JP2003275324A - Infection-preventive gastrostomy kit - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide an infection-preventing gastrostomy kit by which a catheter is made to dwell simply without infecting an wound part and without giving a pain to a patient when performing gastrostomy operation through an endoscope. <P>SOLUTION: The kit comprises: a catheter which has a stopper at its one terminal end to be fixed through an abdominal wall between the lumen of the gaster and the outside of the body; an over tube to be inserted for the purpose of introducing the catheter into the lumen of the gaster; and a soft cover installed in the lumen of the over tube. By folding back the terminal end of the soft cover, an outer peripheral wall at a distal end on the insertion side of the over tube is covered, and the other terminal end of the soft cover projects from the proximal end of the over tube. <P>COPYRIGHT: (C)2003,JPO

Description

Description: BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to an infection preventing gastrostomy kit. More particularly, the present invention relates to an infection-preventing gastrostomy kit, which is used to prevent bacterial infection from the oral cavity and the like when performing gastrostomy through an endoscope and to easily place a catheter. [0002] As a method of administering nutrition to patients who cannot take nutrition orally, generally, intravenous nutrition,
Nasal gastrointestinal nutrition and enteral nutrition from gastrostomy were performed. [0003] Intravenous nutrition is a so-called intravenous drip that replenishes nutrients from the vein. This has the advantage that it can be easily applied to any patient, but it requires strict cleanliness and thus burdens the caregiver. But management at home was very difficult. In addition, the increase in medical expenses further increases the burden on the caregiver, and thus it has been difficult to adapt especially to patients who require long-term nutritional management. [0004] Nasogastric tube feeding is a method in which a catheter is inserted through the nose and a catheter is placed in the stomach to supply nutrients. This also has the advantage that it can be easily performed, but the catheter is easily pulled out and placed. Not only is it painful for the patient because the catheter comes into contact with the nasal cavity and pharynx, the catheter may be pulled out due to the feeling of restraint by placing the catheter, and because the catheter comes out from the nose in appearance, Severe feeling was strong.
In the case of a longer period of time, ulcers are formed in the portion in contact with the catheter, so that this method is also difficult to adapt to patients who require long-term nutritional management. [0005] Enteral nutrition from gastrostomy: A fistula for supplying nutrients from the abdominal wall to the stomach lumen is constructed by a small operation using an endoscope, and the fistula is inserted through a catheter through a catheter. Supplement nutrients. Although small surgery is necessary as described above, general anesthesia is not required, and it is a small operation of about 10 minutes in time, the wound is small, the burden on the patient is small, and the recovery is fast, so even severe patients can be recovered. Enforcement is possible. In addition, enteral nutrition from a gastrostomy requires less strict cleanliness than the above-mentioned intravenous nutrition, so bathing is possible, and there is less discomfort than nasogastric tube nutrition. QOL (quality of life) is improved. Furthermore, since it can be sufficiently managed even at home and in facilities, it is an optimal nutritional administration method for patients and caregivers who require long-term nutritional management, and further spread is expected in the future. [0006] The minor operation shown in enteral nutrition from gastrostomy is a percutaneous endoscopic gastrostomy.
