastic , so long as the combined units provide a nozzle 1 of functionally sufficient rigidity and flexibility . the elongate sheet 41 is made of any suitable flexible material , such as polyethylene plastic . adhesive layer 42 is any suitable adhesive for contacting the skin . the protective tabs 43 are made of any suitable peelable material . adapter 30 is made from any suitable rigid plastic and may be a commercially available tubing connector or adapter available from well known sources . the flat collar extension 24 of the embodiments illustrated herein is round , but it may also be rectangular , square , or any suitable shape or size that will adequately support self - adhesive sheet 40 for its intended use . nozzle 1 of the present invention is constructed by pushing terminus 14 of tube 10 through recess 25 and out of nipple 21 through orifice 22 until positioning collar 20 is situated at the desired position along the longitudinal axis of tube 10 . alternatively , positioning collar 20 of the invention may be put into place prior to attachment of terminus 14 to shaft 11 by inserting end 12 of shaft 11 through recess 25 and out nipple 21 through orifice 22 until positioning collar 20 is situated at the desired position along the longitudinal axis of tube 10 . in one embodiment of the invention disclosed herein a conventional nipple colostomy tip , such as catalog no . 9517 of therapex , div . of e - z - em , inc ., 7 portland ave ., westbury , n . y . 11590 , was modified for use as positioning collar 20 by removing a portion of the tip to form a frustoconical nipple 21 . flat collar extension 24 has a first surface 27 which faces the patient &# 39 ; s body when the nozzle is in use and has a second surface 28 which faces away from the body . self - adhesive sheet 40 comprises an elongated sheet 41 or strip of flexible plastic firmly attached by thermal bonding or gluing to first surface 27 of extension 24 . elongate sheet 41 is of sufficient length and width to securely attach to and hold the patient &# 39 ; s buttocks against tube 10 . in one embodiment intended for use on an infant , the elongate sheet is about 25 × 40 mm and has an annular opening 44 of about 5 mm diameter through which frustoconical nipple 21 protrudes about midway . as best shown in the exploded view of fig4 self - adhesive sheet 40 further comprises a suitable adhesive layer 42 which coats the underside or first surface 45 of elongate sheet 41 for sticking to the patient &# 39 ; s buttocks . in one embodiment of the invention , the area coated by adhesive excludes that portion of the elongate sheet 41 which overlies frustoconical nipple 21 and flat collar extension 24 . at least two plastic protective tabs 43 peelably overlie adhesive layer 42 for covering the adhesive until ready for adhering to the skin . although a rectangular shape has been shown by the inventors to be a suitable shape , the size and shape of elongate sheet 41 are not critical so long as it adequately attaches to the collar extension 24 and sufficiently secures to the patient &# 39 ; s buttocks . when employed in an enema procedure such as , for example , a pediatric radiological barium enema , a tubing leading from an enema bag ( not shown ) is connected to adapter 30 of the invention disclosed herein . tube 10 is lubricated with a suitable lubricant such as petroleum jelly , k - y jelly ™, or surgilube ™, and terminus 14 and shaft 11 are inserted into the child &# 39 ; s rectum approximately two inches . while tube 10 is held by the technologist in the desired position relative to the patient &# 39 ; s body the positioning collar 20 is oriented with the elongated dimension of the self - adhesive sheet 40 extending transversely across the patient &# 39 ; s buttocks . the technologist peels off the protective tabs 43 exposing the adhesive layer 42 of self - adhesive sheet 40 . alternatively , the positioning collar 20 of one embodiment of the invention may be adjusted to a position along tube 10 that is closer to or further from the end 15 of tube 10 as may be necessary , depending on such factors as the age of the child or the size of the buttocks , prior to stripping away the tabs 43 . the buttocks may be compressed together to better secure tube 10 in place while the non - adhesive second surface 46 of elongate sheet 41 is pressed down against the buttocks to adhere adhesive layer 42 , thereby anchoring positioning collar 20 and thereby securing nozzle 1 . the barium fluid is then allowed to flow through tube 10 and out into the patient &# 39 ; s rectum through end 15 and auxiliary outlets 18 while being monitored by fluoroscope . when enough barium is in the colon , the radiologist has the patient turn in several different positions for visualizing specific parts of the colon fluoroscopically . the technologist prepares the required number of x - ray films , tuming the patient into different positions as needed . only after the films are developed and checked is the barium solution drained out of the patient through tube 10 and into the bag , and the tube 10 removed . post evacuation films are then taken to complete the procedure . from the above description of a barium enema procedure employing the disclosed nozzle , it can readily be seen how the secure placement of the enema nozzle for the required time and throughout numerous repositionings of the patient is essential to the success of the procedure . other advantages which can be appreciated by those of skill in the art is the elimination of the need for attachment of other materials to secure the nozzle such as , for example , wrapping surgical tape around the tube and strapping it to the patient . the self - adhesive layer of the present invention is easily readied by the technologist and secured to the buttocks . both expulsion of the tube and migration of the tube too far internally during the procedure is avoided because of the stable attachment of the device to the buttocks . in addition , the disclosed device provides more comfort for the patient because it is adhesively anchored to the buttocks rather than contacting the body elsewhere . the nozzle of the invention can be more quickly positioned by the technologist than prior art devices , and is less cumbersome for the patient to wear than prior art devices . the problem of leakage is minimized by the nozzle of the present invention because the patient &# 39 ; s buttocks are firmly held together against the tube by the self adhesive strip . in particular , the disclosed nozzle is advantageous for use in infants , young children , the infirm and the elderly by lessening the risk of injury to the patient &# 39 ; s rectal wall from unanticipated shifting of the tube and by avoiding use of an inflation balloon . while the preferred embodiments of the invention have been shown and described , modifications thereof can be made by one skilled in the art without departing from the spirit and teachings of the invention . the embodiments described herein are exemplary only , and are not limiting . many variations and modifications of the invention and apparatus disclosed herein are possible and are within the scope of the invention . accordingly , the scope of protection is not limited by the description set out above , but is only limited by the claims which follow , that scope including all equivalents of the subject matter of the claims .
a disposable flexible plastic enema nozzle with self - adhesive securing means for convenient attachment to the patient &# 39 ; s buttocks is disclosed . the securing means comprises an annular positioning collar disposed about the enema tip or tube . the positioning collar has an elongated self - adhesive plastic sheet with easily removable protective tabs covering the adhesive . in one embodiment of the invention the positioning collar is fixed near the distal end of the tube , while in another embodiment the positioning collar is slidable along the tube for adjusting the insertion length of the tube . the invention is particularly applicable to diagnostic enema procedures , such as barium enema for radiological examination , performed on infants , small children , the infirm and the elderly .