JP2004194958A

JP2004194958A - Method for artificial dialysis and its holding device with band

Info

Publication number: JP2004194958A
Application number: JP2002367799A
Authority: JP
Inventors: Yukio Horiguchi; 幸夫堀口
Original assignee: Individual
Current assignee: Individual
Priority date: 2002-12-19
Filing date: 2002-12-19
Publication date: 2004-07-15
Anticipated expiration: 2022-12-19
Also published as: JP3811445B2

Abstract

<P>PROBLEM TO BE SOLVED: To provide a method for artificial dialysis and its holding device with a band, which enable a patient to easily undergo artificial dialysis all by oneself. <P>SOLUTION: This method for artificial dialysis is to be done as follows. A T-shaped tubular body 3 comprising a straight part 1 and a stem part 2 is applied on the way of an artificial blood vessel transplanted between prescribed artery and vein of a human body, and the tubular body 3 and the artificial blood vessel are transplanted into the body with an end of the stem part 2 being exposed out of the body. Then each one end of a pair of access tubes (6a, 6b), on which a jack part 5 having needles (4a, 4b) at one end is formed, are connected with the device for artificial dialysis, and the jack part 5 are to be put into the stem part 2 of the tubular body 3. A periphery of the end of the stem part 2 is held by the holding device with the band 20, by its bands (27, 28) the jack part 5 could be put into the stem part 2 or pulled out of it with the holding device 20 fixed on surface of the patient. <P>COPYRIGHT: (C)2004,JPO&NCIPI

