CN104323921B - Multifunctional nasal feeding tube and nasal feeding system - Google Patents

Abstract

The invention provides a multifunctional nasal feeding tube and a nasal feeding system. The multifunctional nasal feeding tube is characterized in that a tube body of the nasal feeding tube is internally provided with a non-return valve; an airbag is arranged at the outer side of the tube body of the nasal feeding tube; the airbag is connected with a pressurizing airbag through an air guiding tube. The non-return valve can be used for preventing nutrient solution in the nasal feeding tube from reflowing; the airbag at the outer side of the tube body of the nasal feeding tube is inserted in the position of stomachus cardiacus; after the inflation of the pressurizing airbag, the situation that gastric contents at the outer side of the nasal feeding tube are sucked into a lung by mistake due to reflow can be effectively prevented. According to the multifunctional nasal feeding tube and the nasal feeding system, aspiration complications caused by enteral nutrition support therapy through nasal feeding can be prevented specifically; the lung infection, severe pneumonia, even asphyxia caused by aspiration progress are effectively reduced, and the death rate is lowered. The multifunctional nasal feeding tube and the nasal feeding system can be widely suitable for popularization and application of clinical enteral nutrition support therapy. Moreover, the nasal feeding tube is further provided with an injector joint and a drug administration joint, so that the drug administration operation is conveniently performed on a patient who cannot swallow drugs independently. A feeding material supply system is arranged in the nasal feeding system, nutrients can be continuously fed to the patient after the connection with the nasal feeding tube, and the feeding efficiency is improved.

Description

A multifunctional nasal feeding tube and nasal feeding system

technical field

The invention belongs to the field of medical appliances, in particular to a multifunctional nasal feeding tube and a nasal feeding system.

Background technique

Enteral nutrition support refers to a treatment method in which a nasal feeding tube is inserted into the gastrointestinal tract through one side of the nasal cavity, oral cavity, gastrointestinal stoma, etc. for artificial feeding to ensure that the patient can absorb enough nutrients such as protein and calories. Nutrient factors input through the nasogastric tube enter the liver through the portal vein, which can promote the recovery of intestinal function, improve the nutritional status of the body, and effectively shorten the course of treatment for the disease.

Enteral nutrition support via nasogastric tube is convenient and effective, and has been recognized by clinicians all over the world. However, problems such as hyperglycemia and stress ulcers may occur at the same time. One of the most serious complications is aspiration. Aspiration refers to the entry of variable amounts of liquid contents or secretions into the airway below the glottis, leading to acute lung injury or infection, and even suffocation or death of the patient. It often occurs during nasal feeding nutritional support treatment .

With the wide application of enteral nutrition support by nasal feeding tube in clinical treatment, foreign scholars reported that the incidence of aspiration caused by gastric reflux has risen to 30.5%-40.8%. The stomach-lung infection route caused by reflux aspiration has become the main cause of related pneumonia, which often endangers the lives of patients. The main mechanisms are: 1. The refluxed gastric juice can directly corrode the airway, respiratory tract and alveolar epithelial cells to cause chemical inflammation. When the body's immunity is weakened, it is easy to cause infectious airway inflammation and severe pneumonia. 2. Aspiration caused by a relatively large amount of gastric content can pass through the stomach-esophagus-airway-pulmonary route, resulting in blockage of the bronchi with multiple lungs, and causing lung abscess, respiratory failure, and even suffocation.

Therefore, it is of great significance to design a nasal feeding tube with multiple functions, which can reduce the incidence of various complications during use.

Contents of the invention

The purpose of the present invention is to provide a multi-functional nasal feeding tube and nasal feeding system, which is convenient for enteral nutritional support and can reduce the incidence of various complications during use.

In order to achieve the above object, the technical scheme adopted in the present invention is:

A multi-functional nasal feeding tube, comprising a nasal feeding tube body, the tube body of the nasal feeding tube is provided with a scale line, and the tube body of the nasal feeding tube is divided into sequentially connected stomach segment, esophagus segment, throat segment, nasal cavity segment and external body segment according to its insertion position. The esophageal section of the nasogastric tube body is provided with a one-way valve for preventing feed backflow; the bottom of the gastric section of the nasogastric tube body is a blind end, and several side holes are opened on the middle wall of the gastric section;

The stomach section of the tube body of the nasal feeding tube is also provided with an inflatable and deflated air bag for preventing backflow of the feeding material outside the tube. An air guide tube is fixed on the outer surface of the tube body of the nasal feeding tube. The air bag is connected with the end of the air guide tube. The front end of the air guide tube is connected with the pressurized air bag used to inflate and deflate the air bag. Tracheal switch.

