CN113559392B

CN113559392B - Central venous catheterization puncture auxiliary system for peripheral venipuncture

Info

Publication number: CN113559392B
Application number: CN202110846220.6A
Authority: CN
Inventors: 田海英; 郑磊
Original assignee: First Affiliated Hospital of Army Medical University
Current assignee: First Affiliated Hospital of Army Medical University
Priority date: 2021-07-26
Filing date: 2021-07-26
Publication date: 2023-08-08
Anticipated expiration: 2041-07-26
Also published as: CN113559392A

Abstract

The invention relates to the field of central venous catheterization puncture, and discloses a central venous catheterization puncture auxiliary system through peripheral venous puncture, which comprises a puncture unit and a detection unit, wherein the puncture unit comprises a hose, a guide wire for guiding and positioning the hose and a puncture needle for placing the hose, the end part of the guide wire is connected with a placement part, and a cavity for accommodating radionuclide is arranged in the placement part; the detection unit comprises a movable supporting mechanism and a detection mechanism arranged on the movable supporting mechanism. The radionuclide can release gamma rays, the gamma rays can be detected by the handheld gamma ray detector, the accurate position of the PICC guide wire tip in the body can be tracked in real time, the situation that the PICC guide wire tip is mistakenly inserted into the jugular vein is avoided, and the catheter is ensured to enter the equal-depth vein of the superior vena cava. By arranging the detection unit to be movable, the movement of the detection unit can be facilitated, the bedside detection can be realized, a special detection chamber is not required to be arranged, patients are not required to be transferred, and the bedside detection device has popularization and application values.

Description

Central venous catheterization puncture auxiliary system for peripheral venipuncture

Technical Field

The invention relates to the field of central venous catheterization puncture, in particular to a central venous catheterization puncture auxiliary system through peripheral venous puncture.

Background

PICC is a central venous catheterization by peripheral venipuncture, and is a treatment method by which a catheter is used for puncturing from veins of peripheral arms, and the catheter directly reaches great veins (superior vena cava or subclavian veins) close to the heart. Currently, many patients clinically, such as tumor chemotherapy patients, need to be treated with PICC. The PICC can avoid direct contact of the chemotherapeutic medicine and arm veins, and the blood flow speed of the great veins is high, so that the chemotherapeutic medicine can be quickly flushed, and the irritation of the medicine to blood vessels is prevented.

During PICC, it is currently determined whether a puncture-implanted catheter enters the central vein (superior vena cava) by means of bedside ultrasound or electrocardiogram. However, the above-described determination method requires a high level of operator, and makes determination difficult. And under the guidance of the method, it is found that partial catheterization can be mistakenly performed into the jugular vein, so that PICC fails, or the front end of the catheterization is difficult to reach the optimal position. The gold standard for judging whether PICC is successful is chest X-ray at present, but the method is difficult to develop beside a bed, and the catheter position cannot be judged in real time in the PICC implementation process. If the PICC fails, the PICC puncture can only be performed again, which increases the pain and cost of the patient and also increases the clinical workload.

Disclosure of Invention

The invention aims to provide a central venous catheterization puncture auxiliary system for peripheral venous puncture so as to realize real-time positioning of a catheter position in the PICC puncture process and avoid puncture failure.

In order to achieve the above purpose, the invention adopts the following technical scheme: the central venous catheterization puncture auxiliary system comprises a puncture unit and a detection unit, wherein the puncture unit comprises a hose, a guide wire for guiding and positioning the hose and a puncture needle for placing the hose, the end part of the guide wire is connected with a placement part, and a cavity for accommodating radioactive nuclides is arranged in the placement part; the detection unit comprises a movable supporting mechanism and a detection mechanism arranged on the movable supporting mechanism.