Description

【０００１】
【発明の属する技術分野】
本発明は、自己透析や家庭透析を可能にするための人工透析方法及びそれに用いるバンド付き保持具に関する。
【０００２】
【従来の技術】
従来、この種の人工透析方法として、例えば特許文献１に開示され、また図９にも示すように、予め人体の所定の動脈と静脈との間、例えば上腕動脈と腋窩静脈との間に移植される人工血管の途中に直管部１とステム部２とからなるＴ字形の管状ボディ３を設け、この管状ボディ３をステム部２の先端側が体外に露出した状態で体内に人工血管と共に移植手術をしておき、しかる後、一端にニードル４ａ，４ｂを有するジャック部５が設けられた一対のアクセス管６ａ，６ｂの他端を人工透析装置側に接続し、このアクセス管６ａ，６ｂのジャック部５を上記管状ボディ３のステム部２に差し込んで人工透析を行うようにしたものは知られている。
【０００３】
【特許文献１】
米国特許第４４１７８８８号明細書(第３欄−第４欄、図１−図７)
【０００４】
【発明が解決しようとする課題】
しかし、上記の如き人工透析方法では、アクセス管６ａ，６ｂのジャック部５を管状ボディ３のステム部２に差し込んだり、ステム部２から引き抜いたりするとき体内の管状ボディ３側に異常な荷重がかからないようにするために、介添え者がハサミ型の保持具７により管状ボディ３のステム部２の体外に露出した部位である先端部外周を保持する必要があり、透析患者一人では人工透析をすることができないのが実情である。
【０００５】
本発明はかかる点に鑑みてなされたものであり、その第１の課題とするところは、上述の如くアクセス管６ａ，６ｂのジャック部５を管状ボディ３のステム部２に差し込んだり、ステム部２から引き抜いたりするとき、介添え者を要することなく管状ボディ３のステム部２の先端部外周を保持して体内の管状ボディ３側に異常な荷重がかからないようにしつつ、透析患者一人でも人工透析を容易に行い得る人工透析方法を提供せんとするものである。
【０００６】
また、本発明の第２の課題は、今回提供する人工透析方法を実施するに当たり、それに用いるのに適したバンド付き保持具を提供せんとするものである。
【０００７】
【課題を解決するための手段】
上記第１の課題を達成するため、請求項１に係る発明は、人体の所定の動脈と静脈との間に移植される人工血管の途中に直管部とステム部とからなるＴ字形の管状ボディを設け、この管状ボディをステム部の先端側が体外に露出した状態で体内に人工血管と共に移植した後、一端にニードルを有するジャック部が設けられた一対のアクセス管の他端を人工透析装置側に接続し、このアクセス管のジャック部を上記管状ボディのステム部に差し込んで人工透析を行う人工透析方法において、上記管状ボディのステム部の先端部外周をバンド付き保持具により保持し、この保持具のバンドにより保持具を人体の皮膚面に固定した状態でアクセス管のジャック部を管状ボディのステム部に差し込んだり、ステム部から引き抜いたりする構成とする。
【０００８】
この構成では、体内に移植した管状ボディの体外に露出するステム部の先端部外周を保持するバンド付き保持具をそのバンドにより人体の皮膚面に固定した状態でアクセス管のジャック部を管状ボディのステム部に差し込んだり、ステム部から引き抜いたりするため、体内の管状ボディ側に異常な荷重がかかることはない。しかも、保持具による管状ボディのステム部の保持及びバンドによる保持具の固定は、透析患者一人でも行うことができるので、人工透析をも介添え者を要することなく行うことができる。
【０００９】
また、上記第２の課題を達成するため、請求項２に係る発明は、請求項１記載の人工透析方法に用いるバンド付き保持具として、上記管状ボディのステム部の先端部外周を保持する保持具本体を備え、この保持具本体は、ステム部の先端部外周を挟む２つの半割り部を有し、この半割り部の一端同士を支軸回りに回動可能に結合し、他端同士を結合構造により取り外し可能に結合してなる構成とする。この構成では、管状ボディのステム部の先端部外周を保持具本体により保持するときには、保持具本体の２つの半割り部同士を開いた状態からステム部の先端部外周を挟むように一端側の支軸回りに回動して閉じ、他端側の結合構造により半割り部の他端同士を結合することにより、保持具(詳しくは保持具本体)による管状ボディのステム部の保持を透析患者一人でも容易に行うことができる。
【００１０】
請求項３に係る発明は、請求項２記載のバンド付き保持具において、上記２つの半割り部にそれぞれ片バンドの一端を結合し、この各片バンドの他端部に互いに結合する結合部を設け、この両結合部同士を結合して保持具本体を人体の皮膚面に固定する構成とする。この構成では、保持具のバンドにより保持具を人体の皮膚面に固定するときには、保持具本体の２つの半割り部にそれぞれ一端が結合された２つの片バンドを人体の上腕部などに巻き付け、この各片バンドの他端側の結合部同士を結合することにより、バンドによる保持具の固定を透析患者一人でも容易に行うことができる。
【００１１】
請求項４に係る発明は、上記結合部の好ましい具体例として、面ファスナーを提示するものである。この面ファスナーでは、片バンド同士の結合をワンタッチで簡単にかつ確実に行うことができる。
【００１２】
請求項５に係る発明は、請求項２〜４のいずれか一つに記載のバンド付き保持具において、保持具本体の２つの半割り部の他端同士を取り外し可能に結合する結合構造の好ましい形態を提供するものである。すなわち、上記結合構造は、保持具本体の一方の半割り部に形成された突出部と、保持具本体の他方の半割り部に設けられた弾性材からなる係合部材とを備え、この係合部材は、上記突出部と係合可能な係合部と、係合部材の弾性変形によりこの係合部と突出部との係合を解除するための押圧操作部とを有しており、保持具本体の２つの半割り部同士を支軸回りに回動させて閉じたとき上記突出部が係合部材の係合部と係合して結合させる構成とする。この構成では、保持具本体の２つの半割り部同士を支軸回りに回動させて閉じたとき、一方の半割り部側の突出部が他方の半割り部側の係合部材の係合部と係合して半割り部同士を結合することができる。また、この状態から係合部材の押圧操作部を押圧して係合部材を弾性変形させると係合部材の係合部と突出部との係合ひいては半割り部同士の結合を容易に解除することができる。
【００１３】
請求項６に係る発明は、請求項２〜５のいずれか一つに記載のバンド付き保持具において、上記保持具本体の内周面に、管状ボディのステム部の先端部外周に形成したフランジエッジ部が嵌合する環状凹部を形成する構成とする。この構成では、保持具本体により管状ボディのステム部の先端部外周を保持するときには、ステム部の先端部外周に形成したフランジエッジ部が保持具本体の内周面に形成した管状凹部に嵌合するため、保持具本体による管状ボディのステム部の保持を確実に行うことができる。
【００１４】
請求項７に係る発明は、請求項２〜６のいずれか一つに記載のバンド付き保持具において、上記保持具本体に、管状ボディのステム部の先端部に形成した位置決め溝に嵌合する第１の位置決め凸部と、アクセス管のジャック部に形成した位置決め溝に嵌合する第２の位置決め凸部とを共に形成する構成とする。この構成では、保持具本体と管状ボディのステム部との間では保持具本体側の第１の位置決め凸部とステム部側の位置決め溝との嵌合により位置決めが行われ、保持具本体とアクセス管のジャック部との間では保持具本体側の第２の位置決め凸部とジャック部側の位置決め溝との嵌合により位置決めが行われるため、アクセス管のジャック部を管状ボディのステム部に対し正常な位置に差し込むことができる。
【００１５】
【発明の実施の形態】
以下、本発明の実施の形態を図面に基づいて説明する。
図１及び図２は本発明の一実施形態に係るバンド付き保持具２０を示す。この保持具２０は、透析患者の上腕部に移植された管状ボディ３のステム部２にアクセス管６ａ，６ｂのジャック部５を差し込んで人工透析を行うときに用いるものあるが、その説明に先立って、管状ボディ３及びアクセス管６ａ，６ｂについて簡単に説明する。
【００１６】
すなわち、管状ボディ３は、図３ないし図５にも示すように、直管部１とステム部２とからなるＴ字形のものであり、直管部１の両端にそれぞれ人工血管(図示せず)が接続されるようになっている。そして、移植手術時には、この管状ボディ３は、透析患者の上腕部にステム部２の先端側が体外に露出した状態で体内に人工血管と共に移植され、人工血管は上腕動脈と腋窩静脈との間に移植される。ステム部２の内部には２つのニードル挿入部８ａ，８ｂが直管部１の軸方向に沿って一列に並んで設けられており、ステム部２の先端部には、その外周面の全周に断面半円形状に膨出するフランジエッジ部９が形成されているとともに、外周の直管部１軸方向と略直交する位置に切り欠き状の位置決め溝１０が形成されている。
【００１７】
また、２本のアクセス管６ａ，６ｂは、一端側をジャック部５により結合して１つのアクセスセット６を構成するようになっており、各アクセス管６ａ，６ｂは透明な樹脂からなり、各アクセス管６ａ，６ｂの他端側は、それぞれ動脈用又は静脈用として人工透析装置側に接続される。アクセスセット６のジャック部５は、上記管状ボディ３のステム部２内に挿入可能な円筒状の挿入部５ａを有し、この挿入部５ａから２本のニードル４ａ，４ｂが延出して設けられている。この各ニードル４ａ，４ｂは、それぞれ対応するアクセス管６ａ，６ｂに連通されており、各ニードル４ａ，４ｂの先端部には小孔１１，…が設けられている。上記挿入部５ａの外周面にはニードル４ａ，４ｂの軸方向に延びる位置決め溝１２が形成されている。そして、上記管状ボディ３などの移植手術後、アクセスセット６のジャック部５の挿入部５ａを管状ボディ３の体外に露出するステム部２内に所定の位相位置で差し込むとジャック部５側の各ニードル４ａ，４ｂがそれぞれステム部２の対応するニードル挿入部８ａ，８ｂを通して管状ボディ３の直管部１内にまで達し、人工透析を行い得るようになっている。
【００１８】
上記バンド付き保持具２０は、図１、図２及び図６に示すように、管状ボディ３のステム部２の先端部外周を保持するステンレス鋼などの金属からなる保持具本体２１を備え、この保持具本体２１は、ステム部２の先端部外周を挟む２つの半割り部２２，２３を有し、この半割り部２２，２３の一端同士を支軸２４回りに開閉するように回動可能に結合し、他端同士を結合構造２５により取り外し可能に結合してなる。上記各半割り部２２，２３の外側面にはそれぞれ矩形枠状のバンド結合部２６，２６が設けられ、この各バンド結合部２６には片バンド２７又は２８の一端部が挿入してピン２９止めにより結合されている。
【００１９】
上記各片バンド２７，２８は、消毒再使用に適するように織布からなり、この各片バンド２７，２８の他端部には互いに結合する結合部として面ファスナー３１，３２が設けられている。そして、両方の片バンド２７，２８を透析患者の上腕部に巻き付けた後、上記面ファスナー３１，３２同士を結合して保持具本体２１を上腕部の皮膚面に固定するようになっている。
【００２０】
また、上記結合構造２５は、図７に示すように、保持具本体２１の一方の半割り部２２の端面に形成されたフック状又はループ状の突出部３３と、保持具本体２１の他方の半割り部２３に設けられた係合部材３４とを備えている。この係合部材３４は、金属製の薄板からなり、かつＵ字状に折り曲げた弾性変形部３４ａを有し、弾性材として弾性変形を生じ易い構造になっている。また係合部材３４は、保持具本体２１の２つの半割り部２２，２３同士を支軸２４回りに回動させて閉じたとき半割り部２３の端面に設けた開口部３５を通して侵入する上記突出部３３と係合可能なフック状の係合部３４ｂと、半割り部２３の外側面に設けた開口部３６から若干突出する押圧操作部３４ｃとを有しており、保持具本体２１の２つの半割り部２２，２３同士を支軸２４回りに回動させて閉じたとき上記突出部３３と係合部３４ｂとの係合により半割り部２２，２３同士を結合し、押圧操作部３４ｃを押すことでこの突出部３３と係合部３４ｂとの係合ひいては半割り部２２，２３同士の結合を解除するようになっている。
【００２１】
さらに、上記保持具本体２１の各半割り部２２，２３の内周面には、図６に示すように、管状ボディ３のステム部２のフランジエッジ部９が嵌合する環状凹部３７が形成されている。また、保持具本体２１の一方の半割り部２３には管状ボディ３のステム部２の位置決め溝１０に嵌合する第１の位置決め凸部３８が内周面より突出して形成されているとともに、保持具本体２１の他方の半割り部２２の上面にはアクセスセット６のジャック部５の位置決め溝１２に嵌合する第２の位置決め凸部３９が内周面より突出して形成されている。
【００２２】
次に、上記バンド付き保持具２０を用いて人工透析を行う場合の手順について説明するに、先ず始めに、透析患者の上腕部に移植した管状ボディ３の体外に露出したステム部２の先端部外周に形成したフランジエッジ部９を保持具本体２１により保持する。このステム部２の保持は、保持具本体２１の開いた状態の２つの半割り部２２，２３でステム部２のフランジエッジ部９を囲みかつ一方の半割り部２３の第１の位置決め凸部３８をステム部２の位置決め溝１０に嵌合して位置合わせをした後、半割り部２２，２３を支軸２４回りに回動して閉じ、その半割り部２２，２３同士を結合構造２５により結合することにより行われるものであるため、透析患者一人でも行うことができる。しかも、結合構造２５は、半割り部２２，２３を支軸２４回りに回動して閉じると一方の半割り部２２の突出部３３が他方の半割り部２３の係合部材３４の係合部３４ｂと係合して半割り部２２，２３同士が結合される構成になっているため、ステム部２の保持を透析患者一人でも容易に行うことができる。また、保持具本体２１の各半割り部２２，２３の内周面に、ステム部２のフランジエッジ部９が嵌合する環状凹部３７が形成されているため、保持状態での接触面を大きく確保してステム部２の保持を強固に行うことができる。
【００２３】
続いて、保持具本体２１の各半割り部２２，２３にそれぞれ一端が連結された２つの片バンド２７，２８を透析患者の上腕部に巻き付け、この両片バンド２７，２８の他端側の面ファスナー３１，３２同士を重ね合わせて結合することにより、保持具本体２１を上腕部の皮膚面に固定する。この片バンド２７，２８による保持具本体２１の固定も、ステム部２の保持のときと同様に透析患者一人でも容易に行うことができる。
