370 – Improving NG Tube Placement: What Every Med SLP Should Know About the PatCom Introducer

If you’ve ever wondered, “Wait… are we as SLPs really allowed to be in the esophagus?” — this episode is for you. Theresa brings on two MedSLP Collective favorites, Christoph Schmitz, CEO of PatCom Medical, Inc, and Laura McWilliams, med SLP + board-certified swallowing specialist + all-around powerhouse. Together, they unpack what might just be […]

The post 370 – Improving NG Tube Placement: What Every Med SLP Should Know About the PatCom Introducer appeared first on Swallow Your Pride Podcast.

Episode Transcript

(00:10):
Welcome to the Swallow Your Pride podcast. I'm
your host, Theresa Richard. I'm a board certified
specialist in swallowing and swallowing disorders
and founder of the MedSLP Collective and MedSLP
Education.
This podcast is dedicated to delivering the latest
evidence-based practice to medical SLPs everywhere while
also recognizing that medical SLPs everywhere are doing

(00:31):
the best with what they've got. Whether you
are a new clinician seeking tangible tools for
therapy or a seasoned vet stuck in a
rut, my goal is simple, to help you
advance your practice practice without feeling overwhelmed or
underappreciated.
This means that together, we'll build confidence, broaden
your knowledge, and reignite your passion for our
fields. So if you're listening, I encourage you

(00:51):
to swallow your pride and be open to
new ideas because at the end of the
day, you and your patients deserve that kind
of support. Just a quick disclaimer that all
statements and opinions expressed in this episode do
not reflect on the organizations associated with the
speakers and are their own opinions solely. With
that, let's dive in.
Welcome to the swallow your pride podcast. I

(01:11):
am so excited for today's guest. This conversation
has been a long time coming. I know
there's a lot of questions that SLPs have
about this.
I have a lot of questions myself, and
I'm so excited to dive in. So today,
we have Christoph Schmitz with us and Laura
McWilliams,
and they are a really interesting dynamic duo.
They've both been on the podcast previously
for

(01:32):
various different reasons, but today coming together for
a really cool reason that we will talk
about in just a bit. So Christoph is
an experienced med device expert, entrepreneur, and inventor.
He's driven by the desire to help clinicians
provide best patient care. He takes pride in
creating innovative device solutions in the field of
speech language pathology.
As the CEO of PatCom Medical, his goals

(01:52):
include giving more patients access to instrumental swallow
assessments and raising the customer service experience for
SLPs to a new level.
I love that bio, Christoph. That's great.
Yes. I deliver it every day. Yeah. And
Laura McWilliams is an SLP and board certified
specialist in swallowing with a passion for change
management, safety, quality, informatics,

(02:12):
team development, and workplace culture. She's a leader,
mentor, supervisor, and consultant,
and still isn't sure what she wants to
be when she grows up. She's a mom
to three kiddos under the age of five
and has a deep appreciation for innovation, elevating
others, and finding courage in our daily practice.
Awesome. Welcome to the show, you guys. I
feel like those are, like, the best bios
ever, so I love them both.

(02:34):
Christoph, without further ado, tell the people a
little bit more about yourself.
Yes. Sure. Yeah. Absolutely.
So I've been,
in the medical,
and medical device world, for almost twenty years
now. I was thinking like
back in preparation of this. How long has
it been? Twenty years almost, coming up to
twenty years. And then,

(02:55):
you know, seven out of the twenty years,
lucky enough to,
to be running PatCom Medical,
for the reasons that you've mentioned already.
And, yeah, I'm very excited to to be
here. This this topic that we're gonna talk
about is
really probably,
you know, I'll say the thing that I'm

(03:16):
most proud of in a way, because it's
it's, you know, truly where I,
you know, was able to invent something that,
hopefully will, you know, help many, many patients,
feel better,
be more comfortable,
and here and there, maybe even save a
life. So that's why I'm so excited to
be talking about that with you. Yeah. Yep.

(03:36):
I love that, Christoph. And I think one
of my most favorite sayings is, like, every
overnight success story has twenty years of experience
that you never heard about. And I think
that describes you perfectly. I think people are
like that that don't know you are like,
who's Christoph? What does he have to do
with speech pathology? And it's like, no. He's
been around a while, you guys. Like, he
knows this stuff.
Yeah. So
thank you for being here. And, Laura,

(03:58):
tell us what you've been up to because
I know you've had some really exciting career
changes.
Yeah. So I,
yeah, so my bio's, you know, definitely changed
a little bit. So I'm now moving into
more patient safety,
health care innovation. I'm pursuing an executive MBA
now. But I also really love just the

(04:18):
science of
how humans and technology
and especially the development of products can better
serve
not only the patient but also the clinician
providing care.
And as a speech therapist, I'm always things
that gets me excited
are stories like the first therapist that asked

(04:39):
for a pistol grip scope
compared to the overhead scope and how ergonomically
that saves our arms and shoulders.
And I naturally gravitate towards innovators like Christoph.
And so when I was, introduced
to the introducer
product, it just really aligned with my core

(05:01):
values of supporting the clinician patients,
and also that that growing interest of human
factors engineering and human factors health care. How
to do things easier, kinder, and better for
our patients.
I love that. This aligns with
I had some shower thoughts this morning. And
I was like, you know what? I really

(05:21):
love where we are right now
in business and in health care because it's
fun. Like, there's so much cool technology
and AI coming and, you know, people are
intimidated by that, but it's either you've got
either
run away from it or embrace it. Right?
And those are the kind of things that
get me so excited. Like, we're just trying
so many new things in the collective right

(05:42):
now with AI and just really advanced technology,
but there's also we all know that human
element that can never be replaced. So I
just I think it's a really cool time
for innovators and people that are willing to
step outside the box and use these technologies
to our advantage to help patients and to
help SLPs. So,
Christoph, tell us why we're here today and
what we're gonna talk about.

