JP2009261650A - Removal assist appliance of indwelling catheter - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a removal assist appliance of an indwelling catheter capable of surely deforming a fixture in a body cavity and pulling it out from a stoma at a little force. <P>SOLUTION: This removal assist appliance is provided with an inner tube 3 allowing the insertion of a tube body 41 of a gastrostomy catheter 4 in its inside, and an outer tube 2 mounted around the peripheral face of the inner tube 3. The outer tube body 21 and the inner tube body 31 have an outer tube cutout portion and an inner tube cutout portion 32 inclined toward the distal end respectively. The outer tube 2 and the inner tube 3 are relatively rotatably assembled axially by 180°. The gastrostomy catheter 4 is inserted in the interior of the inner tube 3 with the cutout directions of the outer cutout portion and the inner cutout portion 32 fitted to each other, and the outer tube 2 and the inner tube 3 are inserted in the stoma A. The inner tube 3 is rotated to clamp a bumper 42 between the outer tube cutout portion and the inner tube cutout portion 32. After that, the removal assist appliance 1 is removed along with the gastrostomy catheter 4 with a guide wire 5 indwelled in the stoma A. This method can reduce the burden applied to a patient by the procedure. <P>COPYRIGHT: (C)2010,JPO&INPIT

Description

  The present invention relates to an auxiliary tool used when removing an indwelling catheter placed in a body cavity such as a stomach or a bladder.

  As this type of indwelling catheter removal aid, for example, one disclosed in Patent Document 1 below is known. Patent Document 1 discloses an auxiliary tool for removing a fistula catheter provided with a bumper formed at a distal end portion of a tube having a diameter larger than the outer diameter of the tube. The auxiliary tool includes a cylindrical member having an inner diameter that is substantially the same as the outer diameter of the tube. The tube is inserted into the cylindrical member from the rear end, and the cylindrical member is inserted into the fistula in this state. Insert the tip into the body cavity. By pulling the tube backward from this state, the bumper can be deformed and pulled into the cylindrical member, and the bumper can be pulled out from the cylindrical portion.

However, it is actually not easy to draw a bumper having a diameter larger than the outer diameter of the tube into a cylindrical member having an inner diameter substantially the same as the outer diameter of the tube. If the surgeon tries to pull the bumper into the cylindrical member and pulls the tube strongly against the cylindrical member, the bumper may come off from the tip of the tube. In addition, when the tube is pulled strongly, the cylindrical member must be pressed with a strong force. However, when a strong force is applied to the cylindrical member, the cylindrical member moves in the axial or radial direction of the fistula, causing pain to the patient. There is also a risk of giving.
JP 2005-168980 A, paragraphs 0018, 0019, FIG.

  An object of the present invention is to improve an auxiliary tool used for removing an indwelling catheter placed in a body cavity. More specifically, in order to eliminate the inconvenience, the body cavity fixing tool is reliably deformed with a light force. It aims at providing the indwelling catheter removal assistance tool which can be extracted from a fistula.

  In order to achieve the above object, an indwelling catheter removal assisting device according to the present invention includes a flexible tube main body whose distal end is inserted into a body cavity through a fistula, and a body cavity provided at the distal end of the tube main body. An extraction assisting tool for extracting an indwelling catheter from the body cavity with a flexible bowl-shaped body cavity fixing part that regulates the extraction of the tube body from the outer cylinder, An inner cylinder that is inserted into the outer cylinder and into which the tube main body can be inserted, and the outer cylinder is cut out at a distal end portion inserted into the body cavity so as to face the body cavity fixing portion. An outer cylinder notch is provided, and the inner cylinder is provided with an inner cylinder notch that is notched so as to face the body cavity fixing portion at the distal end inserted into the body cavity. Insert the inner cylinder to cut the outer cylinder notch and the inner cylinder With the notch direction of the parts aligned, the rear end side of the tube body is inserted from the distal end side of the inner cylinder, and the outer cylinder and the inner cylinder are moved so that each distal end reaches the body cavity through the fistula. Inserting and pulling the tube main body backward causes the body cavity fixing portion to face the inner tube notch, and rotates either the outer tube or the inner tube or both around the axis to rotate the outer tube The body cavity fixing part is sandwiched between the notch part and the inner cylinder notch part, and the indwelling catheter and at least the inner cylinder can be removed from the body cavity via a fistula.