It also includes an oxygen tube arranged outside the tube body of the nasal feeding tube. The tail of the oxygen tube is fixed on the nasal cavity section of the tube body of the nasal feeding tube. , the oxygen tube cap is fixed on the oxygen tube through the connector.

The top end of the extracorporeal section of the nasal feeding tube body is provided with a nasal feeding tube joint, and the top end of the nasal feeding tube joint is covered with a dust-proof plug, and the extracorporeal section of the nasal feeding tube body is fixed with a fitting that matches the nasal feeding tube joint. Feeding tube cap, syringe connector and administration connector.

The size of the upper end of the drug delivery connector matches the size of the liquid outlet of the syringe, and the size of the lower end matches the size of the nasal feeding tube connector. The drug delivery connector is provided with a knife net for crushing medicine, and the upper end of the drug delivery connector is plugged There is an extruding plug for extruding medicine to pass through the knife net, and the extruding plug is fixed on the drug delivery joint through a connecting piece, and the lower end of the drug delivery joint is also covered with a dust-proof plug.

The size of the lower end of the syringe connector matches the size of the nasal feeding tube connector, the size of the upper end matches the size of the liquid outlet of the syringe, and the upper end of the syringe connector is plugged with a sealing plug, and the lower end is covered with a dust-proof plug, and the sealing plug passes through The connector is fixed on the syringe connector;

The upper end of the nasal feeding tube cap is closed, and the lower end is covered with a dustproof plug.

The connector of the nasal feeding tube is provided with an external thread, and the cap of the nasal feeding tube, the syringe connector and the drug delivery connector are all provided with an internal thread matching the external thread.

The outer surface of the throat section of the tube body of the nasal feeding tube is provided with an anti-inflammatory drug coating.

A multifunctional nasal feeding system, comprising a nasal feeding tube and a feed supply system connected to the nasal feeding tube, wherein the feed supply system includes a nutrition bag storing feed, the top of the nutrition bag is provided with a hanging ring, and the bottom of the nutrition bag is There is a hose for connecting with the nasal feeding tube, the hose is provided with a flow regulator, the hose is provided with a filter screen, and the end of the hose is provided with a nutrition bag connector, the size of the nutrition bag connector is the same as the size of the nasal feeding tube connector match.

It also includes a heating jacket with an opening at the bottom, the heating jacket is arranged on the outside of the nutrition bag, and the hose protrudes from the opening at the bottom of the heating jacket; the heating jacket is connected with an electric plug and is equipped with a storage battery and a temperature adjustment control button.

The nutrition bag is provided with a feeding port;

The nutrition bag joint is provided with an internal thread matching the external thread of the nasal feeding tube joint, and its bottom end is covered with a dustproof plug.

Compared with the prior art, the beneficial effects of the present invention are:

The multifunctional nasal feeding tube provided by the present invention can effectively prevent gastric content reflux for the aspiration complications caused by enteral nutritional support through the nasal feeding tube, and has double anti-aspiration functions inside and outside the nasal feeding tube. In the present invention, a one-way valve is arranged inside the tube body of the nasal feeding tube, an air bag is arranged outside the tube body of the nasal feeding tube, an air guide tube is connected to the air bag, a pressurized air bag is arranged on the front end of the air guide tube, and a pressure air bag is arranged on the air guide tube. Airway switch. The one-way valve in the nasal feeding tube can prevent the reflux of the nutrient solution in the nasal feeding tube. The air bag outside the nasal feeding tube is inserted into the gastric cardia. After the pressurized air bag is inflated, it can effectively prevent the reflux and aspiration of gastric contents outside the nasal feeding tube to the lungs. In addition, there is a scale mark marking the length on the tube body of the nasal feeding tube, which can facilitate the grasp of the depth of the intubation, and can fully consider the reflux of gastric contents, secretions, blood, etc. Moreover, the bottom of the stomach section of the nasal feeding tube body is a blind end, and several side holes are provided on the middle tube wall of the stomach section, so that the feed can flow out from the side holes to reduce the stimulation to the stomach. The present invention has a thoughtful and simple overall design, is suitable for use in medical institutions at all levels, is convenient and simple to operate when treating patients, and is easy for medical workers to grasp and apply. It is targeted for the complications of aspiration caused by enteral nutrition support through nasal feeding, and has a more comprehensive anti-aspiration effect, effectively reduces the risk of aspiration, and reduces the lung infection, severe pneumonia and even suffocation caused by the progress of aspiration, which can be effective Reduce the mortality rate of patients due to aspiration. It reduces the work difficulty of medical workers and the treatment pain of patients, effectively avoids over-treatment, and reduces the medical expenses and clinical medical costs of patients. It can be widely used in clinical enteral nutrition support therapy, especially for critically ill patients, unconscious patients, hemiplegic patients, elderly patients and critically ill patients.