(06:03):
Yes. We're here today to talk about the
Patcom
Introducer,
a product that,
assists the placement
of
catheters
that otherwise would be placed blindly
into the gut system. System. So,
We make use of, the flexible endoscopes
that so many of you already know from

(06:25):
doing fees, for example.
That's the visualization
aspect that we benefit from. And then,
the Introducer is what,
gets placed into the esophagus. And then,
once the endoscope is extracted,
we can place a catheter
through the Introducer,
being guided by that channel,

(06:46):
and really just helps with
the safe and more comfortable placement of
any catheters,
into the esophagus.
Okay. So, Christoph,
everybody's number one question is why are we
as SLPs doing this? Is this within our
scope of practice?
What in the world were you thinking here?
Okay. Yes. Alright. So that,

(07:08):
that's, like, the final very,
very No. We're going we're going right into
it. We're going right into it. Totally. Absolutely.
So let me start by saying this. When
you register a medical device with the food
and drug Administration,
it is a long process. It's a very

(07:29):
difficult process. You have to prove a lot
of things before you're allowed to market
your product to, you know, the health care
world and to patients, etcetera. There's a lot
of bench testing. It's about material compatibility
that you have to show. You know, this
does not cause harm to
the human body.

(07:50):
You
have to do a lot of things.
Of course, the, you know, the manufacturer that
that's making this has to be certified.
So, like, a long, long journey to get
something,
FDA approved. Now as part of that,
what you do is you tell your intended
use.

(08:10):
OK. So what is this device for? And
that is actually a fairly brief typically paragraph
where you just say, okay. What what does
this device do?
And
that is part of your submission to FDA,
and that is part of what they look
at, and they will accept what you say
or they will not accept what you say.
So for example, if your medical device,

(08:32):
you know, is,
a surgical device where you,
cut the body open,
it probably has to be a surgeon, a
physician, a trained surgeon who is allowed to
do this. Right? Can't be an allied
health professional probably cutting the the body open,
as an extreme example.
Now,

(08:53):
from the industry perspective, if you
try to market your product, of course, you
want this to be,
you know, sort of as broad as
possible because you don't want to limit,
your product,
unnecessarily
to only a very specific
group of people. Now talking about the Introducer,

(09:14):
our initially,
suggested intended use
did get accepted. Actually, we never had to
change it. And it simply says that,
the Introducer is to be used
by trained
health care professionals.
So that is a very important,
you know, regulatory,

(09:34):
even legal, if you wanna call it that,
aspect of it. Because if this said
has to be used by a gastroenterologist,
then that's it. Scope of practice
answered. It's a GI. If it's, you
know,
some other device and a specific,
type of, doctor, then it would be that.

(09:55):
But it says trained health care professional. So
when you say, like, is scope of practice
for SLP? Because my first question would be,
is
an SLP a health care professional,
and can they be trained
in using this device?
And I would assume that, you know,
the two of you and many others
would say yes to both of these questions.

(10:17):
Right? So from that perspective,
SLPs are already within, for us, our scope
of people that we can work with for
this device.
Right? Now,
why do we, work with SLPs also? Of
course, the history of the company, right, is
that we are very, very focused on working
with speech language pathologists.

(10:38):
And, we know about SLPs
that there
a lot of them are very, very good
with flexible endoscopes because you're already doing FEEs.
So you already have
experience
using the instrument that is also quite crucial
for using the Introducer. You know, another group
would be an ENT physician. They're naturally using
the same type of endoscope,

(11:01):
as well. So the benefit of working with
speech pathologists,
part of it is that, you know, you
are already trained in using the endoscope. So
just makes sense to also work with
the Introducer.
And then of course, you know, if you
work with dysphagia and you're working with swallowing,
then it comes to be,

(11:22):
you know, you're dealing with,
recommending,
you know, source of nutrition for patients. So
now the question is because we now
know that, you know, nasogastric
tubes and g tubes are in a really
way we probably benefit the most from the
Introducer.
So the recommendation whether or not one of
those tubes is actually necessary also,

(11:44):
you know, is something that SLPs, of course,
are involved with.
And those are the reason from my
perspective, and maybe,
you know, Laura can add to it why
it does absolutely make sense to have SLPs
look at this.
Yep. Awesome.
I have so many more questions, but I
want to bring Laura in on this for
for a minute. Laura, tell the people

(12:07):
why you're here and why you've become so
passionate about this. And actually when
I heard you were involved in this, it
made perfect sense with, as you said, your
core values of, you know, patient safety, quality,
all of those things. So,
let's hear your praises on this.
Yeah. Yeah. So,
I first learned about this while I was

(12:27):
actually at a course learning about manometry
myself,
pharyngeal manometry, pharyngeal and esophageal manometry.
And I,
also came to that course with
a bit of a novice interest
and trying to figure out why my acute
care team at the time was really having
a hard time getting involved early in critical

(12:51):
care ICU cases.
Patients were being told they were telling us
they were too sick for us to start
working with them, to scope them. They were
too metabolically deranged. They were trying to get
access. So I sort of had these
two looming things in my brain, wanting to
learn about pharyngeal manometry,
wanting to solve this problem of early intervention,

(13:14):
early access, and working in unison with our
critical care team.
So
my experience
actually,
was
was more,
pronounced because I experienced a blind pass at
this pharyngeal manometry course.
And,
the student who was placing the catheter

(13:37):
to get into my esophagus actually entered my
airway before they got into my esophagus.
And that was
that was, I think, life changing for me,
because I started to ask the question, can
we do this better? Is there a tool
out there? Do we already have
anybody
in health care who has the skills

(13:58):
to,
to
to scope somebody
and to have eyes on where we are
going and what is this practice,
and why does it feel so archaic and
intrusive?
So at that point, I said, I commit
to never,
experiencing a blind past myself and also trying