【００２４】
しかる後、人工透析装置側に接続されたアクセスセット６のジャック部５を管状ボディ３のステム部２内に差し込む(図８に示す状態)。その際、管状ボディ３のステム部２はバンド付き保持具２０により保持され、このステム部２に作用する荷重が保持具２０を介して透析患者の上腕部の皮膚面側に分散されるため、管状ボディ３の体内側である直管部１側に異常な荷重がかかることはなく、安全に操作をすることができる。その上、アクセスセット６のジャック部５は、その位置決め溝１２に保持具本体２１の半割り部２２の第２の位置決め凸部３９を嵌合させて位置合わせをしないと管状ボディ３のステム部２内に差し込むことができないようになっており、また管状ボディ３のステム部２と保持具本体２１とは、既にステム部２の位置決め溝１０と保持具本体２１の半割り部２３の第１の位置決め凸部３８との嵌合により位置合わせが行われているため、ジャック部５の２本のニードル４ａ，４ｂをそれぞれステム部２の対応するニードル挿入部８ａ，８ｂに正常に差し込むことができ、安全性をより高めることができる。
【００２５】
以上の手順で操作をした後に人工透析を行うことができる。また、人工透析の後は、先ず、アクセスセット６のジャック部５を管状ボディ３のステム部２内から引き抜く。その際、管状ボディ３の直管部１側に異常な荷重がかかるのを防止できるのは、差し込みのときと同様である。続いて、片バンド２７，２８の面ファスナー３１，３２同士の結合を外した後、結合構造２５の係合部材３４の押圧操作部３４ｃを押して係合部材３４の係合部３４ｂと突出部３３との係合ひいては保持具本体２１の半割り部２２，２３同士の結合を解除し、その半割り部２２，２３を支軸２４回りに回動して開くことにより、バンド付き保持具２０を透析患者の上腕部から取り外す。
【００２６】
このように、バンド付き保持具２０を用いた人工透析方法では、透析患者一人でも容易にかつ安全に人工透析を行うことができるので、自己透析や家庭透析の実用化に寄与することができる。しかも、既存の管状ボディ３及びアクセスセット６に対しては、それぞれ位置決め溝１０，１２を切削加工により形成すれば足りるので、実施化を容易に図ることができる。
【００２７】
尚、本発明は上記実施形態に限定されるものではなく、その他種々の実施形態を包含するものである。例えば上記実施形態では、保持具本体２１の２つの半割り部２２，２３にそれぞれ片バンド２７，２８の一端を結合し、この両片バンド２７，２８の他端側に面ファスナー３１，３２を設けて、両片バンド２７，２８同士を結合するようにしたが、本発明のバンド付き保持具としては、面ファスナー３１，３２の代わりに、フック金具や腕時計用バンドの留め金具などを用いて、片バンド２７，２８同士を結合するようにしてもよい。また、バンドに伸縮性のものを使用し、そのバンドの両端をそれぞれ保持具本体２１の２つの半割り部２２，２３に結合するように構成してもよい。
【００２８】
さらに、保持具本体２１の２つの半割り部２２，２３同士を取り外し可能に結合する結合構造２５としては、上記実施形態の如きものに限らず、半割り部２２，２３同士をピンやネジなどで結合するように構成してもよいのは勿論である。
【００２９】
【発明の効果】
以上のように、本発明の人工透析方法によれば、体内に移植した管状ボディの体外に露出するステム部の先端部外周を保持するバンド付き保持具をそのバンドにより人体の皮膚面に固定した状態でアクセス管のジャック部を管状ボディのステム部に差し込んだり、ステム部から引き抜いたりするため、体内の管状ボディ側に異常な荷重がかかることはなく、安全に操作をすることができる。しかも、保持具による管状ボディのステム部の保持及びバンドによる保持具の固定は、透析患者一人でも行うことができるので、人工透析をも介添え者を要することなく行うことができ、自己透析や家庭透析に適したものである。
【００３０】
また、本発明のバンド付き保持具によれば、管状ボディのステム部の先端部外周を保持具本体により保持するときには、保持具本体の２つの半割り部同士を開いた状態からステム部の先端部外周を挟むように一端側の支軸回りに回動して閉じ、他端側の結合構造により半割り部の他端同士を結合することにより、保持具による管状ボディのステム部の保持を透析患者一人でも容易に行うことができるので、自己透析や家庭透析の実用化に寄与することができる。
【００３１】
特に、請求項３に係る発明では、保持具のバンドにより保持具を人体の皮膚面に固定するときには、保持具本体の２つの半割り部にそれぞれ一端が結合された２つの片バンドを人体の上腕部などに巻き付け、この各片バンドの他端側の面ファスナーなどの結合部同士を結合することにより、バンドによる保持具の固定を透析患者一人でも容易に行うことができるので、自己透析や家庭透析の実用化に一層寄与することができる。
【００３２】
請求項５に係る発明では、保持具本体の２つの半割り部同士を支軸回りに回動させて閉じたとき、一方の半割り部側の突出部が他方の半割り部側の係合部材の係合部と係合して半割り部同士を結合することができる上、この状態から係合部材の押圧操作部を押圧して係合部材を弾性変形させると係合部材の係合部と突出部との係合ひいては半割り部同士の結合を容易に解除することができるので、自己透析や家庭透析の実用化により一層寄与することができる。
【００３３】
請求項６に係る発明では、保持具本体により管状ボディのステム部の先端部外周を保持するときには、ステム部の先端部外周に形成したフランジエッジ部が保持具本体の内周面に形成した管状凹部に嵌合するため、保持具本体による管状ボディのステム部の保持を確実に行うことができるという効果をも奏する。
【００３４】
さらに、請求項７に係る発明では、保持具本体と管状ボディのステム部との間では保持具本体側の第１の位置決め凸部とステム部側の位置決め溝との嵌合により位置決めが行われ、保持具本体とアクセス管のジャック部との間では保持具本体側の第２の位置決め凸部とジャック部側の位置決め溝との嵌合により位置決めが行われるため、アクセス管のジャック部を管状ボディのステム部に対し正常な位置に差し込むことができ、安全性を高めることができる。その上、既存の管状ボディ及びアクセス管に対しては、それぞれ位置決め溝を切削加工により形成すれば足りるので、実用性に優れた効果を有するものである。
【図面の簡単な説明】
【図１】本発明の実施形態に係るバンド付き保持具、管状ボディ及びアクセスセットを示す斜視図である。
【図２】図１のバンド付き保持具の保持具本体付近の拡大図である。
【図３】管状ボディの斜視図である。
【図４】管状ボディの一部を切開して見た正面図である。
【図５】同平面図である。
【図６】バンド付き保持具の保持具本体付近の斜視図である。
【図７】図６のＸ−Ｘ線における拡大断面図である。
【図８】アクセスセットのジャック部を管状ボディのステム部に差し込んだ状態の図２相当図である。
【図９】従来の技術を説明するための斜視図である。
【符号の説明】
１直管部
２ステム部
３管状ボディ
４ａ，４ｂニードル
５ジャック部
６ａ，６ｂアクセス管
９フランジエッジ部
１０，１２位置決め溝
２０バンド付き保持具
２１保持具本体
２２，２３半割り部
２４支軸
２５結合構造
２７，２８片バンド
３１，３２面ファスナー(結合部)
３３突出部
３４係合部材
３４ｂ係合部
３４ｃ押圧操作部
３７環状凹部
２８第１の位置決め凸部
２９第２の位置決め凸部[0001]
TECHNICAL FIELD OF THE INVENTION
The present invention relates to an artificial dialysis method for enabling self-dialysis and home dialysis, and a holder with a band used for the method.
[0002]
[Prior art]
Conventionally, as this type of artificial dialysis method, for example, as disclosed in Patent Document 1 and also shown in FIG. 9, transplantation is previously performed between a predetermined artery and a vein of a human body, for example, between a brachial artery and an axillary vein. A T-shaped tubular body 3 composed of a straight tube portion 1 and a stem portion 2 is provided in the middle of the artificial blood vessel to be implanted, and this tubular body 3 is implanted together with the artificial blood vessel into the body with the distal end side of the stem portion 2 exposed outside the body. Surgery is performed, and after that, the other ends of a pair of access tubes 6a and 6b provided with a jack portion 5 having needles 4a and 4b at one end are connected to the artificial dialysis machine side, and the access tubes 6a and 6b are It is known that the jack portion 5 is inserted into the stem portion 2 of the tubular body 3 to perform artificial dialysis.
[0003]
[Patent Document 1]
U.S. Pat. No. 4,417,888 (columns 3-4, FIGS. 1-7)
[0004]
[Problems to be solved by the invention]
However, in the artificial dialysis method as described above, when the jack portion 5 of the access tubes 6a, 6b is inserted into or pulled out of the stem portion 2 of the tubular body 3, an abnormal load is applied to the tubular body 3 side in the body. In order to prevent the dialysis, it is necessary for an attendant to hold the outer periphery of the distal end portion, which is a portion exposed outside the stem portion 2 of the tubular body 3, with the scissors-type holder 7, and only one dialysis patient performs artificial dialysis. The fact is that you cannot do it.
[0005]
The present invention has been made in view of the above point, and a first object thereof is to insert the jack portion 5 of the access pipes 6a and 6b into the stem portion 2 of the tubular body 3 as described above, When the dialysis patient 2 is pulled out of the dialysis patient, the dialysis patient can hold the outer circumference of the distal end portion of the stem portion 2 of the tubular body 3 without requiring an attendant to prevent an abnormal load from being applied to the tubular body 3 side in the body. The purpose of the present invention is to provide an artificial dialysis method that can easily perform the dialysis.
[0006]
A second object of the present invention is to provide a holder with a band suitable for use in the artificial dialysis method provided this time.
[0007]
[Means for Solving the Problems]