The principle and the advantages of the scheme are as follows: during practical application, in the PICC puncture process, the end part of the guide wire is connected with the placement part, and the radionuclide (clinically commonly used technetium liquid, the use amount is 1-2 ul) is arranged in the cavity of the placement part, so that the position of the tip of the guide wire can release gamma rays, and the gamma rays can be detected by detection equipment such as a handheld gamma ray detector. The PICC catheter puncture position can be detected in real time, the situation that the catheter enters the jugular vein by mistake is avoided, and the catheter enters the equal-depth vein of the superior vena cava is ensured. The detection unit is used for detecting the position of the radionuclide in real time, and can conveniently move by arranging the detection unit to be movable, so that bedside detection is realized, a special detection chamber is not required to be arranged, a patient is not required to be transferred, and popularization and application values are very high.

Preferably, as an improvement, the movable supporting mechanism comprises a cart body and wheels arranged at the bottom of the cart body, and the detecting mechanism is one or the combination of two of a handheld detector and a gamma camera.

In this technical scheme, the shallow body plays the effect of whole support, and detection mechanism can be handheld detector (handheld gamma ray detector) exclusive use, also can use handheld detector and gamma camera combination, at the operation in-process, fuses seal wire front end position and human imaging photo together in real-time, and practicality and accuracy are all stronger.

Preferably, as an improvement, the movable supporting mechanism is rotationally connected with a fixing mechanism, and the fixing mechanism comprises an arm fixing assembly and an ultrasonic probe fixing assembly, and the ultrasonic probe fixing assembly can slide along the arm fixing assembly.

In the technical scheme, the arm fixing component in the fixing mechanism is used for fixing the arm of the patient, so that the arm of the patient can maintain the optimal puncture position; the ultrasonic probe fixing component is used for supporting and fixing an ultrasonic probe, and can avoid the problem that the puncture is affected due to instability of holding one hand of an operator when the PICC is used for conducting ultrasonic guided puncture in the earlier stage. In addition, by arranging the ultrasonic probe fixing assembly in a form capable of sliding along the arm fixing assembly, the ultrasonic probe fixing piece can be moved to find the optimal puncture site when the ultrasonic probe is guided to puncture in the early stage.

Preferably, as an improvement, the arm fixing assembly comprises an arm fixing frame rotationally connected to the side part of the cart body, an arc-shaped accommodating groove is formed in the arm fixing frame, and slide ways for sliding the ultrasonic probe fixing assembly are formed in two sides of the accommodating groove.

In the technical scheme, the arm fixing frame and the accommodating groove are used for supporting and fixing the arm to be punctured of a patient, the slide way is used for standardizing the sliding path (sliding along the length direction of the arm to be punctured of the patient) of the ultrasonic probe fixing assembly, and the structural design is reasonable. In addition, through setting up the arm mount to rotate to connect the lateral part at the shallow body, when using, rotate the arm mount to the state (horizontal) of perpendicular to shallow body, after the use, reverse rotation with the arm mount for the arm mount hangs the lateral part at the shallow body, avoids taking too much space, is convenient for induction and places.

Preferably, as an improvement, the ultrasonic probe fixing assembly comprises a probe bracket and an elastic support; the probe support is connected in the slideway in a sliding way, the bottom of the probe support is provided with an upward concave arc groove, both sides of the probe support are provided with supporting grooves for accommodating elastic supporting pieces, and one opposite sides of the two supporting grooves are provided with operation holes for the ultrasonic probe to pass through.

In this technical scheme, the probe support plays the effect of whole support ultrasonic probe, and in the probe support was inserted to the ultrasonic probe during the use, through set up the circular arc groove in the bottom of probe support, made circular arc groove and holding tank cooperation hold patient's arm, can not oppress patient's arm at the in-process that the probe support removed along the slide. When the ultrasonic probe is used for guiding puncture, the ultrasonic probe is inserted between two supporting grooves of the probe support, at the moment, the elastic supporting piece plays a supporting role, then the ultrasonic probe is pressed down, so that the ultrasonic probe overcomes the supporting force of the elastic supporting piece and moves down along the operation hole, the bottom of the ultrasonic probe is contacted with the arm of a patient, and in the state, the probe support is pushed to slide along the slideway to find the optimal puncture site. After the ultrasonic probe searches the optimal puncture site, the early-stage puncture can be completed under the guidance of the ultrasonic probe, the operation is very convenient, and in the process, medical staff only need to push the probe support to move, so that the problem of instability in single-hand holding of the medical staff is avoided.