The nasal feeding system provided by the present invention, in addition to the effect of double anti-aspiration inside and outside the nasal feeding tube and the effect of facilitating drug administration, since it is provided with a feed supply system, it can continuously feed the patient with nutrients after being connected with the nasal feeding tube. The design of the ring is convenient for hanging the nutrition bag, the feeding speed can be adjusted through the flow regulator, and the large particles are filtered out through the filter to avoid clogging the nasal feeding tube. Compared with feeding with a needle tube one time at a time, the operation is greatly simplified and the work of medical staff is reduced. Strength, and can also improve feeding effect.

Further, the multifunctional nasal feeding tube provided by the present invention is also provided with a nasal feeding tube connector, and a nasal feeding tube cap, a syringe connector and a drug delivery connector matched with the nasal feeding tube connector. Or nutrient solution is very convenient and easy to operate; there is also a knife net and a squeeze plug in the drug delivery connector, which is convenient for feeding medicine to the patient, especially large pieces of solid medicine can enter the patient through the nasal feeding tube after being backlogged until the knife net is crushed The stomach, which is convenient for administering drugs to patients who cannot swallow their own medicines. When feeding is not needed, just put the cap of the nasal feeding tube on the connector of the nasal feeding tube, which is safe, hygienic and easy to operate. The outer surface of the throat section of the nasal feeding tube body is provided with an anti-inflammatory drug coating, which can prevent and treat throat inflammation and foreign body sensation in patients caused by long-term insertion of the nasal feeding tube. Moreover, there is also an oxygen tube, which can supply oxygen to the patient while performing nasal feeding, without additional use of oxygen tubes, reducing the number of tubes on the patient and facilitating nursing care. In addition, the arrangement of connecting parts at various places can make each joint not detached from the nasal feeding tube, which is convenient for use; the arrangement of dust-proof plugs at various places can ensure the sanitation of each joint during use.

Furthermore, the multi-functional nasal feeding system provided by the present invention has a heating jacket outside the nutrition bag. The design of the heating jacket can keep the animals in the nutrition bag at an appropriate temperature, avoiding the stimulation of the intestinal tract of the patient caused by temperature discomfort. , and the heating jacket also has a temperature adjustment function, which is convenient to use, and the dual power supply mode of the electric plug and the battery is more flexible and convenient to use. In addition, feeders can be conveniently added through the feeding port, so that the nutrition bag can be used continuously and repeatedly to avoid adding too much medical waste.

Description of drawings

Fig. 1 is the structural representation of multifunctional nasal feeding tube provided by the present invention;

Fig. 2 is the structural representation of multifunctional nasal feeding system provided by the present invention;

Among them: 1. Hanging ring; 2. Nutrition bag; 3. Heating jacket; 4. Electric plug; 5. Nutrition bag connector; 6. Nasogastric tube connector; 7. Squeeze plug; 8. Knife net; ;10, pressurized airbag; 11, airway switch; 12, airway; 13, anti-inflammatory drug coating; 14, airbag; 15, side hole; 16, one-way valve; 17, nasal feeding tube body; 18, scale Line; 19, oxygen tube; 20, oxygen tube cap; 21, syringe connector; 22, sealing plug; 23, dust plug; 24, nasal feeding tube cap; 25, hose; 26, filter screen; 27, flow regulator ; 28, feeding port.

detailed description

The present invention will be described in further detail below in conjunction with the accompanying drawings.