(14:19):
to figure out a solution
to support,
more humane,
catheter feeding tube,
guidance
for patients in my care.
And then I met the Patcom team, and
I met Shelby,
And I wanna bounce back to the first

(14:39):
question, which was
the scope of practice and the responsibility
for the therapist to be involved in the
esophagus because I get asked this question all
the time.
So a little bit about me, I started
as a head and neck clinician
changing
tracheoesophageal,
voice prosthesis,
working with advanced surgeons,

(14:59):
and also doing very initial for pharyngeal manometry
about ten years ago.
So in my perspective and in my raising,
I've been in the esophagus
since the beginning of my career.
I'm actually in the esophagus
when my surgeons call me into the OR
and say, we're doing a secondary placement on
a laryngectomy. Where is the best place to

(15:21):
place this? And I am guiding
the surgeon's placement of that voice prosthesis.
When I'm in my outpatient clinic and I'm
changing the voice prosthesis, we're working together to
to size to make sure that the patient
is, sized appropriately and they're getting good voicing.
I think, also,
you know, we have to care about the

(15:41):
esophagus as it relates to dysphagia for all
the good reasons. Your recent focus on the
rest protocol,
we
we truly have separated the parts of the
body from a,
insurance billing reimbursement
perspective, but we really are in total
connected, and we need to remember that in
our care.

(16:03):
So in my perspective,
I have been in the esophagus
since the start of my career,
and it actually was
pretty shocking when people would ask, let's say,
from
modified barium swallows, why are we why are
we messing with the esophagus?
We clearly know we should be getting visualization
of the esophagus to inform dysphagia diagnostic. So

(16:25):
those questions and that response goes hand hand
in hand with our general responsibility of care.
So I did my due diligence. And
as I was bringing this on to my
team and learning more about this, I started
to look at ASHA's code of ethics and
picking it apart as how do they define
our scope of practice, how do they define
competency,

(16:46):
how do they define our different skills and
everything. And they were wonderful.
Every question that I asked, you know, the
person who was receiving them knew, okay. This
is Laura now. She's she's gonna just keep
hitting me with all these questions.
And I did it intentionally because I led
a team of eighteen, nineteen clinicians where they

(17:07):
were relying on me to get
a good understanding,
a good patient safety,
perspective
on bringing this into our practice.
And I had a lot of responsibility on
my shoulders to really make sure we were
we were aligned and good to go and
feeling confident.
And ASHA's code of ethics, they cited back

(17:29):
to me, competence in training.
As as long as you are
defining that and well within the parameters of
how you define competence, have you defined training
on your team to implement this skill,
it is very similar to what we
encourage with
tracheoesophageal
voice prosthesis training. Have you been to a

(17:49):
course? Have you had patient passes? Do you
have guided,
mentorship?
And do you have a long term quality,
quality observation
process?
Now they can't help you set that up,
but those are the things that they encourage,
and that is what ASHA does encourage the
clinician clinician leaders to implement as they're bringing

(18:09):
anything new, not just the introducer.
And then I guess
the more feedback that they gave me, the
more I realized, wow.
A lot of the processes and the quality
improvement work that I had been focusing on
with my own team set the stage for
for this to really fit nicely into expanding
our clinical services

(18:30):
and just simply adding this into our care.
Because the reality is, and I think you
can speak to this, you know, there are
endoscopy programs without competencies and without real training.
So when you look at ASHA code of
ethics,
you have to validate you have those that
minimum skill, minimum competence, and,
we really need to be taking a hard
look at even just the basics of our

(18:51):
field
to then get to the point of being
able to,
bring this type of care
to your to your health care settings. So
I hope that answered a few questions about
scope.
Very, very much so.
Let's let's dive into sort of the other
elephant in the room with this topic.
And,

(19:11):
Christoph, why would we do this if we
can't bill for it? I need to make
money if I'm gonna do this this procedure.
Right.
Absolutely. That's,
that's true, and that makes sense. Now, you
know, when sometimes when people see the Introducer
and then actually say, like, you know, can
we do this? They might actually not talk
necessarily about the Introducer itself, but they might

(19:33):
talk about the ng tube placement,
which, again, is the one just because
how of how many
times it's placed each year, and there really
is, like, 12,000,000,
a year worldwide. So the the number is
very large, so it makes sense. But so
when they say, like, can we do this?
They actually might refer to, can we place
an NG tube? Is that within the scope

(19:54):
of our practice? And, you know, I'll I'll
just mention it, but then, I think Laura
can probably expand on that, better because,
honestly, we actually really learned from Laura and
her team in that regard how,
you know, it's like, the SLP using the
Introducer and the nurse
still placing the NG tube
where then the,

(20:15):
you know, the the actual placement of the
NG tube
remains with nursing rather than SLPs taking that
over. Now
as far as,
you know, making the introducer,
placement in itself something that's billable and it's,
you know, sort of like a service that
SLPs can do,
that is something that hopefully at some point

(20:37):
in the future will be possible. And that's
something that, you know, of course, PatCom would
absolutely advocate for,
but we can't do it alone, right? We
need to do that together with,
healthcare professionals. And then of course, one of
the questions is, okay,
how needed is this? How many
people out there, you know, want to do

(20:57):
that are already doing it? So it's a
little bit the chicken in the egg question
where it's like, okay, can you first,
go somewhere and receive an actual amount of
money for placing an Introducer,
and then you start,
you know, everyone starts using it? That's not
really how it works in reality. Right? You
need to actually
have that,

(21:19):
group that's spearheading things and that is using
it
for the number one reason, which is, patient
benefit. And then, you know, from there,
in collaboration,
absolutely also look at, okay, how can this
be built for? I do wanna say when
I asked Christoph that, I was being very
facetious when I was at I need to
bill for that. I need to get

(21:39):
paid bills. I was being facetious in saying
that. So thank you for sharing that, Christoph.
Go ahead, Laura. So with the billing,
I actually that's a good I get asked
that question. And I think the perception of
anything new is much more work or more
work, and I want to invite everybody to
kind of pause on that thought. I think
we're all burned by the productivity discussion. But