Preferably, as a modification, the placement portion is detachably connected to the guide wire.

In this technical scheme, through setting up into the mode of dismantling the connection between portion of placing and the seal wire, before using, can be with holding the portion of placing that holds the radionuclide and be connected to the tip of seal wire temporarily, need not have the radionuclide all the time to make the front end of seal wire, when operating skilled medical personnel put the PICC and managing, can not use portion of placing and radionuclide completely, improved the flexibility of using.

Preferably, as an improvement, the detachable connection mode is threaded connection, the end part of the guide wire is provided with a connector, the connector is provided with internal threads, the end part of the placement part is provided with a connection protrusion, and the connection protrusion is provided with external threads which can be matched with the internal threads.

In this technical scheme, through the detachable connection mode selection between placing portion and the seal wire for threaded connection, its simple structure, technical maturity, the operation degree of difficulty is low.

Preferably, as an improvement, an injection hole is arranged in the middle of the connecting protrusion, and the injection hole is communicated with the cavity.

In the technical scheme, the injection hole is formed in the middle of the connecting protrusion, so that the radioactive nuclide can be temporarily injected into the cavity when the radioactive nuclide is needed to be used; after the injection is finished, the placing part is connected to the end part of the guide wire, so that the sealing of the injection hole can be realized at the same time, the leakage of the radionuclide is avoided, and the use safety of the device is improved.

Preferably, as an improvement, one end of the guide wire far away from the placement part is provided with a handle, a carding part is detachably connected to the handle, and the carding part is sleeved outside the guide wire.

In the technical scheme, the handle at the end part of the guide wire can be conveniently held by medical staff, so that the guide operation is convenient. The carding part on the handle is used for carding and straightening the guide wire, so that the subsequent penetration is facilitated.

Preferably, as an improvement, the carding part is a carding sleeve, and the carding sleeve is detachably connected with the handle.

According to the technical scheme, the carding sleeve and the handle are detachably connected, and when the guide wire is carded and straightened, the carding sleeve is detached from the handle, so that the carding sleeve moves along the axial direction of the guide wire, and the full length straightening of the guide wire is realized; after carding, the carding sleeve is connected to the handle, so that subsequent penetration is avoided.

Drawings

Fig. 1 is a front view showing a state where a hose is engaged with a puncture needle in accordance with the first embodiment of the present invention.

Fig. 2 is a front view showing a state where a hose is engaged with a guide wire in accordance with the first embodiment of the present invention.

Fig. 3 is an enlarged view at A1 in fig. 2.

Fig. 4 is a front view showing a state in which the fixing mechanism is accommodated in the recess in the detecting unit according to the first embodiment of the present invention.

Fig. 5 is a front view showing a state in which the fixing mechanism in the detecting unit is screwed out of the groove in the first embodiment of the present invention.

Fig. 6 is a side view of the securing mechanism.

Fig. 7 is an enlarged view at A1 in fig. 6.

Fig. 8 is a front view showing a state where a hose is engaged with a guide wire in the second embodiment of the present invention.

Fig. 9 is an enlarged view at A2 in fig. 8.

Fig. 10 is a front view showing a state where a hose is engaged with a guide wire in the third embodiment of the present invention.

Fig. 11 is an enlarged view at A3 in fig. 10.