  According to the indwelling catheter removal assisting device of the present invention, the outer cylinder and the inner cylinder are inserted into the body cavity in a state where the notch directions of the outer cylinder notch and the inner cylinder notch are aligned, and the tube body is moved in this state. Since it is pulled backward, the body cavity fixing portion faces the inner tube notch. In order to achieve such a state, it is not necessary to forcefully deform the body cavity fixing portion, and therefore the tube body may be pulled with a force smaller than that of a conventional auxiliary tool. Then, the outer cylinder or the inner cylinder is rotated about its axis, and the body cavity fixing portion is sandwiched between the outer cylinder notch and the inner cylinder notch. Since the notches are formed at the tips of the outer cylinder and the inner cylinder, respectively, the body cavity fixing part is deformed by rotating the outer cylinder or the inner cylinder around its axis, and the outer cylinder notch and It can be clamped between the inner tube notch. As described above, when the body cavity fixing portion is sandwiched between the notches, the body cavity fixing tool can reduce the amount of protrusion of the outer cylinder and the inner cylinder toward the outer peripheral side. Therefore, when the outer tube, the inner tube, and the fistula catheter are removed from the fistula in this state, the pain given to the patient can be minimized.

  In the indwelling catheter removal assisting tool of the present invention, only the fistula catheter and the inner tube can be removed while the outer tube is inserted into the fistula. In this case, since the body cavity fixing portion is already sandwiched between the outer tube notch portion and the inner tube notch portion and is folded small, it is easy to pass the inside of the outer tube. In this case, since the fistula catheter and the inner cylinder do not touch the fistula, there is no pain to the patient. Moreover, since the outer cylinder is left in the fistula, when exchanging the fistula catheter, it is also easy to insert a new fistula catheter into the body cavity via the outer cylinder.

  In the indwelling catheter removal assisting device of the present invention, it is preferable that the outer tube notch portion and the inner tube notch portion are inclined obliquely toward the distal end portions of the outer tube and the inner tube. Thus, when the outer cylinder notch part and the inner cylinder notch part are inclined obliquely, when the outer cylinder or the inner cylinder is rotated to clamp the body fixing part, the body fixing part is The outer cylinder or the inner cylinder is gradually deformed with the rotation. For this reason, deformation of the in-vivo fixing part is performed smoothly.

  In the indwelling catheter removal assisting device of the present invention, it is preferable that a deforming protrusion for deforming the body cavity fixing portion is provided on an inner peripheral surface in the vicinity of the inner tube notch portion. By providing the deformation protrusion on the inner peripheral surface of the inner tube notch, the body cavity fixing portion deforms the deformation protrusion when the tube body is pulled backward with respect to the outer tube and the inner tube. Deform from the base point. Thereby, since the deformation of the body cavity fixing portion is smoothly performed as compared with the case where there is no deformation protrusion, the body cavity fixing portion can be quickly deformed, and the outer cylinder or the inner cylinder thereafter can be deformed. Rotating operation is also easy. In addition, it is preferable that the deformation protrusion is provided at a position slightly deviated in the rotational direction side from the center of the inner cylinder when viewed from the front. When the body cavity fixing part is deformed in the absence of the deformation protrusion, deformation often starts from a position slightly shifted to the rotational direction side from the front center of the inner cylinder. By providing the deformation protrusion, the body cavity fixing portion is deformed more smoothly.

  In the indwelling catheter removal assisting device of the present invention, it is preferable that a guide passage for guiding the linear or bar-shaped temporary indwelling member is provided inside the outer peripheral surface of the outer cylinder. When a new indwelling catheter is attached instead of simply removing the indwelling catheter, it is necessary to insert the new indwelling catheter into the body cavity through the fistula. At that time, if a linear or rod-like temporary indwelling member such as a guide wire is placed in the fistula, it can be easily inserted when a new indwelling catheter is inserted. In addition, since the guide passage is provided on the inner side of the outer peripheral surface of the outer cylinder, the temporary indwelling member does not touch the fistula even when the temporary indwelling member is inserted into the fistula.

