CN116271298A

CN116271298A - Atrial septum puncture double-cavity VA-ECMO cannula

Info

Publication number: CN116271298A
Application number: CN202310263745.6A
Authority: CN
Inventors: 刘洋; 翟蒙恩; 段维勋; 刘金成; 杨剑; 薛武超; 罗建超; 朱岩
Original assignee: Air Force Medical University of PLA
Current assignee: Air Force Medical University of PLA
Priority date: 2023-03-18
Filing date: 2023-03-18
Publication date: 2023-06-23

Abstract

The invention relates to a atrial septum puncture double-cavity VA-ECMO cannula which comprises a double-cavity tube and an atrial septum puncture assembly, wherein the atrial septum puncture assembly is used for puncturing an atrial septum, the proximal end of a reflux cavity of the double-cavity tube is communicated with a reflux joint through a reflux tube proximal section, the distal end of the reflux cavity is communicated with one end of a reflux tube distal section, the other end of the reflux tube distal section can enter a left atrium through puncturing, the proximal end of a drainage cavity of the double-cavity tube is communicated with the drainage joint through a drainage tube proximal section, and the distal end of the drainage cavity of the double-cavity tube is positioned in a lower vena cava, an upper vena cava or a right atrium after the cannula is completed. The device has the advantages that only one puncture hole is formed in the body surface, the bleeding infection risk is obviously reduced compared with the conventional body surface in which two puncture holes are formed, and the other puncture hole is formed in the atrial septum during tube placement, and is in the heart, so that the infection risk is lower than the body surface; since the arterial blood outlet of the far section of the return tube is positioned in the left atrium, the perfusion tube belongs to intracardiac direct perfusion, and is obviously superior to the conventional retrograde perfusion through the lower limb artery.

Description

Atrial septum puncture double-cavity VA-ECMO cannula

Technical Field

The invention relates to the field of medical instruments, in particular to a atrial septum puncture double-cavity VA-ECMO cannula.

Background

ECMO, extracorporeal membrane lung oxygenation, is an important technique for the treatment of patients with severe respiratory failure. The technical principle is that human venous blood is led out of the body through an intravascular cannula, and is oxygenated by an artificial oxygenator of ECMO to become arterial blood, and then pumped back to an in-vitro artificial heart-lung auxiliary system in the body of a patient.

The current ECMO technology is mainly divided into VV-ECMO and VA-ECMO, wherein the VV-ECMO is used for introducing venous blood into an oxygenator through veins to remove carbon dioxide, then the venous blood is pumped into another vein, generally the femoral vein is led out, the internal jugular vein is pumped in, and single-tube double-cavity jugular vein catheterization with single puncture hole can also be adopted, the principle is that the venous blood is partially subjected to gas exchange before flowing through the lung, and the deficiency of the lung function is compensated, so that V-V inversion is suitable for cases with impaired pure vein function and no risk of cardiac arrest; the latter is to draw venous blood out through vein and oxygen by oxygenator and pump into artery after removing carbon dioxide, generally select femoral vein to draw out and femoral artery to reflux, and V-A inversion can support heart and lung function at the same time, and is suitable for heart failure, serious failure of lung function and possible cases of heart failure. At present, the VA-ECMO cannula is generally used for puncturing the root parts of the left thigh and the right thigh of a patient, and the VA-ECMO cannula has the following defects: two body surfaces are provided with puncture holes, so that the bleeding infection risk is increased, the operation time is prolonged, and meanwhile, arterial blood has a certain retrograde perfusion problem when pumped into the femoral artery from outside the body, and the heart burden is increased.

Disclosure of Invention

The invention provides a atrial septum puncture double-cavity VA-ECMO cannula, which aims to overcome various defects of high bleeding infection risk, long operation time, certain arterial blood retrograde perfusion problem and the like caused by the need of twice cannula at different positions of the body surface of a patient in the prior art.

The technical scheme for solving the technical problems is as follows: the utility model provides a room separates puncture double-chamber VA-ECMO intubate, its includes two-chamber pipe and room separates puncture subassembly, room separates puncture subassembly and is used for perforating on the room interval, the reflux chamber proximal end of two-chamber pipe passes through the near section of back flow and connects the intercommunication with the backward flow, the distal end of reflux chamber and the far section one end intercommunication of back flow, the other end of back flow far section can be passed through in the perforation gets into left atrium, the drainage chamber proximal end of two-chamber pipe passes through near section of drainage tube and connects the intercommunication with the drainage, the drainage chamber distal end of two-chamber pipe is located inferior vena cava, superior vena cava or right atrium after the intubate is accomplished.