Detailed Description

The following is a further detailed description of the embodiments:

reference numerals in the drawings of the specification include: hose 1, wire 2, pjncture needle 3, placement unit 4, radionuclide 5, handle 6, connector 7, connection boss 8, external screw thread 9, carding sleeve 10, shallow body 11, wheel 12, handle 13, cabinet 14, drawer 15, hand-held gamma ray detector 16, gamma camera 17, recess 18, arm mount 19, fixture block 20, holding tank 21, slide 22, ultrasonic probe 23, probe support 24, support spring 25, support tank 26.

Example 1

This embodiment is basically as shown in fig. 1-7: the central venous catheterization puncture auxiliary system comprises a puncture unit and a detection unit.

Referring to fig. 1-3, the puncture unit includes a hose 1, a guide wire 2 for guiding and positioning the hose 1, and a puncture needle 3 for placing the hose 1, and in this embodiment, the connection modes and use principles of the hose 1, the guide wire 2, and the puncture needle 3 are all in the prior art, which is not described herein. In this embodiment, the end structure of the guide wire 2 is mainly optimized, and as shown in fig. 2 and 3, a transparent placement portion 4 is bonded to the end of the guide wire 2, and the placement portion 4 is smoothly disposed at an end far from the guide wire 2. The holding portion 4 is provided with a cavity in which the radionuclide 5 is contained, and the radionuclide 5 in this embodiment is technetium liquid, and the amount of the radionuclide 5 used is 2ul.

As shown in fig. 4 to 7, the detection unit includes a movable support mechanism and a detection mechanism provided on the movable support mechanism. The movable supporting mechanism comprises a trolley body 11 and four wheels 12, wherein the four wheels 12 are universal wheels, the four wheels 12 are fixed at the bottom of the trolley body 11 through bolts, and a handle 13 is welded at the upper part of the trolley body 11. The cart body 11 is provided with a cabinet 14 and a drawer 15, which can be used for storing spare parts, PICC puncture products and the like. The detection mechanism includes a hand-held gamma ray detector 16 and a gamma camera 17, the hand-held gamma ray detector 16 and the gamma camera 17 are both disposed on the cart body 11, and the structure and the usage of the hand-held gamma ray detector 16 and the gamma camera 17 in this embodiment are all in the prior art.

The side of the trolley body 11 is provided with a recess 18, the top of the recess 18 being substantially level with the bed/test bed height. A fixing mechanism is rotationally connected to the groove 18, and the fixing mechanism comprises an arm fixing component and an ultrasonic probe fixing component, and the ultrasonic probe fixing component can slide along the arm fixing component.

The arm fixing component is used for fixing and limiting the arm of the patient so as to enable the patient to keep the optimal puncture body position. Referring to fig. 5 and 6, the arm fixing assembly includes an arm fixing frame 19 rotatably coupled to the recess 18, and a block 20 for defining the arm fixing frame 19 in the recess 18 is rotatably coupled to a side portion of the cart body 11. The arm fixing frame 19 is long, and the arm fixing frame 19 is provided with an arc-shaped containing groove 21 along the length direction of the arm fixing frame 19, when the arm fixing frame 19 is contained in the groove 18, the containing groove 21 is located at the inner side of the arm fixing frame 19. Both sides of the receiving groove 21 are provided with slide ways 22 for sliding the ultrasonic probe fixing assembly.

Referring to fig. 6 and 7, the ultrasonic probe fixing assembly includes a probe holder 24 and an elastic support member, which in this embodiment is a support spring 25. The probe support 24 has a rectangular frame structure, and two ends of the bottom of the probe support 24 are integrally formed with sliding blocks (not shown) that can slide along the slide ways 22. The bottom of the probe holder 24 (the end in contact with the arm holder 19) is provided with an upwardly concave circular arc groove (not shown) which, in use, cooperates with the receiving groove 21 to receive the arm of the patient. Both side portions of the probe holder 24 are provided with support grooves 26 for accommodating the support springs 25, the support springs 25 are vertically accommodated in the support grooves 26, and support pieces (not shown) are adhered to the top ends of the support springs 25. The opposite sides of the two supporting grooves 26 are respectively provided with a vertical operation hole for the ultrasonic probe 23 to move and pass through.

