CN212281559U

CN212281559U - Puncture instrument

Info

Publication number: CN212281559U
Application number: CN202020398025.2U
Authority: CN
Inventors: 李肖; 李超; 肖剑; 宋成明; 张荣利
Original assignee: Beijing Ailin Medical Technology Co ltd
Current assignee: Beijing Ailin Medical Technology Co.,Ltd.
Priority date: 2020-03-25
Filing date: 2020-03-25
Publication date: 2021-01-05
Anticipated expiration: 2030-03-25

Abstract

The utility model provides a puncture instrument, anti bending performance is good, can prevent that the angulation from buckling when the return bend of doctor, and then guarantees the patency in the pipeline. Puncture apparatus is including leading to the core needle, leading to core needle pipe and sleeve pipe, leads to the core needle and inserts lead to the formation of core needle pipe in first plug connector, first plug connector inserts the intraductal second plug connector that forms of cover, and the sleeve pipe stretches into human distal end when using and is equipped with the bending section, and bending section overcoat has the auxiliary tube of anti buckling to prevent that the art person from appearing becoming the angle and buckling when the return bend. The auxiliary pipe is sleeved outside the bending section at the head end of the sleeve pipe, so that the bending rigidity of the bending section is enhanced, the bending resistance of the sleeve pipe is improved, and angled bending of an operator during bending is prevented, thereby ensuring the smoothness of a pipeline; when the reliability of the sleeve is higher, the sleeve can support the core penetrating needle and the core penetrating needle catheter, prevent the pipe from bending in the blood vessel and improve the puncture safety.

Description

Puncture instrument

Technical Field

The utility model relates to the technical field of medical equipment, especially, relate to a puncture instrument.

Background

Portal hypertension increases the hydrostatic pressure of the capillaries within the visceral vascular bed of the viscera. In addition to impaired renal function and sodium retention, as hydrostatic pressure increases, a leaky fluid accumulation, known as ascites, may form in the abdomen of the patient. Although this is usually managed initially by drug therapy, the amount of fluid can become quite large and drug therapy is difficult to treat.

The principle of intrahepatic portosystemic shunt (TIPS for short) through jugular vein is to use special minimally invasive interventional therapeutic apparatus, to establish an artificial shunt channel between hepatic vein and main branch of portal vein in liver by means of jugular vein approach under the guidance of X-ray fluoroscopy, and to maintain its permanent smoothness by using metal internal support, so as to control and prevent esophageal fundus varices from rupture and bleeding after portal vein high pressure is reduced, and to promote ascites absorption (equivalent to assisting doctors in performing support operation). The method has the advantages of small wound, high success rate, low complication, wide adaptation diseases, obvious portal vein pressure reduction and reliable curative effect of controlling esophageal variceal bleeding, and is a new method for treating portal hypertension in the nineties of the twentieth century. TIPS is one of the treatment measures for portal hypertension, is particularly suitable for patients with late cirrhosis, and plays an extremely important role in the treatment of portal hypertension.

Currently, the following problems exist with the TIPS puncture devices on the market: the hardened sleeve is difficult to mold and easy to bend at an angle; the core-through needle is used as a core piece and is easy to bend and deform in the operation process; the needle point is short, and the puncture resistance is large; the operator cannot easily determine from the proximal end whether the distal tip is ejected from the hardened cannula.

Therefore, there is a need to design a puncture device to overcome the above technical problems and better satisfy the puncture requirements.

SUMMERY OF THE UTILITY MODEL

The utility model aims at providing a puncture instrument, anti bending performance is good, can prevent that the angulation from buckling when the return bend of doctor from appearing, and then guarantees the patency in the pipeline.

In order to achieve the above object, the utility model provides a puncture instrument, including leading to the core needle, leading to core needle pipe and sleeve pipe, lead to the core needle and insert lead to the formation of first plug connector in the core needle pipe, first plug connector inserts the intraductal second plug connector that forms of cover, the sleeve pipe stretches into human distal end when using and is equipped with the bending segment, bending segment overcoat has the auxiliary tube of anti buckling to prevent that the art person from appearing becoming angled bending when the return bend.