On the basis of the technical scheme, the invention can be improved as follows.

Further, the device also comprises an anti-drop limiting mechanism, wherein the anti-drop limiting mechanism comprises a first balloon arranged on the outer wall of the far section of the return pipe and a medium filling joint arranged on the side wall of the return joint, the medium filling joint is communicated with the first balloon through a medium filling channel, and the first balloon is positioned in the left atrium and is close to the atrial septum after the intubation is completed.

Further, the anti-drop limiting mechanism further comprises a second balloon arranged on the outer wall of the far section of the return pipe, the second balloon is communicated with the medium filling joint through the medium filling channel, and the second balloon is positioned in the right atrium and is close to the atrial septum after the intubation is completed.

Further, the first balloon and the second balloon have the medium filling joint and the medium filling passage, respectively, independent of each other.

Further, room separates puncture subassembly includes expansion pipe, pjncture needle, seal wire and operation handle, the proximal end of expansion pipe with the operation handle is connected, the pjncture needle is located in the expansion pipe and by the needle switch control needle point on the operation handle stretches out or withdraws the expansion pipe, still be equipped with on the operation handle and supply the seal wire to penetrate the seal wire interface of pjncture needle.

Further, a developing thread which is convenient for ultrasonic guided puncture is arranged on the outer wall of the distal end of the expansion tube.

Further, the reflux cavity of the reflux pipe near section, the reflux pipe far section and the double-cavity pipe consists of one reflux catheter, the drainage cavity of the drainage pipe near section and the drainage cavity of the double-cavity pipe consist of another drainage catheter, and the double-cavity pipe is a pipe section formed by mutually attaching, adhering and fixing the reflux catheter and the drainage catheter.

Further, the total length of the reflux catheter is larger than that of the drainage catheter, the distal end of the reflux catheter is positioned in the left atrium after the intubation is completed, and the distal end of the drainage catheter is positioned in the right atrium.

Compared with the prior art, the invention has the beneficial effects that:

the VA-ECMO cannulSup>A provided by the invention is provided with Sup>A double-cavity tube, which is provided with Sup>A drainage cavity and Sup>A reflux cavity, enters Sup>A right atrium through Sup>A lower venSup>A cavSup>A or an upper venSup>A cavSup>A after body surface puncture once, and then punctures an atrial septum in Sup>A heart to enable the reflux cavity of the double-cavity tube to be communicated with Sup>A left atrium, so that typical V-A current transformation is realized, the VA-ECMO cannulSup>A is suitable for cardiopulmonary support, is suitable for cases with heart failure and serious pulmonary failure and has the possibility of cardiac arrest, belongs to Sup>A single-tube double-cavity tube arrangement of V-A current transformation, and can obviously save operation time; the VA-ECMO cannula only forms one puncture hole on the body surface, the bleeding infection risk is obviously reduced compared with the conventional mode that two puncture holes are formed on the body surface, and the other puncture hole of the VA-ECMO cannula is formed on the interatrial septum, and is in the heart, so that the infection risk is lower; meanwhile, as the arterial blood outlet of the far section of the return pipe is positioned in the left atrium, the device belongs to the direct perfusion of the intracardiac arterial blood and is obviously superior to the conventional retrograde perfusion through the lower limb artery.

Drawings

FIG. 1 is a schematic view of an assembled atrial septum puncture double-lumen VA-ECMO cannula according to the present invention;

FIG. 2 is a schematic view of the structure of the dual lumen tube and the connecting members at both ends of the cannula shown in FIG. 1;

FIG. 3 is a schematic view of the septum cap assembly of the cannula of FIG. 1;

fig. 4 is a schematic diagram of the usage state of the atrial septum puncture double-cavity VA-ECMO cannula provided by the invention after the cannula is completed.