The specific implementation process is as follows: the cart body 11 is pushed to the patient's side of the bed before the PICC puncturing procedure. Before the ultrasonic probe 23 at the front end guides the puncture, the clamping block 20 is rotated, so that the clamping block 20 does not abut against the arm fixing frame 19 any more, and then the arm fixing frame 19 is rotated relative to the groove 18, so that the arm fixing frame 19 is transversely placed on a sickbed (as shown in fig. 5), and at this time, the accommodating groove 21 is arranged upwards. The patient places the arm with puncture in the accommodation groove 21, then the slider at the bottom end of the probe support 24 is slidably mounted in the slide 22, and the ultrasonic probe 23 is inserted between the two support grooves 26 of the probe support 24, and the support springs 25 play a supporting role. The ultrasonic probe 23 is then pressed down so that the ultrasonic probe 23 overcomes the supporting force of the supporting spring 25 and moves down the operation hole, bringing the bottom of the ultrasonic probe 23 into contact with the arm of the patient. In this state, the ultrasonic probe 23 is pushed so that the probe holder 24 slides along the slideway 22, and at this time, the detection end of the ultrasonic probe 23 slides along the arm of the patient to find the optimum puncture site. When the ultrasonic probe 23 searches for the optimal puncture site, the early puncture can be completed under the guidance of the ultrasonic probe 23.

When the guide wire 2 is used for guiding and positioning the hose 1, the end part of the guide wire 2 is connected with the placement part 4, and the radionuclide 5 is arranged in the cavity of the placement part 4, gamma rays can be released from the tip position of the guide wire 2, and the gamma rays can be detected by the handheld gamma ray detector 16. The accurate position of the tip of the PICC guide wire 2 in the body can be tracked through the handheld gamma ray detector 16, the PICC guide tube position can be detected in real time by the patient, the jugular vein can be prevented from being mistakenly entered, and the guide tube can be ensured to enter the equal-depth vein of the superior vena cava.

When detecting guide wire 2 real-time penetrating site, can be handheld gamma ray detector 16 exclusive use, also can use handheld gamma ray detector 16 and gamma camera 17 combination, in the operation in-process, real-time fuses guide wire 2 front end position and human imaging photo together, and practicality and accuracy are all stronger, can realize bed side detection moreover, need not remove the patient, are particularly suitable for popularization and application.

Example two

As shown in fig. 8 and 9, the present embodiment is different from the first embodiment in that: in this embodiment, the connection mode between the placement portion 4 and the guide wire 2 is a threaded connection, specifically: the end part of the guide wire 2 is integrally formed with a connector 7, a connecting groove is formed in the connector 7, and an inner thread is formed in the inner wall of the connecting groove; the tip integrated into one piece of placing portion 4 is connected with connecting protrusion 8, is provided with on the connecting protrusion 8 can with internal thread complex external screw thread 9, and the middle part of connecting protrusion 8 is provided with the filling hole, filling hole and cavity intercommunication.

In specific use, the radionuclide 5 may be temporarily injected into the cavity prior to PICC penetration; after the injection is completed, the placement part 4 is screwed to the connection head 7 of the guide wire 2 by the connection protrusion 8 at the tip end thereof. In this way, the placing part 4 is connected to the end part of the guide wire 2, so that the sealing of the injection hole can be realized at the same time, the leakage of the radionuclide 5 is avoided, and the use safety of the device is improved. In addition, when the medical staff skilled in operation carries out PICC and puts the pipe, need not to use the portion of placing 4 and radionuclide 5 completely, just need not connect the portion of placing 4, has improved the flexibility of using.