In order to achieve the first object, an invention according to claim 1 is a T-shaped tubular member comprising a straight tube portion and a stem portion in the middle of an artificial blood vessel implanted between a predetermined artery and a vein of a human body. A body is provided, and the tubular body is implanted together with an artificial blood vessel into the body in a state where the distal end side of the stem is exposed outside the body. Then, the other end of a pair of access tubes provided with a jack having a needle at one end is provided with an artificial dialysis device. In the artificial dialysis method of performing artificial dialysis by inserting the jack portion of the access tube into the stem portion of the tubular body and performing artificial dialysis, the outer periphery of the distal end portion of the stem portion of the tubular body is held by a holder with a band. The jack portion of the access tube is inserted into or pulled out of the stem of the tubular body while the holder is fixed to the skin surface of the human body by the band of the holder.
[0008]
With this configuration, the jack part of the access tube is fixed to the skin surface of the human body by the band with the holder with the band holding the outer periphery of the distal end of the stem part exposed outside the body of the tubular body implanted in the body. Since it is inserted into or pulled out of the stem, no abnormal load is applied to the tubular body in the body. In addition, the holding of the stem portion of the tubular body by the holding tool and the fixing of the holding tool by the band can be performed by only one dialysis patient, so that the artificial dialysis can be performed without requiring an attendant.
[0009]
According to a second aspect of the present invention, there is provided a holder with a band for use in the artificial dialysis method according to the first aspect, which holds the outer periphery of the distal end of the stem of the tubular body. The main body of the holder has two halves sandwiching the outer periphery of the distal end portion of the stem portion. One end of the halves is rotatably connected around a support shaft, and the other ends are connected to each other. Are detachably connected by a connection structure. With this configuration, when the outer periphery of the distal end portion of the stem portion of the tubular body is held by the holder main body, one end side of the stem portion is sandwiched from the open state of the two halves of the holder main body so as to sandwich the distal end outer periphery of the stem portion. By rotating around the support shaft and closing, and connecting the other ends of the half-split parts by the connecting structure at the other end, the holding of the tubular body stem by the holding tool (specifically, the holding tool main body) can be performed by the dialysis patient. Even one person can do it easily.
[0010]
According to a third aspect of the present invention, in the holder with the band according to the second aspect, one end of one band is coupled to each of the two halves, and a coupling portion coupled to the other end of each band is provided. The holder body is fixed to the skin surface of a human body by connecting the two connecting portions. In this configuration, when the holder is fixed to the skin surface of the human body by the band of the holder, two pieces of bands each having one end coupled to the two half portions of the holder main body are wound around the upper arm of the human body, By connecting the connecting portions on the other end side of each band, fixing of the holder by the band can be easily performed by one dialysis patient.
[0011]
The invention according to claim 4 presents a hook-and-loop fastener as a preferred specific example of the connecting portion. With this hook-and-loop fastener, the joining of the single bands can be performed easily and reliably with one touch.
[0012]
According to a fifth aspect of the present invention, in the holder with the band according to any one of the second to fourth aspects, it is preferable that the other end of the two half portions of the holder main body is detachably connected to each other. It provides a form. That is, the coupling structure includes a projection formed on one half of the holder main body, and an engaging member made of an elastic material provided on the other half of the holder main body. The joining member has an engaging portion engageable with the projecting portion, and a pressing operation portion for releasing the engagement between the engaging portion and the projecting portion by elastic deformation of the engaging member, When the two half-split portions of the holder main body are rotated around the support shaft and closed, the projecting portion engages with the engaging portion of the engaging member to be joined. With this configuration, when the two half-split portions of the holder main body are rotated around the support shaft and closed, the protrusion on one half-split side engages with the engagement member on the other half-split side. The halves can be connected to each other by engaging with the halves. In this state, when the pressing operation portion of the engaging member is pressed to elastically deform the engaging member, the engagement between the engaging portion and the protruding portion of the engaging member, and furthermore, the coupling between the half-split portions is easily released. be able to.
[0013]
According to a sixth aspect of the present invention, in the holder with the band according to any one of the second to fifth aspects, a flange formed on an inner peripheral surface of the holder main body and at an outer periphery of a distal end portion of a stem portion of the tubular body. A configuration is adopted in which an annular recess is formed in which the edge portion is fitted. With this configuration, when the outer periphery of the distal end of the stem portion of the tubular body is held by the holder main body, the flange edge formed on the outer periphery of the distal end of the stem fits into the tubular recess formed on the inner peripheral surface of the holder main body. Therefore, it is possible to reliably hold the stem portion of the tubular body by the holder body.
[0014]