In the drawings, the list of components represented by the various numbers is as follows:

1. a dual lumen tube; 2. a return pipe near section; 3. a return joint; 4. a return pipe distal section; 5. a drainage tube proximal section; 6. a drainage joint; 7. a first balloon; 8. medium fills the joint; 9. expanding the tube; 10. a puncture needle; 11. an operation handle; 12. a needle switch; 13. a guidewire interface; 14. and developing the screw thread.

Detailed Description

The principles and features of the present invention are described below with reference to the drawings and specific embodiments, the examples being provided for illustration only and not for the purpose of limiting the invention.

In the description of the present invention, if terms indicating orientations such as "upper", "lower", "left", "right", "top", "bottom", "inner", "outer", etc. are used, the indicated orientations or positional relationships are based on the orientations or positional relationships shown in the drawings, only for convenience in describing the present invention and simplifying the description, and do not indicate or imply that the indicated devices or elements must have a specific orientation, be configured and operated in the specific orientation, and thus are not to be construed as limiting the present invention.

As shown in fig. 1 to 4, the invention provides a atrial septum puncture double-cavity VA-ECMO cannula, which comprises a double-cavity tube 1 and an atrial septum puncture assembly, wherein the atrial septum puncture assembly is used for puncturing an atrial septum, the proximal end of a reflux cavity of the double-cavity tube 1 is communicated with a reflux joint 3 through a reflux pipe proximal section 2, the distal end of the reflux cavity is communicated with one end of a reflux pipe distal section 4, the other end of the reflux pipe distal section 4 can enter a left atrium through the puncturing, the proximal end of a drainage cavity of the double-cavity tube 1 is communicated with a drainage joint 6 through a drainage pipe proximal section 5, and the distal end of the drainage cavity of the double-cavity tube 1 is positioned in a lower vena cava, an upper vena cava or a right atrium after the cannula is completed.

The drainage cavity distal end of the double-cavity tube is positioned in the inferior vena cava, the superior vena cava or the right atrium for sucking venous blood into the drainage cavity of the double-cavity tube and leading the venous blood to the outside of the body, then the venous blood is oxidized by an oxygenator and discharged carbon dioxide to be processed into oxygen-enriched arterial blood, and finally the oxygen-enriched arterial blood is directly infused into the left atrium by a centrifugal pump through a reflux connector, a reflux tube proximal section, a double-cavity tube reflux cavity and a reflux cavity distal section in sequence.

In a preferred embodiment of the present invention, the device further comprises an anti-drop limiting mechanism, as shown in fig. 1, wherein the anti-drop limiting mechanism comprises a first balloon 7 arranged on the outer wall of the distal section 4 of the return pipe and a medium filling joint 8 arranged on the side wall of the return joint 3, the medium filling joint 8 is communicated with the first balloon 7 through a medium filling channel, and the first balloon 7 is positioned in the left atrium and is close to the atrial septum after the intubation is completed.

The anti-drop limiting mechanism has the function of preventing the return pipe distal section inserted into the left atrium from being pulled back, and prevents the distal end of the return pipe distal section from being pulled out of the left atrium. After the medium filling joint is connected with the injector or the pump, the injector or the pump injects the medium such as air or water into the first saccule, the first saccule expands after being injected with the medium, and the diameter of the first saccule is larger than that of the puncture hole on the interatrial septum, so that the far section of the reflux pipe inserted into the left atrium is guaranteed to be retracted to the right atrium through the puncture hole.

On the basis of the embodiment, the anti-drop limiting mechanism further comprises a second balloon arranged on the outer wall of the far section 4 of the return pipe, the second balloon is communicated with the medium filling joint 8 through a medium filling channel, and the second balloon is positioned in the right atrium and is close to the atrial septum after the intubation is completed.

In other words, the first balloon and the second balloon can be arranged on the far section of the return pipe at the same time, the two balloons are respectively positioned on two sides of the atrial septum, when the two balloons are inflated by filling medium, the far section of the return pipe can be guaranteed to be retracted to the right atrium, the far section of the return pipe can be guaranteed to be inserted into the left atrium after being placed in place in subsequent use, and the problem that the far end of the return pipe scratches the wall of the left atrium to cause damage when the insertion is excessive can be avoided.

On the basis of the above embodiment, the first balloon 7 and the second balloon have the medium charging joint 8 and the medium charging passage, respectively, which are independent of each other.