Example III

As shown in fig. 10 and 11, the present embodiment is different from the first embodiment in that: in this embodiment, a handle 6 is attached to the end of the guidewire 2 remote from the placement portion 4. The handle 6 is connected with a carding sleeve 10 in a threaded manner, and the carding sleeve 10 is sleeved outside the guide wire 2.

When the guide wire carding machine is particularly used, the carding part on the handle 6 is used for carding and straightening the guide wire 2, so that the guide wire carding machine is convenient for subsequent penetration. When the guide wire 2 is carded and straightened, the carding sleeve 10 is unscrewed from the handle 6, and the carding sleeve 10 moves along the axial direction of the guide wire 2, so that the full length straightening of the guide wire 2 is realized; when combing is finished, the combing sleeve 10 is connected to the handle 6 again, so that subsequent penetration is prevented from being influenced.

The foregoing is merely exemplary of the present invention, and specific technical solutions and/or features that are well known in the art have not been described in detail herein. It should be noted that, for those skilled in the art, several variations and modifications can be made without departing from the technical solution of the present invention, and these should also be regarded as the protection scope of the present invention, which does not affect the effect of the implementation of the present invention and the practical applicability of the patent. The protection scope of the present application shall be subject to the content of the claims, and the description of the specific embodiments and the like in the specification can be used for explaining the content of the claims.

Claims

1. The central venous catheterization puncture auxiliary system is characterized in that: the device comprises a puncture unit and a detection unit, wherein the puncture unit comprises a hose, a guide wire for guiding and positioning the hose and a puncture needle for placing the hose, the end part of the guide wire is connected with a placement part, and a cavity for accommodating radioactive nuclides is arranged in the placement part; the detection unit comprises a movable supporting mechanism and a detection mechanism arranged on the movable supporting mechanism; the movable supporting mechanism comprises a cart body and wheels arranged at the bottom of the cart body, and the detection mechanism is one or the combination of two of a handheld detector and a gamma camera; the movable supporting mechanism is rotationally connected with a fixing mechanism, the fixing mechanism comprises an arm fixing assembly and an ultrasonic probe fixing assembly, and the ultrasonic probe fixing assembly can slide along the arm fixing assembly.

2. The peripherally inserted central catheter puncture assistance system of claim 1, wherein: the arm fixing assembly comprises an arm fixing frame rotationally connected to the side portion of the cart body, an arc-shaped containing groove is formed in the arm fixing frame, and sliding ways for the ultrasonic probe fixing assembly to slide are formed in two sides of the containing groove.

3. The peripherally inserted central catheter puncture assistance system of claim 2, wherein: the ultrasonic probe fixing assembly comprises a probe bracket and an elastic support piece; the probe support is connected in the slideway in a sliding way, the bottom of the probe support is provided with an upward concave arc groove, both sides of the probe support are provided with supporting grooves for accommodating elastic supporting pieces, and one opposite sides of the two supporting grooves are provided with operation holes for the ultrasonic probe to pass through.

4. A peripherally inserted central catheter-insertion puncture assistance system according to claim 3, wherein: the placement part is detachably connected with the guide wire.

5. The peripherally inserted central catheter puncture assistance system of claim 4, wherein: the detachable connection mode is threaded connection, the end part of the guide wire is provided with a connector, the connector is provided with internal threads, the end part of the placement part is provided with a connection protrusion, and the connection protrusion is provided with external threads which can be matched with the internal threads.

6. The peripherally inserted central catheter puncture assistance system of claim 5, wherein: and an injection hole is formed in the middle of the connecting protrusion, and the injection hole is communicated with the cavity.

7. The peripherally inserted central catheter puncture assistance system of claim 6, wherein: the one end that the wire kept away from the portion of placing is provided with the handle, can dismantle on the handle and be connected with the portion of carding, the portion of carding cover is established in the outside of wire.

8. The peripherally inserted central catheter puncture assistance system of claim 7, wherein: the carding part is a carding sleeve, and the carding sleeve is detachably connected with the handle.