Referring to Fig. 1, the multifunctional nasal feeding tube provided by the present invention includes a nasal feeding tube body 17, which is provided with a scale line 18 for marking the length, and the nasal feeding tube body 17 is divided into sequentially connected tubes according to their insertion positions. Stomach section, esophagus section, throat section, nasal cavity section and extracorporeal section; Wherein the throat section outer surface of nasal feeding tube body 17 is provided with anti-inflammatory drug coating 13; The bottom of the gastric section of nasal feeding tube body 17 is a blind end, And the middle tube wall of the stomach section is provided with several side holes 15; the esophagus section of the nasal feeding tube body 17 is provided with a one-way valve 16 for preventing the backflow of feed; The inflatable and deflated air bag 14 that prevents the backflow of the feeding tube, the air bag 14 is wrapped on the outer surface of the upper end of the gastric section of the nasal feeding tube body 17, and is tightly connected with the nasal feeding tube body 17; the outer surface of the nasal feeding tube body 17 An air guide tube 12 is fixed on the top, and the air bag 14 communicates with the end of the air guide tube 12. The front end of the air guide tube 12 communicates with the pressurized air bag 10 for inflating and deflated air bag 14. Tracheal switch 11.

The outside of the nasal feeding tube body 17 is provided with an oxygen tube 19, the tail of the oxygen tube 19 is fixed on the nasal cavity section of the nasal feeding tube body 17, and the head of the oxygen tube 19 is provided with an interface connected to the oxygen supply device, and the interface is provided Oxygen tube cap 20, the oxygen tube cap 20 is fixed on the oxygen tube 19 through a connector.

The top end of the extracorporeal section of the nasal feeding tube body 17 is provided with a nasal feeding tube connector 6 , and the top end of the nasal feeding tube connector 6 is covered with a dustproof plug 23 . The in vitro section of the nasal feeding tube body 17 is fixed with a nasal feeding tube cap 24, a syringe connector 21 and a drug delivery connector 9 matched with the nasal feeding tube connector 6 through connectors; wherein the nasal feeding tube connector 6 is provided with external threads, and the nasal feeding tube cap 24, the syringe connector 21 and the drug delivery connector 9 are all provided with internal threads that match the external threads. And the upper end of the nasal feeding tube cap 24 is closed, and the lower end is covered with a dustproof plug 23 . The size of the lower end of the syringe connector 21 matches the size of the nasal feeding tube connector 6, the size of the upper end matches the size of the liquid outlet of the syringe, and the upper end of the syringe connector 21 is plugged with a sealing plug 22, and the lower end is covered with a dust plug 23, which is sealed The stopper 22 is fixed on the syringe adapter 21 by a connecting piece. The drug delivery joint 9 is provided with a knife net 8 for pulverizing medicine, and the upper end of the drug delivery joint 9 is plugged with an extrusion plug 7 for extruding medicine to pass through the knife net 8, and the extrusion plug 7 is fixed on the delivery side by a connector. and the size of the upper end of the drug delivery connector 9 matches the size of the liquid outlet of the syringe, the size of the lower end matches the size of the nasal feeding tube connector 6, and the lower end of the drug delivery connector 9 is also covered with a dust plug 23.

Referring to Fig. 2, the multifunctional nasal feeding system provided by the present invention includes the above-mentioned nasal feeding tube, and a feed supply system connected with the nasal feeding tube, wherein the feed supply system includes a nutrition bag 2 which stores feed and a bag with an opening at the bottom. Heating jacket3. The nutrition bag 2 is provided with a feeding port 28 and a pressure regulating device, the top of the nutrition bag 2 is provided with a hanging ring 1, and the bottom of the nutrition bag 2 is provided with a flexible pipe 25 for communicating with a nasal feeding tube. The heating jacket 3 is set on the outside of the nutrition bag 2, and the hose 25 stretches out from the opening at the bottom of the heating jacket 3; the heating jacket 3 is connected with an electric plug 4 and is equipped with a storage battery and a temperature adjustment control button. The hose 25 is provided with a flow regulator 27 , the hose 25 is provided with a filter screen 26 , and the end of the hose 25 is provided with a nutrition bag connector 5 . The size of the nutrition bag connector 5 matches the size of the nasal feeding tube connector 6, and the inner thread of the nutritional bag connector 5 is provided with an internal thread matching the external thread of the nasal feeding tube connector 6, and the bottom end of the nutrition bag connector 5 is covered with a dustproof plug 23 .