The puncture instrument of the utility model has the advantages that the auxiliary tube is sleeved outside the bending section of the far end of the sleeve tube extending into the human body when the sleeve tube is used, so as to enhance the bending rigidity of the bending section, improve the bending resistance of the sleeve tube, prevent the operator from bending at an angle when bending the tube, and further ensure the smoothness of the pipeline; and the sleeve is used as a leading-in passage of the core needle catheter, when the reliability of the sleeve is higher, the sleeve can play a certain supporting role on the core needle and the core needle catheter, prevent the pipe from being bent in a blood vessel, and improve the safety and efficiency of puncture.

Optionally, the stylet is provided with a stylet hub, and the stylet catheter comprises a first hub and a first catheter;

after the core needle is inserted into the first guide pipe, the core needle is fixedly connected with the first guide pipe through the first joint to form the first plug connector.

Optionally, the sleeve includes a second conduit and a second joint, the first connector is inserted into the second conduit to form the second connector, and the bending section is disposed at a distal end of the second conduit far from the second joint.

Optionally, a proximal end of the first catheter near the first connector is provided with a scale.

Optionally, the scale is formed by ink printing after plasma surface treatment.

Optionally, the second conduit is a steel pipe, and is subjected to bending and shaping treatment at least by the bending section; and/or the head end of the stylet catheter extends out of the second catheter and is subjected to bending and shaping treatment.

Optionally, the second joint has an anti-slip operation portion.

Optionally, a first dilator is included for dilating the body wound and blood vessel.

Optionally, the stylet includes a first needle with a conical needle tip and a second needle with a triangular needle tip, and one of the first needle and the second needle is in insertion fit with the stylet catheter to form the first insertion piece.

Optionally, the guide device further comprises a guide inner tube, the guide inner tube comprises a third guide tube and a third joint, and the second plug connector is inserted into the third guide tube and then fixedly connected with the third guide tube through the third joint to form a third plug connector.

Drawings

FIG. 1 is a schematic, exploded view of a puncture instrument in accordance with one embodiment of the present invention;

FIG. 2 is a schematic structural view of a first dilator of the puncture instrument provided in the present invention;

fig. 3 is a schematic structural view of a second dilator of the puncture instrument provided in the present invention.

In fig. 1-3:

the method comprises the following steps of core penetrating needle-1, first needle-11, second needle-12 core penetrating needle joint-13 core penetrating needle guide tube-2, first joint-21, first guide tube-22 scale-23 conical joint-24 sleeve tube-3, second guide tube-31, second joint-32 bending section-33 auxiliary tube-4, first expander-5 guide inner tube-6, third guide tube-61, third joint-62 sheath tube-7, fourth guide tube-71 sheath tube joint-72, second expander-8.

Detailed Description

The present invention will be described in detail below with reference to the accompanying drawings so that those skilled in the art can accurately understand the technical solution of the present invention.

The terms first, second, etc. are used herein to distinguish two or more elements of the same or similar structure and do not denote any particular order.

The fore and aft described herein is defined with reference to the use of the puncture instrument. When the puncture instrument is used, one end of the needle point used for puncture is a far end, and the other end opposite to the far end is a near end, namely one end close to an operator when in use.

As shown in figure 1, the scheme relates to a puncture instrument, which comprises a core needle 1, a core needle guide pipe 2 and a sleeve 3, wherein the core needle 1 is inserted into the core needle guide pipe 2 to form a first plug connector, the first plug connector is inserted into the sleeve 3 to form a second plug connector, the far end of the sleeve 3, which extends into a human body when in use, is provided with a bending section 33, and an anti-bending auxiliary pipe 4 is sleeved outside the bending section 33 to prevent an operator from bending at an angle when bending.

Wherein, the specification of auxiliary tube 4 is: the length is 100mm, the inner diameter is 1.9-1.95mm, and the outer diameter is 2.0-2.1 mm.

When the puncture operation is performed, sometimes the puncture of the blood vessel and the tissue is performed after the distal end of the core needle 1 is changed to a certain angle, therefore, in practice, the distal end of the cannula 3 is provided with the bending section 33, the bending section 33 can guide the first plug connector formed by the core needle 1 and the core needle catheter 2, specifically, the proximal end of the cannula 3 can be rotated to change the direction of the distal end (during the operation, an operator can adjust the direction of the bending section 33 of the distal end by rotating the proximal end of the cannula 3 under the visual environment of an external instrument, so that the outlet direction of the bending section is aligned with the blood vessel and the tissue to be punctured), and further, the communication of the blood vessel and the tissue in the different planes is realized. However, in order to reduce the bending resistance, the bending section 33 has low strength, which affects the transmission of the puncture force, and is also prone to bending at an angle when bending, thereby causing an unclogged puncture path.