  Further, in the indwelling catheter removal assisting device of the present invention, the wall surface of the inner cylinder is linearly deformed inward in the axial direction, and the deforming projection and the guide passage are integrally formed. preferable. In this way, by forming the deforming projection and the guide passage integrally, the processing at the time of manufacturing the inner cylinder becomes easy.

  Further, in the indwelling catheter removal assisting device of the present invention, the outer cylinder protrudes radially outward from a cylindrical outer cylinder main body and a rear end portion of the outer cylinder main body, and the direction of the outer cylinder notch portion is A discriminating outer cylinder flange, and the inner cylinder protrudes radially outward from a cylindrical inner cylinder main body and a rear end portion of the inner cylinder main body so that the direction of the inner cylinder notch can be identified. It is preferable that the outer cylinder and the inner cylinder are assembled so as to be rotatable by 180 ° around the axis. According to this configuration, the outer cylinder flange part and the inner cylinder flange part can identify the directions of the outer cylinder notch part and the inner cylinder notch part. Even when it is inserted in the, the direction of each notch can be grasped. Furthermore, since the outer cylinder and the inner cylinder are assembled so as to be rotatable by 180 ° around the axis, it is easy to position the inner cylinder notch on the side facing the outer cylinder notch.

  In the indwelling catheter removal assisting device of the present invention, the tube body is clamped so that the body cavity fixing portion can be held on the inner tube flange portion while facing the inner tube notch portion. It is preferable that a groove is provided. According to this configuration, the outer cylinder or the inner cylinder can be rotated around the axis while the tube main body is clamped in the clamping groove, so that the operation is facilitated.

  Next, an example of an embodiment of the indwelling catheter removal assisting device of the present invention will be described with reference to FIGS. FIG. 1 is an explanatory view showing a gastrostomy catheter removal aid (hereinafter simply referred to as “removal aid”) as an example of an embodiment of the present invention, FIG. 2 is an exploded view of the removal aid of FIG. 1, and FIG. Fig. 4 is a cross-sectional view taken along line III-III in Fig. 1. Figs. 4 (a) to 4 (c) are explanatory views showing a procedure for inserting the removal aid into the fistula with the gastrostomy catheter inserted therein. Fig. 5 (a). FIGS. 6A to 6D are explanatory views showing a procedure when the intragastric fixation portion of the gastrostomy catheter is deformed and removed from the fistula, and FIGS. It is explanatory drawing which shows.

  As shown in FIG. 1, the removal assisting tool 1 of the present embodiment includes an outer tube 2 inserted into a gastrostoma (fistula) A, and a gastrostomy catheter (fistula catheter) inserted into the outer tube 2 and contained therein. And an inner cylinder 3 into which the four tube main bodies 41 can be inserted.

  As shown in FIGS. 1 to 3, the outer cylinder 2 includes an outer cylinder main body 21 and an outer cylinder flange portion 22. The outer cylinder main body 21 is a cylindrical member made of synthetic resin, and has an outer cylinder cutout portion 23 that is inclined toward the distal end side at the distal end portion. Further, the outer cylinder flange portion 22 is provided on the proximal end side (the upper side in FIG. 1) of the outer cylinder main body 21 and protrudes outward from the outer peripheral surface of the outer cylinder main body 21. Above the outer cylinder flange portion 22, an outer cylinder extension portion 24 that is cylindrical and extends upward is provided. On the peripheral wall of the outer cylinder extending portion 24, there is provided a rotary slit 25 that penetrates the peripheral wall in a range of about 180 °. As shown in the partially enlarged view of FIG. 2, the rotation slit 25 is provided with a protrusion 26 for stabilizing the position of the inner cylinder 3 with respect to the outer cylinder 2. Further, in the notch direction of the outer cylinder notch portion 23, a notch display 27 for displaying the notch direction on the surface of the outer cylinder flange portion 22 is provided.