When using the nasal feeding tube provided by the present invention to perform enteral nutritional support treatment on patients via nasal feeding, the air in the air bag should be discharged first, and then the nasal feeding tube should be inserted into the gastrointestinal tract through one side of the nasal cavity, oral cavity, gastrointestinal stoma, etc. 45 ~55cm, turn on the airway switch 11, adjust the pressurized air bag 10, so that the air bag 14 is filled in the gastric cardia and close to the wall of the digestive tract, so as to prevent the reflux of gastric contents through the cardia, which can effectively prevent gastric acid, secretions and other gastric contents Aspiration caused by reflux of food through the cardia-esophagus-airway, this is an anti-aspiration design outside the nasogastric feeding tube. It is enough to supply the nutrients needed by the patient through the nasal feeding tube. The one-way valve 16 can effectively prevent the reflux of the gastric contents and the material in the nasal feeding tube when the nutrients are perfused. If there is gastric juice or food reflux, the one-way valve 16 will automatically Closed to avoid aspiration and serious complications caused by aspiration, this is an anti-aspiration design in the nasal feeding tube. The nasal feeding tube and nasal feeding system provided by the present invention are targeted to aspiration complications caused by enteral nutrition support through nasal feeding, and can effectively reduce asphyxia or death rate of patients caused by aspiration.

In addition, the multifunctional nasal feeding tube and nasal feeding system provided by the present invention have the following functions in addition to the double anti-aspiration function when in use: 1. Since the outer surface of the throat section of the nasal feeding tube body is provided with an anti-inflammatory drug coating , can prevent and treat throat inflammation and foreign body sensation in patients caused by long-term insertion of nasal feeding tubes; 2. Since there is an oxygen tube, it can supply oxygen to the patient while performing nasal feeding, without using additional oxygen tubes, reducing the number of tubes on the patient , easy to care; 3. Feeders flow out from the side hole can reduce the stimulation of the stomach; 4. Since there is a nasal feeding tube connector, it is convenient to connect with nutrition bags, syringe connectors, drug delivery connectors, nasal feeding tube caps, etc.; When feeding is required, just put the cap of the nasal feeding tube on the connector of the nasal feeding tube, which is safe, hygienic and easy to operate; 6. The setting of the syringe connector makes it very convenient and easy to operate when directly injecting feed or nutrient solution with a needle tube; The setting of the joint is convenient for feeding medicine to the patient, especially the medicine in large flakes can be squeezed to the knife net for crushing through the extrusion plug, and then the syringe is connected to the medicine knife head to inject water and the medicine powder is washed into the nasal feeding tube, which solves the problem The trouble of feeding medicine to the patient; 7. The setting of the connectors at various places can make each joint not detached from the nasal feeding tube, which is convenient to use; 8. The setting of dust-proof plugs at various places can ensure the sanitation of each joint during use; 9. The design of the nutrition bag can feed the patient continuously, which saves the inconvenience of injecting with a needle again and again; 10. The design of the heating jacket can keep the feed at an appropriate temperature, avoiding the discomfort caused by the temperature discomfort to the patient's intestinal tract The heating jacket also has a temperature adjustment function, which is convenient to use. The dual power supply mode of the electric plug and the battery is more flexible and convenient to use; 11. The flow regulator can regulate the feeding speed of the rearing animals; the filter screen can filter out particles Larger substances can avoid clogging the nasal feeding tube; the feeding port is convenient for adding feed; the hanging ring is convenient for hanging the nutrition bag.

Claims (8)

1. a kind of Multifunctional nasal feeding tube it is characterised in that: include nasal feeding tube body (17), nasal feeding tube body (17) is provided with scale Line (18), nasal feeding tube body (17) is divided into by its on position and is sequentially connected logical stomach section, esophaguses section, throat section, nasal cavity section With external section；Wherein it is provided with the esophaguses section of nasal feeding tube body (17) for preventing from feeding the one-way valve (16) that thing flows backwards；Nose The stomach section bottom of feeding tube body (17) is to offer some side openings (15) on cecum, and the middle part tube wall of stomach section；