To solve the technical problem, the puncture instrument of the utility model is provided with the auxiliary tube 4 which is sleeved outside the bending section 33 at the far end of the sleeve 3 and used for enhancing the bending rigidity of the bending section 33, improving the bending resistance of the sleeve 3 and preventing the bending of the angle when the operator bends the tube, thereby constructing the bending section 33 (the bending section 33 is beneficial to the puncture of the blood vessel or the tissue with different surfaces) and ensuring the smoothness of the pipeline of the sleeve 3; specifically, the inner diameter of the auxiliary tube 4 is slightly larger than the outer diameter of the casing 3, for example, the inner diameter of the auxiliary tube 4 is 1.5-2.5mm larger than the outer diameter of the casing 3, specifically 1.5mm, 2mm or 2.5mm, so that the two are in clearance fit, and the auxiliary tube 4 can slide on the casing 3 without affecting the use. The sleeve 3 is used as a leading-in passage of the stylet catheter 2, can play a certain supporting role for the stylet 1 and the stylet catheter 2, prevents the pipe from bending in the blood vessel, improves the safety and operability of puncture, and improves the puncture efficiency.

In order to achieve a reliable connection between the stylet 1 and the stylet catheter 2, the stylet catheter 2 may comprise a first connector 21 and a first catheter 22, the first connector 21 being disposed at a proximal end of the first catheter 22, the stylet 1 being fixed to the first catheter 22 by the first connector 21 after being inserted into the first catheter 22 to form a first connector. The stylet 1 and the stylet catheter 2 are connected and fixed by a luer taper. Specifically, a luer male connector (with a male luer lock portion) is arranged at the end of the proximal end of the stylet 1, correspondingly, a luer female connector (with a female luer lock portion) is arranged at the first connector 21 of the stylet catheter 2, and after the luer male connector and the luer female connector are mutually matched, a complete luer connector is formed, so that locking is realized, and the stylet 1 and the stylet catheter 2 are fixedly connected. Luer connection belongs to the prior art, wherein the key features of luer taper are defined in the ISO 594-1:1986 standard, which is not described herein in detail, and only schematic diagrams of luer connection are given in the corresponding parts of fig. 1 to 3.

As shown in fig. 1, in the present scheme, the core needle 1 may specifically include two types of needle heads, which are respectively: the needle point (needle head) is the first needle 11 of coniform and the needle point is the second needle 12 of trigonometry, and first needle 11 and second needle 12 are selected for use alternatively, according to the puncture needs promptly, select one as the logical core needle 1 that uses in first needle 11 and second needle 12, and another can regard as reserve needle. When the device is used, after one of the first needle 11 and the second needle 12 is in inserted fit with the stylet catheter 2, the two are locked through the luer connector to realize the connection and fixation of the two, and the first connector is formed by the whole body after the two are connected and fixed.

The core needle 1 is also provided with a core needle joint 13 (coated on the periphery of the luer male joint), the core needle joint 13 is made of metal, and the outer surface of the core needle joint is provided with a hemp thread surface, so that a doctor can prevent slipping when holding the core needle. In addition, the through-core needle joint 13 made of metal has more texture, so that a doctor can feel better when puncturing.

The needle tip of the first needle 11 is tapered to have a conical tip for performing a puncturing operation in a human body. After the first plug is inserted into the sleeve 3, the second plug is formed as a whole.

The tip of the second needle 12 is tapered to have a triangular prism-shaped tip for performing a puncturing operation in a human body. In practice, the first needle 11 is usually used as a normal needle and the second needle 12 is used as a spare needle. In the case of severe cirrhosis patients, the first needle 11 (the conventional needle) is easily bent at the time of puncturing, resulting in a failed puncturing, and only a new set of products can be re-opened, which undoubtedly increases the operation time and cost. It has been found through experiments that the stylet 1 with the triangular prism tip has better puncture effect than the stylet 1 with the conical tip, and has more excellent puncture performance when facing patients with severe liver cirrhosis. Therefore, the puncture instrument of the scheme is provided with two types of needles simultaneously, and compared with the puncture instrument in the prior art, one more needle is provided, so that the fault tolerance rate of the operation is improved, and the operation time and cost are reduced. When the second needle 12 is selected as the core needle 1, the first connector is assembled according to the same steps, and then the sleeve 3 is inserted to form the second connector.