It should be noted that, when the first balloon and the second balloon have independent medium filling connectors and medium filling channels, respectively, the medium filling and discharging of the two balloons do not affect each other. Therefore, after the second balloon enters the right atrium, media can be filled first, then, atrial septum puncture is carried out, and the left atrium is fed into the far section of the return pipe, and due to the blocking effect of the expanded second balloon, the excessive length of the left atrium when the left atrium is fed into the far section of the return pipe can be avoided. The medium filling channel can be a channel embedded in the wall of the reflux cavity of the reflux pipe far section, the near section and the double-cavity pipe, or can be an independent pipeline positioned in the reflux cavity of the reflux pipe far section, the near section and the double-cavity pipe.

In the above embodiments, as shown in fig. 3, the septum primum puncture assembly includes a dilating tube 9, a puncture needle 10, a guide wire and an operating handle 11, the proximal end of the dilating tube 9 is connected with the operating handle 11, the puncture needle 10 is located in the dilating tube 9, the needle tip is controlled to extend or retract into the dilating tube 9 by a needle running switch 12 on the operating handle 11, and a guide wire interface 13 for penetrating the guide wire into the puncture needle 10 is further provided on the operating handle 11.

It should be noted that the atrial septum puncture assembly is a relatively mature assembly, and its more detailed structure and specific puncture operation are well known to those skilled in the art, and will not be described herein. Of course, the implementation of the atrial septum puncture in the invention is not limited to the atrial septum puncture assembly with the structure, and is not limited to ultrasonic image guidance during puncture guidance, but also can realize the positioning of the atrial septum puncture position in a mode of matching the X-ray guidance with the head electrode arranged at the distal end of the expansion tube.

In one embodiment of the invention, the distal outer wall of the dilation tube 9 is provided with visualization threads 14 to facilitate ultrasound guided penetration.

The developed thread can be clearly observed under the ultrasonic image, so that puncture can be guided to be accurately performed.

In one embodiment of the present invention, the reflux cavity of the reflux pipe near section 2, the reflux pipe far section 4 and the double-cavity pipe 1 is composed of one reflux catheter, the drainage cavity of the drainage pipe near section 5 and the double-cavity pipe 1 is composed of another drainage catheter, and the double-cavity pipe 1 is a pipe section where the reflux catheter and the drainage catheter are mutually attached and adhered.

It should be noted that the dual-lumen tube with the above structure has the advantages of convenient processing and low cost.

In one embodiment of the invention, the total length of the return catheter is greater than the total length of the drainage catheter, the distal end of the return catheter being located in the left atrium and the distal end of the drainage catheter being located in the right atrium after catheterization is completed.

It is understood that draining venous blood in the right atrium is more efficient and effective than draining venous blood in the superior or inferior vena cava.

The basic principle of the invention is briefly described as follows:

the working principle is as follows: the septum puncture assembly is provided with a guide wire connector, and the needle travel switch can control the needle point of the puncture needle to retract or extend out of the distal end of the expansion tube; the device is guided by the guide wire to enter the inferior vena cava from the femoral vein puncture port (or can be placed by the superior vena cava through the jugular vein), so as to reach the right atrium, the atrial septum puncture assembly is adjusted to the target position under the guidance of ultrasound, and the needle point is released by the needle travel switch so as to puncture the atrial septum. After puncture is successful, the distal section of the return pipe enters the left atrium through the puncture, physiological saline is injected into the first saccule after the first saccule enters the left atrium, and the outer diameter of the saccule after inflation is larger than the diameter of the puncture hole, so that the return pipe is effectively prevented from being separated; withdrawing the puncture needle assembly. After the intubation, as shown in fig. 4, the distal end (drainage port) of the drainage cavity of the dual-cavity tube is positioned in the right atrium, and the distal end (return port) of the distal section of the return tube is positioned in the left atrium. The drainage connector and the reflux connector are respectively connected with the ECMO. Venous blood is introduced from the drainage port, is drained into the ECMO through the drainage cavity, is oxidized by the oxygenator, eliminates carbon dioxide, and enters the right atrium through the backflow port through the backflow connector and the backflow cavity.