(22:01):
when you add the Introducer to your general
skill set
on the team that I was with in
my current team, you know, we consider this,
like, the fourth step of our endoscopy. It's
in our policy and procedure. It is the
fourth step. You know, you have your anatomy,
your swallowing, your content story strategies,
introduce replacement if indicated. Right? It is just
simple.
And

(22:21):
what you are offering to that patient and
actually to the hospital is very similar and
not just hospital to the clinic, to the
subacute
facility is,
efficiency and care around nutritional stability to participate
in their medical care.
So you are helping with throughput.
It's very similar to what happens with the
magic of a trach team. Once we start

(22:43):
talking about trachs, we start talking about decannulation,
patients start getting trachs out of their neck,
and they start getting out the door. Right?
So when we talk about
temporary,
NG
by way of dysphagia diagnostics,
you have early access
to therapeutic assessment,
earlier access to medical stability by way of

(23:04):
nutrition and medical,
intake
for,
medicines that have to be taken orally.
And you then have early partnership with your
critical care providers or your other providers
to help facilitate
rehab sooner, earlier, faster.
One of the biggest interest that I have

(23:25):
is the geriatric trauma population
who
falls,
gets a UTI,
and suddenly they can't swallow.
Right? So that hip that hip bone is
connected to the swallow bone. Well, what is
that?
that's not small. That's medical instability and medical
derangement, and some of that is induced by

(23:45):
coming to the hospital.
So what an Introducer can offer with a
Dysphagia diagnostic or partnered with it and your
care team is actually more efficient delivery of
care and medical stability
to prevent
medical derangement or metabolic derangement.
So
it's cost benefit and cost positive

(24:07):
because you're actually getting
at some of the,
health care quality improvement,
the health care acquired injuries such as pressure
injuries,
a
nutritional instability,
dehydration,
pressure wounds
by offering this.
My argument my question, Laura, is

(24:29):
wouldn't a nurse be able to just do
this quick fast
anyways?
Mhmm. Great question. And that was part of
my learning curve. So when I started
to when I did my due diligence before
I
reached out further with the Patcom team for
competencies, I started to ask nurses
similar to asking the question, how do you

(24:51):
do oral care?
How do you pass an NG tube? Who
is good at it? Tell me how you
do it. Show me how you do it.
And what I noticed is there was such
variance across the bedside. There was,
kind of a degrading training since COVID.
And I found one nurse who's an amazing

(25:12):
nurse who was the NG tube passer, and
she described
this
very common way of coaching a patient through
getting the tube placed, but it hinged on
the patient being able to cough and swallow
and voice.
What do we know about our patients? What
do we know about our acutely ill patients
who've had a stroke and might not be

(25:33):
able to do those things? What do we
know from doctor Humbert who says, you don't
know if they're swallowing unless you're seeing it.
Right?
So
to me, that was a pathway into
politely disrupt
a very,
common nurse practice to say, I support you.
You have confidence.
But could there be another way to make

(25:53):
this safer,
more accurate,
and also couple with a diagnostic that's already
needed?
And in that population, say,
neuro neurotrauma,
you're likely gonna be doing a FEES as
one of the first dysphagia diagnostics in acute
care anyway.
So
in sense, some of those nurse leaders

(26:15):
who
have had that confidence and somewhat overconfidence
and didn't know that there was could be
a different way
are some of the biggest champions for using
the Introducers on their units because they know
the benefits of coupling it with the Dysphagia
diagnostic
and
not having to do things like sedate patients

(26:35):
to pass the tube and also the risks
that they have learned
with patients who they think are swallowing, but
they're not.
Talk to me about logistics, Laura. So
is this something that okay. So so say
we have a patient come into the ER.
They need a FEES
relatively quickly.
When you're doing the FEES, do you automatically

(26:57):
have an NG ready to go
during that and do it right then, or
do you do a FEES,
take the scope out, regroup later, and do
another fees with the Introducer? I'm just
Mhmm. Verify the logistics for me. Yeah. So
that was that was a learning curve, I
think, and it's all facility dependent. So if
you have
an access team, a vascular access team who

(27:19):
is your tube team or just a tube
team,
finding their leader, partnering with them, they often
sit under the critical care nursing leadership.
And
what we did at first
is we would let them know the room
we were going to to see if they
had orders for a tube. Because if we
had a patient who had had
a stroke or was admitted for,

(27:43):
a myasthenic
crisis,
that's likely a patient that's going to
trigger an auto,
tube placement.
And they would
match their workflow
with when we were doing our endoscopy.
We would pull the,
our scope out, leave the introducer in, and

(28:03):
they would align
their next steps with placing the NG, whether
it would be in the stomach or post
pryolark position
with immediately after
we were done.
Now, you know, I think we worked
very closely
with the that team, the tube team,
but
nurses, critical care ICU nurses, saw

(28:26):
that these patients were more comfortable, better supported,
and there was good understanding of where the
tube needed to go. So if the tube
only needed to go to the stomach,
ICU nurses were jumping in ready to place
the tube after we had the Introducer in
place. So it just became more efficient.
And
some of the logistics,
so in my observation of the logistics around

(28:49):
tubes, I started to follow patients that also
went to fluoroscopy
to have tubes placed.
And if you're thinking about the Introducer, you're
thinking about your endoscopy program,
You really need to figure out what's going
on when a patient goes to fluoro to
get a tube placed. Because I think a
lot of speech therapists think,
oh, they couldn't pass it at bedside.