strostomy: PEG). In general, percutaneous endoscopic gastrostomy is performed using a pull method, a push method,
There are three methods, the Introducer method. [0007] The introducer method is a method in which a catheter is inserted from the lumen of a trocar punctured from the abdominal wall and placed there. It is said that there is little infectious disease because the endoscope only needs to be inserted once and the catheter is inserted from the punctured lumen of the trocar. A catheter having a diameter larger than that of the pull or push method cannot be placed. In addition, at the time of construction, only the balloon shape as a stopper shape at one end of the catheter to be placed on the stomach wall can pass through the trocar lumen, so if the balloon leaks or ruptures after construction, the catheter may deviate There is. For this reason, caregivers had to periodically manage balloon inflation. In the push method, a catheter to be placed along a guide wire protruding from the mouth to the outside of the abdominal wall is pushed into the stomach from the mouth, and when the distal end of the catheter protrudes from the abdominal wall,
This is a method in which a guide wire is pulled out and placed together with this catheter, and a catheter having a larger diameter can be placed as compared with the introducer method. In addition, the shape of the stopper at one end of the catheter placed in the stomach wall is a bumper shape that can firmly hold and fix the stomach wall, so there is less deviation of the catheter than in the balloon shape, and regular management such as balloon shape is not required. . However, at the time of a small operation, the endoscope must be inserted twice in order to construct the catheter and check the indwelling position of the catheter. It is indispensable for formation. But this was painful for the patient. In addition, when inserting a catheter placed in the mouth, bacteria in the oral cavity adhere to the outer periphery of the catheter, and this part passes through the punctured abdominal wall, causing a problem that infection of the wound occurs. Prior to disinfecting the oral cavity and administering antibiotics, it was troublesome and it was difficult to completely prevent the infection by this alone. In order to further prevent infection, a method of placing a tube from the mouth to the stomach and placing a catheter through the lumen has been practiced, but when inserting the tube saliva etc. flows into the tube lumen and this is placed Since it adhered to the catheter at the time, it was still impossible to completely prevent the infection. With the pull method, a catheter to be indwelled is connected to a guide wire protruding from the mouth to the end of the guide wire protruding from the mouth to the outside of the abdominal wall,
This is a method in which a guide wire that has protruded out of the abdominal wall is pulled into the stomach from the mouth by pulling the guide wire, and is placed in the stomach. This method has the same advantages and disadvantages as the push method, since there is no difference in the method of placing the catheter from the mouth to the stomach only in the difference between pushing or pulling. SUMMARY OF THE INVENTION An object of the present invention is to prevent infection when a gastrostomy is performed through an endoscope and a catheter can be easily placed without infecting a wound. A gastrostomy kit is provided. That is, the present invention provides a catheter which has a stopper at one end and is fixed through the abdominal wall between the lumen of the stomach and the outside of the body. It is composed of an overtube to be inserted into the cavity, and a soft cover installed in the lumen of the overtube, and covers the outer peripheral wall of the insertion side tip of the overtube by folding back the end of the soft cover, In addition, the present invention provides an infection-preventing gastrostomy kit, wherein the other end of the soft cover protrudes from the base end of the overtube. The present invention will be described below in detail with reference to the drawings. FIG. 1 shows the entire overtube used in one embodiment of the present invention, and FIG. 2 shows the overtube used in one embodiment of the present invention in which a soft cover is installed in the lumen. FIG. 3 is a view showing an entire pull catheter having a stopper at a distal end used in an embodiment of the present invention. FIG. 4 is a cross-sectional view of a human body when a soft cover is installed in the lumen of an overtube by a pull method according to an embodiment of the present invention and an endoscope is inserted therein. FIG. 5 is a sectional view of the human body when the endoscope and the soft cover are removed together with the guide wire held by the snare. FIG. 6 is a cross-sectional view of the human body when the end of the guide wire is connected to the other end of the catheter for the pull method, and the catheter is indwelled through the overtube. FIG. 7 is a cross-sectional view of a human body when an indwelling position is confirmed by an endoscope after constructing a catheter according to one embodiment of the present invention. (Overtube) The overtube (1) in FIG. 1 comprises a mouthpiece (2) and a tube (3). A mouthpiece (2) is attached to the proximal end of the tube (3), and flanges (4) are provided at both ends thereof, so that the patient can hold the mouthpiece (2) in a stable state. So that you can
It is provided to provide rigidity so that the patient does not break when biting the mouthpiece (2). The material is preferably a styrene-based hard resin, but when added, there is no uncomfortable feeling and the rigidity is low. The material is not limited to this as long as it is a certain material. Overtube inserted from mouth (1)