In the process of assembling to form the first connector, after the stylet 1 is inserted into the first conduit 22, its tip projects beyond the distal tip of the first conduit 22 to facilitate penetration. The first conduit 22 may be provided with a scale 23, and the scale 23 may be provided at a proximal end of the first conduit 22 near the first connector 21, and may be formed by printing ink after plasma surface treatment. The scale 23 is used for judging the extending position of the needle point of the first plug connector at the far end relative to the end of the second guide pipe 31 by the scale of the scale 23 exposed between the end of the near-end sleeve 3 and the first connector 21 of the first guide pipe 22 when an operator uses the second plug connector; further controlling the telescopic length of the needle tip so as to accurately control the depth of the puncture needle inserted into the focal tissue and improve the operation precision. Particularly, the ink printing is carried out after the plasma surface treatment, so that the problems of low surface adhesion and difficult ink adhesion of the Teflon material are solved.

The sleeve 3 may comprise a second guide tube 31 and a second connector 32, the first connector being inserted into the second guide tube 31 and fixed to the second guide tube 31 by the second connector 32 to form a second connector, and the bending section 33 being provided at the distal end of the second guide tube 31. Here, the root of the first joint 21 of the first connector is provided with a conical joint 24, and correspondingly, the second joint 32 is provided with a conical hole with a certain depth, so that the first joint 21 and the second joint 32 form a taper fit connection and fixation. It should be noted that, during the use process, the first connector 21 and the second connector 32 do not necessarily need to be fixedly connected, and the operator can flexibly grasp the depth of the insertion needle according to the liver requirement of the patient, and when the insertion depth is large, the first connector 21 and the second connector 32 are close to each other and fixedly connected through taper fit; when the insertion depth is small, a distance exists between the first connector 21 and the second connector 32, the scale 23 is exposed, and the needle insertion depth is judged according to the change scale of the scale 23.

The second guiding pipe 31 can be a steel pipe, and is at least bent and shaped by the bent section 33, before the bending and shaping step, the auxiliary pipe 4 needs to be sleeved and then bent and shaped, so that the bent part of the second guiding pipe 31 does not bend at an angle, but forms the bent section 33 with smooth transition, which is beneficial for the first plug connector to pass smoothly and perform puncture. The distal end of the stylet catheter 2 protrudes out of the second catheter 31, and the stylet catheter 2 is subjected to a bending shaping process with its distal end protruding out of the second catheter 31. That is to say, the stylet catheter 2 is longer than the cannula 3, the stylet catheter 2 extends out of the cannula 3 along the bent distal end thereof to perform the heterofacial puncture, and after the puncture needle is used by the operator to complete the puncture and when the guide wire needs to be inserted, the stylet catheter 2 can guide the guide wire by the bent distal end thereof, so that the direction of the guide wire alignment is convenient.

Since the second conduit 31 may be a steel pipe, the casing 3 may also be referred to as a stiffened casing. Wherein, the outer peripheral surface of the second joint 32 can have an anti-slip operation part, which is convenient for the operator to manually rotate, and is used for adjusting the orientation of the bending section 33 at the far end, and has the dual functions of anti-slip and directional adjustment.

The material of auxiliary tube 4 can be rigid materials such as polyurethane, polyethylene, polyether amide, and bending resistance is good, appears becoming angle when can effectually preventing the return bend and buckles, and the angle of buckling can not appear in the in-process of buckling promptly, but with the curve form bending, the broken line can not appear. Just because the second conduit 31 is a hardened sleeve, the second conduit can support the stylet 1 and the stylet conduit 2, prevent the tube from bending in the blood vessel, and provide a smooth leading-in passage for the stylet 1 and the stylet conduit 2.

In the above, the puncture instrument may further include an inner guide tube 6, and the second connector is integrally inserted into the inner guide tube 6 to form a third connector.