(29:09):
So they're gonna go to radiology, and they're
gonna look they're gonna turn their head, and
they're gonna get it in the place that
they need to go. Not the case. Fluoro
is here down, and they're very rarely
turning the patient to get a better look
at how to pass the nasopharynx.
So they're likely getting two double blinded passes
and
a really challenging health care experience when it

(29:31):
comes to transnasal endoscopy.
One thing I'd love to add to
this,
you know, because other groups and people have,
of course, talked about, placement of NG tube.
So ASPEN, the American
Society of Parenteral and Enteral Nutrition,
years ago already,
came out with a statement and

(29:53):
saying that
the goal should be,
zero preventable death from misplaced
feeding tubes.
And their recommendation is
use
a technology.
There should not be
any blind placement whatsoever, and there's several technologies
out there. Right? Of course, we are talking

(30:13):
about the introducer, but there is a,
there is a feeding tube that has a
camera actually integrated.
And then there's also another technology that has
a transmitter receiving
kind of technology,
for
visualization
during placement, not with video, but with a
with a sensor,

(30:34):
as well. And then, you know, our technology,
and that is their
recommendation.
You know, with the Introducer, it was the
goal to really make this very cost effective,
which, you know, with a
relatively,
low price for the Introducer, I think we
achieved.
And you do see that,

(30:54):
so they're saying it, but also,
you know, the top tier
hospitals in the United States,
they've adopted this already. They have zero
blind placement. It's just not tolerated,
in a lot of places already.
And I do think that over time, that
is something where more and more hospitals
will implement that.

(31:16):
And why speech therapists need to be empowered
by this. Because if they've adopted these policies
to reduce
patient
harm
and risk aversion
and
we are having visualized passes,
if these are already in patients who need
a dysphagia diagnostic,
the clinician, the health care professional with the
most technical skill to traverse the nose and

(31:39):
behaviorally work with that patient through that assessment
is a speech pathologist if it aligns with
the functional assessment of swallowing.
And getting over that hump that we should
be part of that and do have skills
to use that, that's our superpower.
We have that training.
And
I continue to be amazed at some of

(31:59):
the training of the nonspeech pathology professionals who
do scope and how little they get for
working with a patient who has dementia
or is confused
to get where they need to go.
That's where we shine, and that's where we
can continue to partner with our critical care
teams to
make it less traumatic for our patients.

(32:21):
Christoph, let me ask you,
where did this idea come from? It did
what was were you did you just keep
hearing about all of these concerns
or yeah.
Yeah. Yeah. Very good, very good question. And,
typically I don't go as far best back
as I will now,
because,
you know, I just celebrated my

(32:42):
my mom's seventieth birthday, and one of
the anecdotes that she's telling from, you know,
when I was,
young following her in the garden, she was
cutting herbs and whatnot. I told her, I
wanna be an inventor. I wanna invent something.
Like, tell me what I can invent.
She didn't tell me about the introducer.
She wanted a,
like a lighter that can

(33:02):
light 10 candles on a birthday cake all
at once. That's what she told me.
Later, I found out that already existed, so
I couldn't invent that anymore. But I, you
know, always really wanted to invent something.
Now
when you look at, you know, where should
I start to invent something? But like a
good idea that many people will say, and

(33:23):
I agree with that is, you know,
in your daily life, if you come across
something that is really
seems to be a problem and you feel
like there
there should be a better way, that's a
good starting point. Right? Now jumping,
many years,
forward,
it was around 2012,

(33:44):
2013
I was a sales rep for,
a company, MEI Scientific here in Canada, who's
now actually our,
manufacturing
partner.
And
I was selling high resolution manometry
equipment.
And so if you're, you know, a proud

(34:04):
sales rep, you volunteer,
for the products that you sell.
If you they're not too invasive anyways,
to be tested on you. So I was
up in Northern British Columbia.
We had sold that equipment. A nurse,
we called them the motility nurses in GI,
was trained on using high rise manometry. So

(34:25):
we know it's a very long,
rather large diameter catheter that is typically placed
blindly.
And I volunteered for that, and
that changed my life, similar to Laura's story.
Right? That it really did because
to this day,
you know, and I've been by now scoped

(34:45):
probably
2,000 times.
I will volunteer with my left nostril all
day long, but I'll never let anyone go
through my right nostril. And that is because
that traumatic experience
there was through my, right nostril.
It was absolutely not the nurse's fault. She
had never done this. Right? If you
never done this and you now have

(35:07):
to blindly play something,
into a human, that's quite difficult. And
even if you think about the steps, right,
the first thing is
go straight in until you feel resistance.
Well, feeling resistance
already means you're hitting something. So that can't
be comfortable.
Right? So then comes the chin tuck and
then you're dangling there in the back of

(35:27):
the throat, and now you instruct the patient,
okay, swallow. And not just swallow, but swallow,
swallow, swallow, swallow. So, you know, do 10
little consecutive swallows with a cup
of water.
Even just like that is hard enough. And
then as you swallow, you know, the
tube is pushed forward.
But even that, you know, that's really something
that you have to learn and

(35:49):
and learn the feeling of what is
the right timing, how fast is the swallow,
how fast should I move this tube forward.
And if someone is new, and that was
my experience,
it's not that easy. Right? I swallowed
and she moved too slowly. Next time, you
know, she too fast. And then hit all
the structured gagging,
lot of discomfort.