According to a seventh aspect of the present invention, in the holder with the band according to any one of the second to sixth aspects, the holder main body is fitted into a positioning groove formed at a distal end portion of a stem portion of the tubular body. The first positioning projection and the second positioning projection fitted into the positioning groove formed in the jack of the access tube are formed together. In this configuration, the positioning between the holder main body and the stem portion of the tubular body is performed by fitting the first positioning projection on the holder main body side with the positioning groove on the stem portion side. Positioning between the jack portion of the tube and the positioning groove of the jack portion is performed by fitting the second positioning convex portion on the holder main body side with the positioning groove on the jack portion side. It can be inserted in a normal position.
[0015]
BEST MODE FOR CARRYING OUT THE INVENTION
Hereinafter, embodiments of the present invention will be described with reference to the drawings.
1 and 2 show a holder 20 with a band according to an embodiment of the present invention. The holder 20 is used for performing artificial dialysis by inserting the jacks 5 of the access tubes 6a and 6b into the stem 2 of the tubular body 3 implanted in the upper arm of the dialysis patient. Then, the tubular body 3 and the access pipes 6a and 6b will be briefly described.
[0016]
That is, as shown in FIGS. 3 to 5, the tubular body 3 has a T-shape including a straight pipe 1 and a stem 2, and has artificial blood vessels (not shown) at both ends of the straight pipe 1. ) Is connected. At the time of transplant operation, the tubular body 3 is implanted together with an artificial blood vessel into the body of the dialysis patient with the distal end side of the stem 2 exposed outside the body, and the artificial blood vessel is inserted between the brachial artery and the axillary vein. Be transplanted. Inside the stem portion 2, two needle insertion portions 8a and 8b are provided in a line along the axial direction of the straight tube portion 1, and the distal end portion of the stem portion 2 has the entire outer peripheral surface thereof. A flange edge portion 9 which bulges in a semicircular cross section is formed, and a notch-shaped positioning groove 10 is formed at a position substantially orthogonal to the axial direction of the straight pipe portion on the outer periphery.
[0017]
The two access pipes 6a and 6b are configured such that one end is connected by a jack portion 5 to form one access set 6, and each access pipe 6a and 6b is made of a transparent resin. The other ends of the access tubes 6a and 6b are connected to the artificial dialysis machine for arteries or veins, respectively. The jack portion 5 of the access set 6 has a cylindrical insertion portion 5a that can be inserted into the stem portion 2 of the tubular body 3, and two needles 4a and 4b extend from the insertion portion 5a. ing. The needles 4a, 4b are connected to the corresponding access pipes 6a, 6b, respectively, and the needles 4a, 4b are provided with small holes 11,. A positioning groove 12 extending in the axial direction of the needles 4a and 4b is formed on the outer peripheral surface of the insertion portion 5a. After the transplant operation of the tubular body 3 or the like, when the insertion portion 5a of the jack portion 5 of the access set 6 is inserted into the stem portion 2 exposed outside the body of the tubular body 3 at a predetermined phase position, each of the jack portion 5 side The needles 4a and 4b reach the straight tube portion 1 of the tubular body 3 through the corresponding needle insertion portions 8a and 8b of the stem portion 2 so that artificial dialysis can be performed.
[0018]
As shown in FIGS. 1, 2 and 6, the band-equipped holder 20 includes a holder main body 21 made of metal such as stainless steel for holding the outer periphery of the distal end portion of the stem portion 2 of the tubular body 3. The holder main body 21 has two half portions 22 and 23 sandwiching the outer periphery of the distal end portion of the stem portion 2, and is rotatable so as to open and close one end of the half portions 22 and 23 around the support shaft 24. , And the other ends are detachably connected to each other by a connection structure 25. On the outer surfaces of the halves 22, 23, there are provided band connecting portions 26, 26 each having a rectangular frame shape. In each of the band connecting portions 26, one end of one band 27 or 28 is inserted and a pin 29 is inserted. They are joined by stops.
[0019]
Each of the bands 27, 28 is made of a woven fabric so as to be suitable for disinfection and reuse, and the other end of each of the bands 27, 28 is provided with a hook-and-loop fastener 31, 32 as a connecting portion for connecting to each other. . Then, after the two band 27, 28 are wound around the upper arm of the dialysis patient, the hook-and-loop fasteners 31, 32 are joined together to fix the holder body 21 to the skin surface of the upper arm.
[0020]
As shown in FIG. 7, the coupling structure 25 includes a hook-shaped or loop-shaped protrusion 33 formed on an end surface of one half portion 22 of the holder main body 21 and the other of the holder main body 21. And an engagement member 34 provided on the half part 23. The engaging member 34 is made of a thin metal plate, has an elastically deforming portion 34a bent in a U-shape, and has a structure that is easily elastically deformed as an elastic material. The engaging member 34 penetrates through the opening 35 provided on the end face of the half part 23 when the two half parts 22 and 23 of the holder main body 21 are closed by rotating them about the support shaft 24. It has a hook-shaped engaging portion 34b that can be engaged with the projecting portion 33, and a pressing operation portion 34c that slightly protrudes from an opening 36 provided on the outer surface of the half portion 23. When the two halves 22 and 23 are rotated around the support shaft 24 and closed, the half halves 22 and 23 are joined by the engagement of the protruding portion 33 and the engaging portion 34b, and the pressing operation portion is formed. By pressing the pressing portion 34c, the engagement between the projecting portion 33 and the engaging portion 34b, and furthermore, the coupling between the half portions 22, 23 are released.