Be additionally provided with the stomach section of nasal feeding tube body (17) for prevent feed property management outside flow backwards can inflation/deflation air bag (14), gas Capsule (14) is wrapped on the outer surface of nasal feeding tube body (17) stomach section upper end, and is tightly connected with nasal feeding tube body (17)；Nasal feeding Airway (12) is fixed with the outer surface of pipe body (17), air bag (14) is connected with the end of airway (12), airway (12) front end is connected with for the pressurised airbag (10) to air bag (14) inflation/deflation, and the leading portion of airway (12) is additionally provided with Airway tube switch (11)；

The top of the external section of nasal feeding tube body (17) is provided with nasal feeding pipe joint (6), and the top of nasal feeding pipe joint (6) is stamped dust-proof Plug is fixed with, by connector, the nasal feeding matching with nasal feeding pipe joint (6) on (23), and the external section of nasal feeding tube body (17) Lid cap (24), syringe adapter (21) and administration joint (9)；The upper end size of administration joint (9) and the liquid outlet of syringe Matching size close, the matching size of lower end size and nasal feeding pipe joint (6) closes, and is provided with for pulverizing medicine in administration joint (9) The knife net (8) of thing, the upper end plug of administration joint (9) has the extrusion plug (7) being passed to knife net (8) for extruding medicine, extruding Plug (7) is fixed in administration joint (9) by connector, and dust plug (23) is also stamped in the lower end of administration joint (9).

2. Multifunctional nasal feeding tube according to claim 1 it is characterised in that: also include being arranged on nasal feeding tube body (17) outward The oxygen hose (19) in portion, the afterbody of oxygen hose (19) is fixed in the nasal cavity section of nasal feeding tube body (17), the head of oxygen hose (19) Portion is provided with the interface being connected with apparatus of oxygen supply, and interface is provided with oxygen hose block (20), and connector is passed through in oxygen hose block (20) It is fixed on oxygen hose (19).

3. Multifunctional nasal feeding tube according to claim 1 it is characterised in that: the lower end chi of described syringe adapter (21) The very little matching size with nasal feeding pipe joint (6) closes, and the matching size of the liquid outlet of upper end size and syringe closes, and syringe connects The upper end of head (21) is plugged with sealing-plug (22), and dust plug (23) is stamped in lower end, and sealing-plug (22) is fixed on injection by connector On device joint (21)；

The upper end closed of nasal feeding tube block (24), dust plug (23) is stamped in lower end.

4. Multifunctional nasal feeding tube according to claim 1 it is characterised in that: described nasal feeding pipe joint (6) is provided with outer spiral shell Stricture of vagina, is equipped with, in nasal feeding tube block (24), in syringe adapter (21) and in administration joint (9), the interior spiral shell matching with external screw thread Stricture of vagina.

5. Multifunctional nasal feeding tube according to claim 1 and 2 it is characterised in that: the pharynx of described nasal feeding tube body (17) Larynx section outer surface is provided with antiinflammatory medicine coating (13).

6. a kind of multi-functional nasal feeding system including the Multifunctional nasal feeding tube described in any one in claim 1-5, its feature It is: include nasal feeding tube, and the nursing thing feed system being connected with nasal feeding tube, wherein feed thing feed system and include storing Have the nutrient bag (2) feeding thing, the top of nutrient bag (2) is provided with link (1), the bottom of nutrient bag (2) be provided with for nasal feeding The flexible pipe (25) that pipe is connected, flexible pipe (25) is provided with flow regulator (27), is provided with filter screen (26), flexible pipe in flexible pipe (25) (25) end is provided with nutrient bag joint (5), and the matching size of the size of nutrient bag joint (5) and nasal feeding pipe joint (6) closes.

7. multi-functional nasal feeding system according to claim 6 it is characterised in that: also include the heating mantle that bottom is provided with opening (3), heating mantle (3) is set in the outside of nutrient bag (2), and the opening from heating mantle (3) bottom for the flexible pipe (25) stretches out；Heating mantle (3) it is connected with plug (4) on and accumulator and temperature adjustment control knob are installed.

8. the multi-functional nasal feeding system according to claim 6 or 7 it is characterised in that: described nutrient bag (2) be provided with plus Material mouth (28)；

It is provided with, in nutrient bag joint (5), the female thread mating with the external screw thread of nasal feeding pipe joint (6), and dust plug is stamped in its bottom (23).