  As shown in FIGS. 1 to 3, the inner cylinder 3 includes an inner cylinder main body 31 and an inner cylinder flange portion 32. The inner cylinder main body 31 is a cylindrical member made of synthetic resin, and has an inner cylinder cutout portion 33 that is inclined toward the distal end side at the distal end portion. Further, on the inner peripheral surface of the inner cylinder 31 in which the notch 33 is provided, a deformation projection 33a that protrudes in a hemispherical shape radially inward is provided. As shown in FIGS. 1 to 3, the deformation protrusion 33 a is provided at a position shifted from the center of the inner cylinder 31 in the front view to the rotational direction side. Further, as shown in FIG. 2, the locking pin 34 is attached to the peripheral wall in the notch direction of the inner cylinder notch 33 on the proximal end side of the inner cylinder main body 31. The locking pin 34 moves in the rotary slit 25 provided in the outer cylinder flange portion 22 described above.

  Further, the inner cylinder flange portion 32 is provided on the proximal end side of the inner cylinder main body 31 and protrudes outward from the outer peripheral surface of the inner cylinder main body 31. A holding groove 35 that can hold the tube main body 41 of the gastrostomy catheter 4 is provided on the upper portion of the inner cylinder flange portion 32. In the present embodiment, the holding groove 35 is provided in the notch direction of the inner cylinder main body 31 and serves as a notch mark in the inner cylinder flange portion 32. Further, the inner cylinder flange portion 32 is provided with a guide hole 36 that penetrates toward the outer peripheral surface of the inner cylinder main body 31. As shown in FIG. 3, a guide groove 37 extending in the axial direction is provided on the outer peripheral surface of the inner cylinder main body 31 at a position opposite to the notch direction of the inner cylinder notch 33. In the present embodiment, a guide passage 38 through which the guide wire 5 is inserted is formed by the guide hole 36, the guide groove 37, and the inner peripheral surface of the outer cylinder main body 21.

  As shown in FIG. 2, the outer cylinder 2 and the inner cylinder 3 configured as described above insert the distal end portion of the inner cylinder main body 31 from the proximal end side of the outer cylinder 2 and insert the locking pin 34 into the rotation slit 25. Then, the locking pin 34 is attached to the hole provided in the inner cylinder main body 31. This prevents the inner cylinder 3 from coming out of the outer cylinder 2. Further, the outer cylinder 2 and the inner cylinder 3 are relatively rotatable by about 180 ° by the rotation slit 25 and the locking pin 34. The outer cylinder 2 and the inner cylinder 3 are positioned lightly by the protrusions 26 and the locking pins 34 provided in the rotation slit 25 in the state shown in FIG. It has become.

  Next, a procedure when the gastrostomy catheter 4 is extracted using the extraction assisting tool 1 having the above configuration will be described with reference to FIGS. 4 and 5. FIG. 4A shows a state where the gastrostomy catheter 4 is inserted into the stomach via the gastrostomy A. In the figure, symbol B is an abdominal wall and symbol C is a stomach wall. The gastrostomy catheter 4 is a so-called bumper-type gastrostomy catheter having a tube body 41 and a bumper 42 as shown in FIG.

  First, as shown in FIG. 4A, the rear end of the tube main body 41 of the gastrostomy catheter 4 is inserted into the inner cylinder 3 of the extraction assisting tool 1 so that the tube main body 41 passes through the inner cylinder 3. At this time, the direction of the notch 27 of the inner cylinder flange portion 32 and the direction of the notch display 27 of the outer cylinder flange portion 22 are matched in advance so that the notch directions of the outer cylinder notch portion 23 and the inner cylinder notch portion 33 are the same. deep.

  Next, as shown in FIG.4 (b), the front-end | tip part of the extraction assistance tool 1 is inserted in the gastrostoma A. FIG. At this time, since the outer tube notch portion 23 and the inner tube notch portion 33 are provided at the distal end portion of the removal assisting device 1, the removal assisting device 1 can be smoothly inserted into the gastrostoma A.

  Next, the operator presses the removal assisting tool 1 by hand, and pulls the tube body 41 backward. Then, as shown in FIG. 4C, the bumper 42 comes to face the notched surfaces of the inner cylinder notch 33 and the outer cylinder notch 23, and the bumper 42 is deformed so as to be contracted. At this time, the bumper 42 is folded from the portion in contact with the deformation protrusion 33a, and the deformation is smoothly performed. Next, the tube main body 41 is clamped in the clamping groove 35 of the inner cylinder flange portion 32 in this state. Thereby, even if the surgeon releases the hand from the tube main body 41, the bumper 42 is held in the state of FIG.