(36:09):
We got it done eventually, so all good.
And,
you know, they got through the learning curve,
eventually.
But that was when initially I thought, man,
there needs to be a better way than
this. Because if I
am barely tolerating this,
like, what are you gonna do with patients
that are already not feeling good? Right? They're
there for something. They're not feeling good or

(36:30):
something. So now you get a test like
that.
And, you know, through my time of selling
this equipment,
I've seen
many,
adult patients
trying to get it in, didn't work, and
they said, no thank you. They were there
for GERD. You know, you know what? I
got GERD, but I'll take my PPI,
you know, for

(36:51):
fifty more years before I have ever
the procedure like that again. And that is,
yeah, where initially it was like, okay, needs
to be a better way.
Then I was lucky enough with that same
company I was working for to take on
an endoscopy
product,
to be sold in Canada, as well.
And, you know, you all know obviously flexible

(37:13):
endoscope has a camera at the end, you
see where you're going. And then
I,
stayed after work and just wrapped the
thing and said, okay, let's see what happens
and started scoping myself for the first time.
And
I think you've both
been through that. That's weird in
the beginning, right? And I, you know, and
even not as a healthcare professional,

(37:34):
like a grandma, I'm gonna end up in
the brain or what. But, anyways, got through
that eventually and then
once that's done, you're like, oh my god.
That is amazing. That experience
in contrast to that blind placement
is day and night. I always say, you
know, would you rather go through a tunnel
blindfolded

(37:55):
or, you know, with your eyes wide open
and a flashlight in hand? That's, like, how
different the two experiences are.
And,
you know, there then was like, oh, thinking
back to years
before, it's like,
that might be a solution. Like, you just
need to see where you're going and then
that's fine. So then it's like okay, high
res manometry probe, let's just put a camera

(38:17):
inside, can't be that hard.
It's doable,
but
those probes are already, you know, $20,000.
If you now add a camera into that,
so now you're like maybe at
$25,000.
So who's truly gonna gonna buy that just
for that?
That's probably pretty tricky.
Right? And,

(38:38):
and then it was,
you know, months and months of thinking about
that.
One good friend of mine, that I grew
up with who is, an orthopedic surgeon now,
I, you know, I used to bounce ideas
back and forth with him a little bit.
And then eventually,
I realized it doesn't have to all happen
in one step.

(38:58):
Right? And the idea of, okay, let me
place
a tunnel first,
and then we can put our catheters through.
That came to mind. And, you know, that
in itself, like, placing something
and then through there or over that you
place something else, that's not new. That's not

(39:18):
the invention because especially in the,
in the vascular field, it's being done all
the time. Right? So you place a guidewire,
and over the guidewire goes something or even
an introducer.
However, what was very new,
is to have that done
in the esophagus
swallowing airway in that field to
play something like that. And,

(39:42):
and, yeah, that's where,
the idea originated from. And then it was
still several years
before,
you know, figuring out a product that could
actually do this. So the introducer,
you
know, it's made of,
a plastic material.

(40:02):
It's in,
like, in intruded,
sort of like, fold as a plastic.
And,
you know, I had to learn about, things
how do plastic behave? There's something called durometer.
It's how plastic bends and how far does
it bend, when does it break. So still,
like, many, many iterations,

(40:23):
to go through to find a product
that will, you know, work
comfortable enough for the patient,
not break, still allows you to slide tubes
through and all of that. And,
you know, eventually, yeah, we got it and
and then, of course,
had the final product
to the FDA, Health Canada. It's approved in
Europe as well,

(40:44):
and getting got the patent on
the way. And, you know, that's something where
where people said, this is never gonna be
patented
because, you know, it's a tube.
It's like I call it the fancy straw
sometimes, a tube with a funnel at the
end. How you know, that's not new.
But thankfully,
you know, we were able to prove that,

(41:04):
indeed, it is new,
specifically for that field of,
that we're in and where we're placing it.
And, yeah. So I'm very happy and
proud that we have a a US patent
Canadian,
and couple others that that I would have
to look up by now. But,
yeah, that's the story behind it and
where it come from. I love that,

(41:24):
Christoph. I love hearing about this nerdy
inventor side of you. So thank you for
sharing that. But, you know, one thing I
I do wanna commend you on, and I
think everybody in this field needs to give
him the respect that is due for going
through the things that you go through to
bring things to market. I don't think people
realize how awful and grueling going through an
FDA process
process

(41:44):
or other things like that. It's just the
most tedious
work that feels like it's never, ever, ever
going to end. So,
thank you for doing that for our field
because I think it's not appreciated
as much as it should be. So thank
you.
Alright. Anything else we wanna cover? I think
you guys answered all of my questions I

(42:06):
had.
I'd like to talk about a couple cases
Yeah. Yeah. Just,
briefly that really opened my eyes as we
were we were working into this and,
pulling it into our endoscopy,
program.
So
I think the the the case that I
talk about the most often when I discuss

(42:26):
the utility of an introducer in your endoscopy
program is actually the placement that didn't happen.
So to your question of do you have
the introducer on with most scopes, so that
goes back to really good conversations with your
doctors, your critical care doctors,
letting them know if this is a very
sick patient that may or may not need

(42:48):
a tube or likely needs a tube and
you're going to be placing it at the
end of your assessment, having that good conversation
before. So everybody's aware. All bases are covered.
You're still working under the doctor's order.
You know, you're saying protocol for this. But,
you know, I had one
of our first patients that
I partnered with our tube team to

(43:10):
work together and really observe each other's workflow.
They had an order for a patient who
had a prior stroke, admitted with a UTI
confusion.
And when she was admitted,
she was really contracted, and I'm doing
this motion of, like, head head retroflexed.
And that wasn't her normal state, but
that was her acute state. And I walked
into this room, and I looked at this

(43:31):
person.
And I said to the clinician I was
working with, because we were partnering, it was
new,
that, you know, I'm I am not confident
we're going to see a swallow in this
person right now. But we also had a
the tube team behind us who
please understand,
they often tube teams follow orders. They have

(43:53):
to
do first and second attempts at trying to
do things before they can move on and
do a different type of access method. So
be kind to your partners. They have very
different guidance, very different workflows.
And
I
scoped this individual as a lady,
and I saw very quickly I couldn't get

(44:13):
good visualization of the airway.
She was not able to volitionally
trigger a swallow.
We could not facilitate
much with oral stimulation.
At that point, we did not advance the
introducer because I we couldn't trigger swallow. Right?
Like, that key point, that key goal
of speech pathology endoscopy.