The guiding inner tube 6 specifically comprises a third guiding tube 61 and a third joint 62, and the second plug connector is inserted into the third guiding tube 61 and then fixedly connected with the third guiding tube 61 through the third joint 62 to form a third plug connector. At this time, the guide inner tube 6 serves as a passage for the sleeve 3 for guiding and supporting the sleeve 3. It should be added that the second connector and the third connector 62 are also connected by a luer connector, specifically, the bottom of the second connector 32 is provided with a luer male connector, correspondingly, the top of the third connector 62 is provided with a luer female connector, and the luer male connector and the luer female connector are matched with each other to realize a fixed connection. Since the connection of luer fittings is common knowledge, it will not be described in detail here.

In the third plug, the guide inner tube 6 can enclose the cannula 3 (the cannula 3 is specifically a stiffening cannula) therein, preventing the tip of the stiffening cannula from scratching the vessel wall.

The puncture instrument may further comprise a sheath 7, the third plug being inserted into the sheath 7 to form a fourth plug.

This sheath pipe 7 includes fourth pipe 71 and sheath union coupling 72, fourth pipe 71 and sheath union coupling 72 have an organic whole structure, set up hemostasis valve (high-elastic silica gel piece) in sheath union coupling 72, but the third plug connector of silica gel piece middle part appearance passes through (there is the opening in the middle of the hemostasis valve, get into human "door" as medical instrument, "door" here owing to the high resilience of silica gel piece when not inserting tubular product, therefore be confined, the hemostasis valve has the function of hindering blood, prevent blood blowout), and hold tight third plug connector through the high resilience power with the frictional force between the high-elastic silica gel piece and silica gel piece, silica gel piece hemostasis valve belongs to prior art, this is not repeated. The fourth catheter 71 may be provided with a visualization mark for representing the position of the fourth catheter in the blood vessel of the human body, specifically, a visualization mark point (not shown in the figure), so that an operator can observe the visualization mark points to confirm the position of the sheath 7 in the human body, the efficiency and success rate of the puncture operation are improved, the pain of the patient is reduced, and the time spent in the operation is reduced. The side branch of the sheath joint 72 may also be connected to a side branch three-way valve (not shown, please refer to the prior art). The side branch three-way valve is used for injecting heparin water and cleaning medical instruments before and after an operation. The sheath 7 is also provided with an anti-bending lining and an ultra-smooth lining (the ultra-smooth standard refers to the requirement of the medical field on the puncture needle) so as to reduce the insertion resistance, improve the puncture efficiency and precision, better transmit the puncture force to the puncture part and reduce the loss of the puncture force in the transmission process. The distal end of the sheath 7 may be tapered to provide a good fit with the third plug.

As shown in fig. 2, the puncture device of the present embodiment may further include a first dilator 5 for dilating the wound and blood vessel of the human body. The first dilator 5 may have a tube and a joint, the tube may have a smooth tip, and before the operator inserts the sheath tube 7, the first dilator 5 may be inserted into the blood vessel first, so as to dilate the insertion site, so that the sheath tube 7 is inserted more smoothly after the first dilator 5 is pulled out, and the pre-dilation function is performed on the puncture site.

As shown in fig. 3, the puncture instrument according to the present embodiment may further include a second dilator 8, and when the operation of inserting the sheath 7 into the blood vessel is performed, the second dilator 8 is inserted into the sheath 7 so as to introduce the sheath 7 into the human body, and the second dilator 8 plays a role of assisting the insertion of the sheath 7 into the human body. The second dilator 8 has a tip needle, so that the second dilator can be easily inserted into a human body for conveying, and on the other hand, the second dilator 8 is inserted into the sheath tube 7, so that the second dilator can also have a certain supporting function on the inside of the sheath tube 7, and the sheath tube 7 is prevented from being extruded in a blood vessel. The second dilator 8 can also comprise a tube and a connecting tube, the tube can also have a smooth tip, and when in use, the second dilator 8 is inserted into the sheath 7 and is inserted into the human body blood vessel together with the sheath 7, so that the feeding of the sheath 7 is realized.

In contrast, the first dilator 5 is also referred to as a short dilator and the second dilator 8 is also referred to as a long dilator, i.e., the first dilator 5 is shorter in length and the second dilator 8 is longer in length.

After the sheath 7 is inserted into the body, the components of the third connector can be inserted into the sheath 7 in the reverse order (i.e. in the reverse order of the formation of the third connector described above) to form the fourth connector required for puncturing.