[0021]
Further, as shown in FIG. 6, an annular concave portion 37 into which the flange edge portion 9 of the stem portion 2 of the tubular body 3 fits is formed on the inner peripheral surface of each of the half portions 22 and 23 of the holder main body 21. Have been. In addition, a first positioning convex portion 38 that fits into the positioning groove 10 of the stem portion 2 of the tubular body 3 is formed in the one half portion 23 of the holder main body 21 so as to protrude from the inner peripheral surface. On the upper surface of the other half portion 22 of the holder main body 21, a second positioning convex portion 39 that fits into the positioning groove 12 of the jack portion 5 of the access set 6 is formed so as to protrude from the inner peripheral surface.
[0022]
Next, a procedure for performing artificial dialysis using the holder 20 with a band will be described. First, the distal end of the stem 2 exposed outside the body of the tubular body 3 implanted in the upper arm of the dialysis patient. The flange edge portion 9 formed on the outer periphery is held by the holder main body 21. The stem portion 2 is held by surrounding the flange edge portion 9 of the stem portion 2 with the two half portions 22 and 23 of the holding tool body 21 in the opened state and the first positioning projection of one half portion 23. 38 is fitted into the positioning groove 10 of the stem portion 2 for positioning, the half-split portions 22 and 23 are turned around the support shaft 24 and closed, and the half-split portions 22 and 23 are joined to each other by the coupling structure 25. Since the dialysis is performed by the combination, the dialysis can be performed by one dialysis patient alone. In addition, the coupling structure 25 is configured such that when the half portions 22 and 23 are rotated around the support shaft 24 and closed, the protruding portion 33 of one half portion 22 engages with the engaging member 34 of the other half portion 23. Since the half portions 22 and 23 are connected to each other by engaging with the portion 34b, the dialysis patient can easily hold the stem portion 2 alone. Further, since an annular concave portion 37 into which the flange edge portion 9 of the stem portion 2 is fitted is formed on the inner peripheral surface of each of the half portions 22 and 23 of the holder main body 21, the contact surface in the holding state is increased. As a result, the stem portion 2 can be held firmly.
[0023]
Subsequently, two bands 27 and 28 each having one end connected to each of the half portions 22 and 23 of the holder main body 21 are wound around the upper arm portion of the dialysis patient. The holder main body 21 is fixed to the skin surface of the upper arm part by overlapping and connecting the surface fasteners 31 and 32 to each other. The fixation of the holder main body 21 by the single bands 27 and 28 can be easily performed by one dialysis patient as in the case of holding the stem portion 2.
[0024]
Thereafter, the jack 5 of the access set 6 connected to the artificial dialysis machine is inserted into the stem 2 of the tubular body 3 (the state shown in FIG. 8). At this time, the stem 2 of the tubular body 3 is held by the holder 20 with a band, and the load acting on the stem 2 is dispersed through the holder 20 to the skin side of the upper arm of the dialysis patient. An unusual load is not applied to the straight pipe portion 1 side, which is the inside of the tubular body 3, and the operation can be performed safely. In addition, the jack portion 5 of the access set 6 is required to be engaged with the second positioning projection 39 of the half part 22 of the holder main body 21 in the positioning groove 12 so that the stem portion of the tubular body 3 must be aligned. 2 and the stem portion 2 of the tubular body 3 and the holder main body 21 are already in contact with the positioning groove 10 of the stem portion 2 and the first half of the half portion 23 of the holder main body 21. Since the positioning is performed by fitting with the positioning projections 38, the two needles 4a and 4b of the jack portion 5 can be normally inserted into the corresponding needle insertion portions 8a and 8b of the stem portion 2, respectively. And safety can be further improved.
[0025]
After the operation according to the above procedure, artificial dialysis can be performed. After the artificial dialysis, first, the jack portion 5 of the access set 6 is pulled out from the stem portion 2 of the tubular body 3. At that time, it is possible to prevent an abnormal load from being applied to the straight pipe portion 1 side of the tubular body 3 as in the case of insertion. Subsequently, after the coupling between the hook-and-loop fasteners 31 and 32 of the one-piece bands 27 and 28 is released, the pressing operation portion 34 c of the engagement member 34 of the coupling structure 25 is pushed to engage the engagement portion 34 b of the engagement member 34 and the protrusion 33 By releasing the engagement between the half-split portions 22 and 23 of the holder main body 21 and by opening the half-split portions 22 and 23 about the support shaft 24, the holder 20 with the band is released. Remove from upper arm of dialysis patient.
[0026]
As described above, the artificial dialysis method using the holder 20 with a band can easily and safely perform artificial dialysis even by one dialysis patient, thereby contributing to the practical use of self-dialysis and home dialysis. In addition, since it is sufficient to form the positioning grooves 10 and 12 by cutting for the existing tubular body 3 and the access set 6, respectively, the implementation can be easily achieved.
[0027]
It should be noted that the present invention is not limited to the above embodiment, but includes various other embodiments. For example, in the above embodiment, one ends of the bands 27, 28 are respectively connected to the two halves 22, 23 of the holder body 21, and the hook-and-loop fasteners 31, 32 are attached to the other ends of the bands 27, 28, respectively. Although the two bands 27 and 28 are connected to each other, the band-equipped holding device of the present invention uses a hook fitting or a clasp of a watch band instead of the hook-and-loop fasteners 31 and 32. Alternatively, the single bands 27 and 28 may be connected to each other. Alternatively, an elastic band may be used, and both ends of the band may be connected to the two halves 22, 23 of the holder body 21, respectively.