(44:34):
And even with that information,
our tube team had to go behind us
and try.
And
they did their normal series of trying to
get them to swallow
to swallow water. As I'm I'm saying, they
they're not able to. They are not able
to do that. This needs to stop.
And,
they advanced

(44:54):
blindly
where they thought was the esophagus, but I
knew they couldn't they could not
the aim was not where they thought it
was because of the anatomical physician. Right?
And that patient actually ended up decompensating and
going to the ICU.
So,
we met that individual days later,

(45:15):
and we had a more relaxed posture.
They survived, and we were able to get
a better visualization,
trigger a swallow,
get a dysphagia diagnostic,
and get the introducer in
place for better access
of a temporary NG.
And she survived, discharged,
recovered through her dehydration and UTI.

(45:39):
However, that was very eye opening to me
because there's just a better way. And since
then, we've had more partner conversations
with our tube team. If we're
not able to get access with eyes and
see with eyes of where to go, that
should be an automatic rollout for a blind
pass at bedside.
So quality improvement.

(46:00):
And
I think one of the questions that I
get, and I know, Christoph, you've probably
gotten this too. You know, what about the
unexpected
anatomical differences of the cervical esophagus?
Right? The Zanker's that's there that you don't
know.
The CP bar,
you know, Barrett's, which is more distal, but
still, what are you doing?

(46:22):
And,
when I was reviewing this with our quality
improvement
partners, patient safety professionals,
what we realized is actually
the medical assessment from the speech pathologist
in partnership with the tube team from a
GI perspective
is actually a stronger
assessment

(46:42):
than when we are doing this in isolation.
So the tube team has to look at
is are there any GI indications? Are there
any issues that I should not place this?
And they're doing their same assessment. So we
actually strengthened
our patient safety by partnering together.
And I have actually run into his anchors
with eyes.

(47:02):
And in contrast
to what has happened before,
because some people have probably seen
a patient who had a blind pass and
then a perforated esophagus
from his anchors.
When I hit resistance in his Zankers diverticulum,
I could see it,
and I stopped. And then I retracted,

(47:22):
and that patient got a different approach to
a tube placement.
And that is the difference between being able
to see in the tunnel
and not
and
likely prevented an adverse event
because there was no awareness of that anatomical
abnormality until that moment.
So
I definitely have a few other, like, patient

(47:43):
case examples, but, you know, I think we
all experience
the silly things that are put in place
in health care to keep us safe, but
actually get it get in our way.
Like, tubes that can't be placed, temporary tubes,
and acute trauma because of facial fractures.
But, like, what if it's, like, orbital, like,
up in your eyebrow?

(48:05):
You know?
Why is why are you know, that's good.
Tube team's not able to place a tube
blindly with anybody who has facial fractures. But
if I'm a speech therapist
that's coming in to scope them and have
confidence that those
eyebrow fractures
or upper orbital fractures
are not a contraindication

(48:26):
to my endoscopy,
Can I facilitate
enteral access sooner, faster, quicker for this acutely
ill patient? We need to be thinking,
how can we make our skills
less like,
what did one of the doctors
say to me? Less like a box cutter
and more like a Swiss army knife. Right?
That is what endoscopy is. We are doing

(48:48):
aerodigestive
diagnostics. We are facilitating early access to enteral
nutrition and medication
and medical stability. We're getting in the room
early, faster, quicker.
So
think about that, that it expands our
tools
to be more useful
if we are showing up

(49:09):
demonstrating competence
and,
partnering with our medical professionals.
Thank you for letting me share those
cases.
Okay. Amazing. And I just quickly wanna mention
to close that circle about contraindication,
which is also something that when you go
through an FDA submission, you have to talk
about. You have to actually say what are
the contraindications

(49:30):
and there are not many but like the
the big and important one and that's exactly
what Laura described
essentially says,
if you can't advance,
don't advance.
Right? That's that's what it comes down to
when he said, okay. Well, what if I,
you know, can't go forward? Yeah. Then you
don't go forward. Right? And and,

(49:50):
that is a great example that illustrates that,
and shows, I think, the, you know,
risk reward ratio that, that using the technology
really
really brings with it. And that patient still
got a dysphagia diagnostic.
Right?
So,
you know, we still saw we still were
able to help them with dysphagia and

(50:11):
also provide a valuable information for what else
is going on with them and causing them
to be acutely ill.
So
And then maybe one last thing if we
we do have the time because I know
that question, I mean, comes to us
all the time and I'll mention my
part, but it's also a great question for
Laura is, you know, now,
there will be many, many listeners to that.

(50:32):
And if someone says, hey. This sounds
amazing, but
where do I start? Like, what's my first
and second and third step? I don't I
don't know what to do.
And Laura can speak, very well too.
They're like within a hospital. Where do we
do you start? Where do you go to?
Who do you talk to?
The part that we do, support is training.
Right? So there is a,

(50:53):
like an ASHA,
approved course, introduce a course
that we host,
several times a year. We do offer them
on-site at facilities,
and all these courses in small groups
because, you know, people need to volunteer to,
to have this placed. And so so it
makes sense in smaller groups. And, you know,
as far as we're concerned, that is absolutely

(51:15):
a good starting point talking to us, to
get trained. But then,
Laura, how is it, you know, someone says
that and was like, what what do what
do I do within my hospital? Like, who
do I talk to? What are my first
steps?
Yeah. So I think first steps, it's actually
taking a look at your own team. What
are your endoscopy competencies? Because if you don't
have any, you need you need an annual

(51:37):
competency for your team. You need to have
good,
standardized approach, a standard I don't wanna say
protocol or framework for how you are
assessing patients. You have to have good mentorship.
Again, if you can't get a scope in,
the study is moot. You have to have,
champions who are interested in really partnering with

(51:58):
the various doctors and, able to speak to
the skill in what we're providing. So
I think having a good
internal team conversation of what this can do
and what how this can help us is
important.
This goes back to a lot of
a culture of continuous quality improvement. You have
to have your your team on the same
page
that this is good and right in part