Must pass through the bent portion (5) near the pharynx, and therefore, a flexible material is preferable, and a polyvinyl chloride resin, a polyurethane resin, or a rubber resin is more preferable. However, because of the flexible material, the lumen of the tube (3) may be crushed at the bent portion (5),
In order to prevent this, it is preferable to embed a metal or a hard resin previously processed into a coil shape into the outer peripheral wall of the tube (3). As the metal, stainless steel is preferable, and as the hard resin, styrene resin is preferable. However, as long as it can be embedded in the outer peripheral wall of the tube (3) and can maintain rigidity without being deformed at the bent portion, it is limited to these. Is not done. The indwelling overtube (1) preferably has a length such that the distal end of the overtube passes through the esophagus and is located near the cardia of the stomach. If the overtube is longer than this position, the operability of the catheter during indwelling becomes poor, so the length of the overtube in the longitudinal direction is preferably selected according to the patient's physique. The inner and outer diameters of the overtube may be adjusted to the outer diameter of the endoscope to be used, and it is preferable to select the inner and outer diameters so as to minimize the burden on the patient during insertion. Next, when the overtube (1) is inserted, the insertability is improved, and a medical instrument such as an endoscope inserted into the lumen of the overtube is prevented from being caught at the tip of the overtube. It is preferable that the tip of the overtube be angled with respect to the longitudinal direction. Although this angle is too large, the insertability becomes worse, and if too small, the tip becomes acute and damages the tissue,
It is preferable that the angle formed by the angled surface with the longitudinal direction of the overtube is in the range of 30 to 70 degrees. Further, it is preferable that the angled tip outer peripheral portion (6) is chamfered to prevent tissue damage at the time of insertion. (Soft Cover) As shown in FIG. 2, the soft cover (7) is installed and used in the lumen of the overtube (1), and the soft cover (7) protruding from the tip of the overtube (1) is used. ) Is folded back to cover the outer peripheral wall at the tip of the overtube, thereby preventing inflow of saliva and the like into the overtube lumen during insertion. The length of the soft cover of the folded portion (8) is preferably 5 to 30 mm. In addition, since this soft cover is removed together with the endoscope, it is installed so that it protrudes from the end of the overtube. Remove. When withdrawn, the folded back portion (8) of the soft cover is also drawn back to its original shape before being folded into the lumen of the overtube, so saliva and the like are removed without adhering to the lumen of the overtube (1). It can be performed without infection even if the catheter is placed through the lumen of the overtube. As described above, the soft cover (7) is installed in the lumen of the overtube (1), and since the endoscope passes through the lumen, the shape is preferably the same cylindrical shape as the overtube. The thickness is preferably very thin, and more preferably 0.05 to 0.3 mm. Preferred materials are thermoplastic polyesters such as polyethylene, polypropylene, crystalline polyolefin, polybutylene terephthalate, and polyethylene naphthalate, polyvinyl chloride, and polyethylene terephthalate. (Catheter) The catheter (9) in FIG. 3 is provided with a stopper (10) for fixing to the stomach wall at the base end side, and is of a type used by a pull method. The stopper is preferably made of a material that is soft and has good biocompatibility in order to fix it to the stomach wall for a long period of time. Silicone and polyurethane are more preferable, and the stopper has a conical shape or a dome shape that deforms when the catheter is pulled with a certain force. preferable. The outer diameter of the catheter (9) is preferably in the range of 4 mm to 18 mm, although it depends on the size of the punctured wound. Further, since nutrients and drugs are poured into the stomach through the lumen of the catheter, clogging occurs. It is preferred to have no internal diameter. The catheter (9) has a stopper (1).
Since it is integrated with 0), it is preferable to use the same material because it is processed by bonding or insert molding. After the construction, the position of the stopper (10) may be confirmed by X-ray contrast. (10) It is preferable that the material itself has a contrast property, and it is more preferable to use a barium-based or bismuth-based contrast agent. Further, when the catheter (9) is replaced, it is necessary to measure the thickness of the abdominal wall. Therefore, it is preferable that scales are printed on the outer periphery of the catheter (9) at regular intervals from the stopper (10). . Since this catheter (9) is used in the pull method,
The other end loop (11) of the catheter is attached, and is preferably made of a flexible material so as to be connected to the end loop (15) of the guide wire when the catheter (9) is drawn through the mouth. (Usage Method) FIG. 4 shows an example of use of one embodiment of the present invention, in which an overtube (1) is inserted from the mouth, and a soft cover (7) is installed in the lumen. Further, the stomach passes through the lumen of the soft cover and enters the endoscope (1
2) is inserted. A puncture needle (13) is inserted into the abdominal wall to pass a guide wire, and a soft cover is installed in the overtube lumen, so that saliva and the like do not directly adhere to the overtube lumen wall. FIG. 5 is an example of use of one embodiment of the present invention.