The design of the atrial septum puncture double-cavity VA-ECMO provided by the invention realizes a single access way and simultaneously realizes two auxiliary treatment functions of ECMO drainage and backflow, and solves the problems of complex operation, large damage, high risk of bleeding infection and the like caused by the fact that two puncture openings are required to be opened on the body surface of the conventional ECMO. By adopting the ultrasonic guide room septum puncture double-cavity VA-ECMO provided by the invention, only one venous vascular access is needed, no additional room septum puncture needle is needed, puncture is completed by adopting the puncture needle assembly, and the double functions of ECMO drainage and backflow are realized by one cannula. The operation is simplified, the wound is reduced, the time of the catheterization operation is shortened, and complications such as bleeding infection and the like are reduced.

The foregoing description of the preferred embodiments of the invention is not intended to limit the invention to the precise form disclosed, and any such modifications, equivalents, and alternatives falling within the spirit and scope of the invention are intended to be included within the scope of the invention.

Claims

1. The utility model provides a room separates puncture double-chamber VA-ECMO intubate, its characterized in that, including two chambeies pipe (1) and room separates puncture subassembly, room separates puncture subassembly and is used for perforating on the room interval, the reflux chamber proximal end of two chambeies pipe (1) is through near section (2) of back flow and reflux joint (3) intercommunication, the distal end and the reflux distal end of reflux chamber (4) one end intercommunication, the other end of reflux pipe distal end (4) can be passed through in perforating gets into the left atrium, the drainage chamber proximal end of two chambeies pipe (1) is through near section (5) of drainage tube and drainage joint (6) intercommunication, the drainage chamber distal end of two chambeies pipe (1) is located inferior vena cava, superior vena cava or right atrium after the intubate is accomplished.

2. The atrial septum puncture double-cavity VA-ECMO cannula according to claim 1, further comprising an anti-drop limiting mechanism, wherein the anti-drop limiting mechanism comprises a first balloon (7) arranged on the outer wall of the distal section (4) of the return tube and a medium filling joint (8) arranged on the side wall of the return joint (3), the medium filling joint (8) is communicated with the first balloon (7) through a medium filling channel, and the first balloon (7) is positioned in the left atrium and is close to the atrial septum after the cannula is completed.

3. The atrial septal puncture double-lumen VA-ECMO cannula of claim 2 wherein the anti-release limiting mechanism further comprises a second balloon disposed on the outer wall of the distal section (4) of the return tube, the second balloon being in communication with the media-filled connector (8) via a media-filled passageway, the second balloon being positioned within the right atrium and proximate the atrial septum after the cannula is completed.

4. A atrial septal puncture double lumen VA-ECMO cannula according to claim 3, characterized in that the first balloon (7) and the second balloon have the medium filling connector (8) and the medium filling channel (the second balloon may have an independent filling connector, the second balloon is filled first after entering the right atrium, avoiding excessive puncture) independently of each other.

5. The atrial septal puncture double-cavity VA-ECMO cannula according to claim 1, characterized in that the atrial septal puncture assembly comprises a dilating tube (9), a puncture needle (10), a guide wire and an operating handle (11), wherein the proximal end of the dilating tube (9) is connected with the operating handle (11), the puncture needle (10) is positioned in the dilating tube (9) and is controlled by a needle-running switch (12) on the operating handle (11) to extend or retract the needle tip into the dilating tube (9), and a guide wire interface (13) for a guide wire to penetrate into the puncture needle (10) is further arranged on the operating handle (11).

6. The atrial septal puncture double lumen VA-ECMO cannula of claim 5 wherein the distal outer wall of the dilation tube (9) is provided with visualization threads (14) for facilitating ultrasound guided puncture.

7. The atrial septum puncture double-cavity VA-ECMO cannula according to any one of the claims 1 to 6, wherein the return lumen of the return tube proximal section (2), the return tube distal section (4) and the double-cavity tube (1) is composed of one return catheter, the drainage lumen of the drainage tube proximal section (5) and the double-cavity tube (1) is composed of another drainage catheter, and the double-cavity tube (1) is a tube section where the return catheter and the drainage catheter are mutually adhered and fixed.

8. The atrial septal puncture double lumen VA-ECMO cannula of claim 7 wherein the total length of the return catheter is greater than the total length of the drainage catheter, the distal end of the return catheter being positioned in the left atrium and the distal end of the drainage catheter being positioned in the right atrium after the cannula is completed.