Has the advantages that:

firstly: the utility model discloses a puncture apparatus for through jugular vein intrahepatic portal vein reposition of redundant personnel art (TIPS) operation, under the guide of X line perspective, through jugular vein admission, puncture between hepatic vein and portal vein, then puncture apparatus intervenes and gets into human passageway as support, sacculus pipe, seal wire in vivo. The puncture instrument of the utility model has the sleeve pipe which is externally sleeved with the auxiliary pipe at the bending section extending into the far end of the human body when in use, is used for enhancing the bending rigidity of the bending section, improving the bending resistance of the sleeve pipe, preventing the operator from bending at an angle when bending the pipe, and further ensuring the smoothness of the pipeline; in addition, the sleeve is used as a leading-in passage of the stylet catheter, and can play a certain supporting role for the stylet and the stylet catheter, prevent the pipe from bending in the blood vessel, and improve the safety and efficiency of puncture; in addition, the distal end of the stylet catheter is bent, so that the direction can be conveniently found when a doctor inserts the guide wire;

the second step is as follows: the puncture instrument of the utility model is provided with the staff gauge at the near end of the operator, which is convenient for the doctor to control the telescopic length of the far-end needle head from the near end of the operation, so as to improve the operation precision of the doctor during the operation;

and thirdly: compare pjncture needle under prior art, the utility model discloses a puncture instrument when the patient in the face of serious cirrhosis, has better puncture effect, can effectively improve the probability of puncture success, reduces operation time, reduces patient's misery, reduces the cost of operation.

The puncture instrument provided by the utility model is described in detail above. The principles and embodiments of the present invention have been explained herein using specific examples, and the above descriptions of the embodiments are only used to help understand the core concepts of the present invention. It should be noted that, for those skilled in the art, without departing from the principle of the present invention, the present invention can be further modified and modified, and such modifications and modifications also fall within the protection scope of the appended claims.

Claims

1. Puncture apparatus, its characterized in that, including logical core needle (1), logical core needle pipe (2) and sleeve pipe (3), logical core needle (1) inserts form first plug connector in logical core needle pipe (2), first plug connector inserts form the second plug connector in sleeve pipe (3), sleeve pipe (3) are equipped with bending segment (33) in the distal end that stretches into the human body when using, bending segment (33) overcoat joint has anti-auxiliary tube (4) of buckling to prevent that the angle from buckling from appearing when the return bend in the art person.

2. A puncture device according to claim 1, characterized in that the stylet (1) is provided with a stylet hub (13), the stylet catheter (2) comprising a first hub (21) and a first catheter (22);

after the core penetrating needle (1) is inserted into the first guide pipe (22), the core penetrating needle is fixedly connected with the first guide pipe (22) through the first joint (21) to form the first plug connector.

3. A puncture instrument according to claim 2, characterized in that the cannula (3) comprises a second duct (31) and a second connector (32), the first connector being inserted into the second duct (31) to form the second connector, the curved section (33) being provided at the distal end of the second duct (31) remote from the second connector (32).

4. A puncture instrument according to claim 3, characterized in that the proximal end of the first catheter (22) near the first connector (21) is provided with a scale (23).

5. A puncture instrument according to claim 4, characterized in that the scale (23) is formed by ink printing after plasma surface treatment.

6. A puncture instrument according to claim 5, characterized in that the second catheter (31) is a steel tube and is subjected to a bending shaping treatment at least in the bending section (33); and/or the head end of the stylet catheter (2) extends out of the second catheter (31) and is subjected to bending and shaping treatment.

7. A puncture instrument according to claim 5, characterized in that the second connector (32) has an anti-slip operation portion.

8. The puncture device according to claim 1, further comprising a first dilator (5) for dilating wounds and blood vessels of the human body.

9. A puncture device according to claim 1, characterized in that the stylet needle (1) comprises a first needle (11) having a conical needle tip and a second needle (12) having a triangular needle tip, one of the first needle (11) and the second needle (12) being in plugging engagement with the stylet catheter (2) to form the first plug.

10. A puncture instrument according to any of claims 1-9, characterized in that it further comprises an inner guide tube (6), said inner guide tube (6) comprising a third guide tube (61) and a third connector (62), said second plug being fixedly connected to said third guide tube (61) via said third connector (62) after insertion into said third guide tube (61) to form a third plug.