The guide wire (14) inserted from the lumen of the puncture needle
The endoscope (12) is gripped by a snare (not shown) passed through the endoscope (12), and the soft cover (7) is removed from the overtube (1) together with the endoscope (12). At this time, the bent portion at the tip of the soft cover is drawn into the overtube lumen so as to return to the original shape, so that the overtube lumen is kept clean. FIG. 6 shows an example of use of an embodiment of the present invention.
After removing the endoscope, the guide wire (15) protruding from the mouth is tied to the other loop (11) of the catheter for the pull method in which the guide wire (15) protrudes from the mouth, and the guide wire (11) protrudes outside the abdominal wall. Although the catheter is drawn into the stomach from the mouth through the overtube lumen by pulling 14), since the catheter passes through the overtube lumen where cleanliness is secured, the catheter can be placed without contamination. At this time, as described above, the stopper (10)
As the material of the overtube, a soft material is used, and the stopper (1) is larger than the inner diameter of the overtube (1).
If the size of 0) is large, the stopper sticks to the lumen of the overtube pulled in, and it is difficult to pass through the overtube. For this reason, it is preferable to apply a hydrophilic treatment to the inner lumen of the overtube (1) or to the indwelling catheter (9) and the stopper (10). It is possible to perform the procedure without pain to the patient by using it after giving it lubricity. This hydrophilic treatment is preferably performed with a hydrogel, and more preferably with hyaluronic acid, polyvinylpyrrolidone, polyvinyl alcohol, polyacrylamide, gelatin, or collagen. After the construction, as shown in FIG. 7, the endoscope is used as it is by using the overtube (1) used for the construction for confirming the indwelling position of the stopper (10) of the catheter (9). Although (12) is inserted, since the endoscope can be inserted smoothly through the overtube, the pain to the patient is greatly reduced. The gastrostomy kit for preventing infection according to the present invention can be used to easily and without pain to a wound when performing a gastrostomy procedure through an endoscope. Detention is possible.

BRIEF DESCRIPTION OF THE DRAWINGS FIG. 1 is a diagram showing an entire overtube used in an embodiment of the present invention. FIG. 2 is a view showing a soft cover installed in an inner lumen of an overtube according to an embodiment of the present invention. FIG. 3 is a view showing an entire pull method catheter having a stopper at a distal end according to an embodiment of the present invention. FIG. 4 is a diagram showing a cross-sectional view of a human body when a soft cover is installed in the lumen of an overtube by a pull method according to one embodiment of the present invention and an endoscope is inserted therein. FIG. 5 is a cross-sectional view of the human body when the endoscope and the soft cover are removed together with the guide wire gripped by the snare according to one embodiment of the present invention. FIG. 6 is a cross-sectional view of a human body when an end of a guide wire according to an embodiment of the present invention is connected to another end of a catheter for a pull method, and the catheter is indwelled through an overtube. FIG. FIG. 7 is a diagram showing a cross-sectional view of a human body when an indwelling position is confirmed by an endoscope after constructing a catheter according to one embodiment of the present invention. [Description of Signs] 1 Overtube 2 Mouthpiece 3 Tube 4 Flange 5 Bend portion 6 Outer peripheral portion 7 Soft cover 8 Folded portion 9 Catheter 10 Stopper 11 Other end ring of catheter 12 Endoscope 13 Puncture needle 14 Guide Wire 15 End wire of guide wire

Claims (1)

Claims: 1. A catheter having a stopper at one end and being fixed through the abdominal wall between the stomach lumen and the outside of the body, and inserted for introducing the catheter into the stomach lumen. And a soft cover installed in the lumen of the overtube. The soft tube is turned over at its distal end to cover the outer peripheral wall of the insertion end of the overtube. An infection-preventing gastrostomy kit, wherein the other end of the soft cover protrudes from one end.