[0028]
Further, the connecting structure 25 for detachably connecting the two half portions 22 and 23 of the holder main body 21 is not limited to the one described in the above-described embodiment. Needless to say, it may be configured so as to be combined with each other.
[0029]
【The invention's effect】
As described above, according to the artificial dialysis method of the present invention, the holder with the band that holds the outer periphery of the distal end of the stem portion exposed outside the body of the tubular body implanted in the body is fixed to the skin surface of the human body by the band. In this state, the jack portion of the access tube is inserted into the stem portion of the tubular body or pulled out from the stem portion, so that an abnormal load is not applied to the tubular body side in the body, and the operation can be performed safely. Moreover, since the holding device can hold the stem portion of the tubular body and the band can fix the holding device, even a single dialysis patient can perform artificial dialysis without the need of an attendant. Suitable for dialysis.
[0030]
According to the holder with a band of the present invention, when the outer periphery of the distal end of the stem of the tubular body is held by the holder main body, the tip of the stem is moved from the state in which the two halves of the holder main body are opened. By rotating around the support shaft on one end side so as to sandwich the outer periphery and closing the other end of the half-split portion by the connecting structure on the other end side, the holding of the stem portion of the tubular body by the holding tool is performed. Since even a single dialysis patient can easily perform the procedure, it can contribute to the practical use of self-dialysis and home dialysis.
[0031]
In particular, in the invention according to claim 3, when the holding tool is fixed to the skin surface of the human body by the band of the holding tool, the two single bands each having one end respectively connected to the two half portions of the holding tool body are connected to the human body. By wrapping around the upper arm etc. and connecting the connecting parts such as hook-and-loop fasteners at the other end of each band, fixing of the holder by the band can be easily performed by one dialysis patient, so that self-dialysis and This can further contribute to the practical use of home dialysis.
[0032]
In the invention according to claim 5, when the two half-split portions of the holder main body are rotated around the support shaft and closed, the protruding portion on one half-split side engages with the other half-split portion. The half-split portions can be joined together by engaging with the engaging portions of the members, and when the pressing operation portion of the engaging members is pressed from this state to elastically deform the engaging members, the engaging members are engaged. Since the engagement between the portion and the projection and thus the connection between the half portions can be easily released, it is possible to further contribute to the practical use of self-dialysis and home dialysis.
[0033]
In the invention according to claim 6, when the outer periphery of the distal end portion of the stem portion of the tubular body is held by the holder main body, the flange edge formed on the outer periphery of the distal end portion of the stem portion has the tubular edge formed on the inner peripheral surface of the holder main body. Since the fitting is performed in the concave portion, an effect that the holding portion main body can surely hold the stem portion of the tubular body can be obtained.
[0034]
Further, in the invention according to claim 7, positioning is performed between the holder main body and the stem portion of the tubular body by fitting the first positioning projection on the holder main body side with the positioning groove on the stem portion side. Since the positioning between the holder main body and the jack portion of the access tube is performed by fitting the second positioning projection on the holder main body and the positioning groove on the jack portion side, the jack portion of the access tube is tubular. It can be inserted into a normal position with respect to the stem portion of the body, and safety can be enhanced. In addition, it is sufficient for the existing tubular body and the access pipe to form the positioning grooves by cutting, so that the present invention has an effect that is excellent in practicality.
[Brief description of the drawings]
FIG. 1 is a perspective view showing a holder with a band, a tubular body, and an access set according to an embodiment of the present invention.
FIG. 2 is an enlarged view of the vicinity of a holder main body of the holder with a band in FIG. 1;
FIG. 3 is a perspective view of a tubular body.
FIG. 4 is a front view in which a part of the tubular body is cut and viewed.
FIG. 5 is a plan view of the same.
FIG. 6 is a perspective view of the vicinity of a holder main body of the holder with a band.
FIG. 7 is an enlarged sectional view taken along line XX of FIG. 6;
FIG. 8 is a diagram corresponding to FIG. 2 in a state where a jack portion of the access set is inserted into a stem portion of the tubular body.
FIG. 9 is a perspective view for explaining a conventional technique.
[Explanation of symbols]
DESCRIPTION OF SYMBOLS 1 Straight pipe part 2 Stem part 3 Tubular body 4a, 4b Needle 5 Jack part 6a, 6b Access pipe 9 Flange edge part 10, 12 Positioning groove 20 Banded holder 21 Holder main body 22, 23 Half split part 24 Shaft 25 Coupling structure 27, 28 Single band 31, 32 Surface fastener (coupling part)
33 projecting part 34 engaging member 34b engaging part 34c pressing operation part 37 annular concave part 28 first positioning convex part 29 second positioning convex part