(52:19):
of,
the quality care that we are providing. So
a good
level setting,
foundational discussion about endoscopy is needed.
Also reaching out
to your tube team if you have one.
If you don't have one, your nurse leaders,
your ICU leaders,
talking with them about current practice, but also

(52:40):
approaching it from a place of no shame.
Right?
A lot of people don't know you could
even have eyes. I mean, think about all
the people we meet who see a scope
for the first
time, who are have been in health care
for a long time. Oh, you can see?
You can do that? You're gonna have that
experience. So just be kind and be ready
to,
understand

(53:00):
their workflow up to this point and how
you can partner and expand
with your knowledge, expertise, and the goals you're
trying to accomplish with your patients.
And, also,
partnering
with,
Patcom
and with just with the Patcom team to
support the competencies
and the training
and,

(53:21):
the supply chain aspect of getting the product
in your hospital well vetted because that takes
some time.
Again, speaking to that FDA approval and, Teresa,
what you said earlier, that's huge to just
make innovative products possible in our health care
system.
That takes interested clinicians
committing to asking good questions about providing good

(53:44):
care. So
I like to think about this as a,
you know, a a a cycle.
You know, Theresa gets the education out.
People like Christoph and Patcom are thinking about
how we can do this better. How can
we make this,
easier for the patient, patient comfortable, and the
therapist who are willing to ask,

(54:05):
could we do this differently where I show
up every day for our patients? So really
supporting that good conversation.
And I I think partnering with your quality
team,
making sure that there isn't anything else that
you need to cover from a consent perspective.
Again, a lot of the feedback from

(54:25):
very seasoned quality improvement professionals is this is
this is kinda
low budget, not not that risky. We've got
a lot of precedent for this and a
lot of other specialties,
and this just makes good sense.
We just need to see that your policy
has been updated and your training is validated.
So I hope that helps the answer, and
I'm obviously

(54:46):
able to speak more to that. And then
Christoph mentioned the course that it covers that,
in their course as well.
Yeah. Christoph,
thank you for that, Laura. Super, super valuable.
And to talk about your circle as well,
we also need people like you who break
down these
big bad administrators

(55:06):
that set all these rules that we think
we can never break, and you teach us
how to play nicely with them and things
that we can bring back to them. So
thank you for thank you for bridging that
gap as well.
Christoph, let me ask you. I I know
Laura's spoken from the lens of acute care
today.
I've also heard from other SLP clinicians that
there may be a use for this in

(55:28):
other settings as well.
Can you speak to that or if if
you've heard of other SLPs using them in
settings outside of hospitals?
Yeah, absolutely.
You know,
generally of course, when whenever there's a blind
placement,
of a tube,
this is where
the Introducer might be an alternative.
So, you know, one of these

(55:50):
these ideas I I would love to see,
happening in the future.
And, you know, goes back to to also
where you come from, mobile fees,
providers. Right? So I
imagine a world where,
if in a nursing homes,
or or a LTCH or where you might

(56:10):
have a patient with an NG tube and
this patient pulls the tube out,
typically now maybe they would be transferred back
to the hospital or to emergency room to
get it replaced or anything like that. Like,
imagine a world where a a mobile fees
provider
instead can go in and,
you know, assist with the placement

(56:32):
of an NG tube through the Introducer.
In my personal opinion is that would make
a lot of sense and,
would be a great asset to communities where
it's just very difficult, you you know, to
transport the patients to the next hospital,
and all of that. I'll interject here because
I think that that is that's where we
need a clinician

(56:53):
to really disrupt the subacute
industry when it comes to offering this,
especially with endoscopy
and still nursing facilities because you you know
those patients that because they are,
trending downward on that vicious cycle
of nutrition
because they might be managed for a pneumonia

(57:15):
or UTI at their location, and they're losing
valuable time in their rehab plan.
If they go to the hospital, they come
back a shell of themselves, or they come
back just so,
you know, deconditioned.
So this tool, this this can really add
an aspect
to stability of subacute care plans with
interested medical providers.

(57:36):
I think this is a great,
aspect for partnership
with a dietitian because a lot of dietitians
at those locations
are the ones who are actually doing the
core track placements
for temporary tubes.
And it's just, like, ripe for a clinician
to say, can we
quality improve this and show we can keep

(57:57):
our patients
well
through
some instability
of their subacute
journey and prevent an unnecessary
admission
just because of nutritional instability.
I think that'd be a good challenge. My
wheels just started turning, like, ninety seven
minutes. So thank you for that.

(58:18):
Christoph, when are the next upcoming courses? I
know I was supposed to go to the
last two, and my daughter's dance ballet plans
have interjected on both of them. So she
she will have to accompany me to the
next one if if that's okay. Yeah. Yes.
Yes. Absolutely. We should have you. You know,
you call me a little bit
I think I think, but, like, maybe

(58:38):
we can add this to Shonas also to
confirm. But I think,
we have August 3
in New York City. Oh, awesome.
And
and the rest will have to put in
show and content. Sounds good. Didn't mean to
put you on the spot there. I just
got really excited because I was like, I
don't know how to get to this dang
course. I know I've been wanting to get
to the course and yeah. So Right. But,

(59:02):
but as I said also,
if you are at a facility where, you
know,
there are a few people that would benefit
from it and from a training, we absolutely
are very happy to do those those as
on-site trainings,
you know, whenever at a facility.
Awesome. Love that. Awesome. Thank you guys so
much. I can't love this conversation anymore.

(59:23):
I obviously love all things
health care innovation. And then, obviously, Laura, I
just always appreciate your wisdom and guidance of
how to actually put all this
meat and potatoes together. So thank you guys
so so much. And, yes, Christoph will link
all the goods in the show notes for
anybody that wants any extra info. And, yeah,
thank you guys again.

(59:43):
Alright. Thanks so much. Thank thank you both.
It was great talking to you. And that's
a wrap for this episode.
As always, thank you so much for listening.