Claims

A T-shaped tubular body consisting of a straight tube portion and a stem portion is provided in the middle of an artificial blood vessel to be implanted between a predetermined artery and a vein of a human body, and this tubular body is in a state where the distal end side of the stem portion is exposed outside the body. After being implanted in the body together with an artificial blood vessel, the other end of a pair of access tubes provided with a jack portion having a needle at one end is connected to the artificial dialysis device side, and the jack portion of the access tube is connected to the stem portion of the tubular body. In the artificial dialysis method of performing artificial dialysis by inserting
The outer periphery of the distal end of the stem of the tubular body is held by a holder with a band, and the jack of the access tube is inserted into the stem of the tubular body while the holder is fixed to the skin surface of the human body by the band of the holder. An artificial dialysis method characterized by pulling out from the stem part.

It is a holder with a band used for the artificial dialysis method of Claim 1, Comprising:
The tubular body includes a holder main body that holds an outer periphery of a distal end portion of a stem portion. The holder main body has two half portions that sandwich the outer periphery of the distal end portion of the stem portion. A holder with a band, wherein the holder is rotatably connected around a support shaft and the other ends are detachably connected by a connection structure.

One end of a band is connected to each of the two halves, and a connecting portion is provided at the other end of each band. The connecting portion is connected to each other to connect the holder body to a human body. 3. The band-equipped holding device according to claim 2, wherein the holding device is fixed to the skin surface.

The holding device with a band according to claim 3, wherein the coupling portion is a hook-and-loop fastener.

The coupling structure includes a projection formed on one half of the holder main body, and an engaging member made of an elastic material provided on the other half of the holder main body. Has an engaging portion engageable with the protruding portion, and a pressing operation portion for releasing the engagement between the engaging portion and the protruding portion by elastic deformation of the engaging member. The projection according to any one of claims 2 to 4, wherein when the two half-split portions of the main body are rotated around the support shaft and closed, the projecting portion engages with the engaging portion of the engaging member. A holder with a band according to any one of the above.

An annular concave portion is formed on an inner peripheral surface of the holder main body so as to fit a flange edge portion formed on an outer periphery of a distal end portion of a stem portion of the tubular body. Holder with band.

The holder main body has a first positioning protrusion that fits into a positioning groove formed at the distal end of the stem of the tubular body, and a second positioning fit that fits into a positioning groove formed in the jack of the access tube. The holder with a band according to any one of claims 2 to 6, wherein the projection is formed together with the projection.