  Next, the surgeon holds the outer cylinder 2 by hand, and rotates the inner cylinder flange portion 32 around the axis as shown in FIG. FIG. 5A shows a state rotated about 90 °. Thus, when the inner cylinder 3 is rotated with respect to the outer cylinder 2, the bumper 42 facing the inner cylinder notch 33 is gradually sandwiched between the inner cylinder notch 33 and the outer cylinder notch 23, Small deformation. Then, as shown in FIG. 5B, when the inner cylinder 3 is rotated 180 ° with respect to the outer cylinder 2, the bumper 42 is sandwiched between the inner cylinder notch 33 and the outer cylinder notch 23. As a result, the bumper 42 is deformed so as to fit inside the outer diameter of the outer cylinder main body 21 substantially.

  Next, as shown in FIG. 5 (c), the guide wire 5 is inserted into the stomach via the removal assisting tool 1. The guide wire 5 is used not only for removing the gastrostomy catheter 4 but also for exchanging it with a new gastrostomy catheter 4. The guide wire 5 is a general one used in this type of gastrostomy procedure. The surgeon inserts the distal end portion of the guide wire 5 into the guide hole 36 of the inner cylinder flange portion 32 and inserts it into the stomach from the distal end portions of the inner cylinder body 31 and the outer cylinder body 21 through the guide passage 38.

  Next, as shown in FIG. 5 (d), the removal assisting tool 1 is removed from the gastrostomy A while the guide wire 5 is left in the gastrostomy A. By the above procedure, the gastrostomy catheter 4 that has been placed in the stomach via the gastrostoma A can be removed.

  In the above embodiment, the outer cylinder notch portion 23 and the inner cylinder notch portion 33 have a shape that is inclined toward the distal end side. However, the shape is not limited to this, and an arcuate inclination may be used. Also good. In the above embodiment, the stomach is taken as an example of the body cavity. However, the removal assisting tool of the present invention can be used for other body cavities such as the bladder and trachea.

  Further, in the above-described bird's eye view, the deformable protrusion 33a has a hemispherical shape, but is not limited thereto, and extends in the axial direction on the inner peripheral surface of the inner cylinder 31, as shown in FIG. It may be a triangular prism-shaped deformation projection 33b. Further, as shown in FIG. 6B, the inner cylinder 31 may be entirely deformed in the axial direction to form a triangular prism-shaped deformed protrusion 33c having a hollow inside. In this case, the deformation protrusion 33c and the guide groove 37 can be formed integrally.

  Moreover, in the said embodiment, although the outer cylinder 2 and the inner cylinder 3 are latched using the latching pin 34, it is not restricted to this, It can insert / remove without latching the outer cylinder 2 and the inner cylinder 3 It is good. Thereby, for example, the inner tube 3 and the gastrostomy catheter 4 can be removed while the outer tube 2 is left in the fistula A in the state of FIG. In this case, it is preferable to provide a valve structure or the like inside the outer cylinder flange portion 22 so that gas in the stomach does not escape from the outer cylinder 2.

Explanatory drawing which shows the gastrostomy catheter removal assistance tool which is an example of embodiment of this invention. The exploded view of the extraction assistance tool of FIG. III-III sectional view taken on the line of FIG. (A) thru | or (c) is explanatory drawing which shows the procedure which inserts a removal assistance tool in a fistula in the state in which the gastrostomy catheter was detained in the stomach. (A) thru | or (d) is explanatory drawing which shows the procedure at the time of deforming the intragastric fixation part of a gastrostoma catheter and extracting from a fistula. (A) And (b) is explanatory drawing which shows the modification of the deformation | transformation protrusion provided in the inner cylinder.

Explanation of symbols

  DESCRIPTION OF SYMBOLS 1 ... Extraction aid, 2 ... Outer cylinder, 3 ... Inner cylinder, 4 ... Gastrostomy catheter (indwelling catheter), 21 ... Outer cylinder main body, 22 ... Outer cylinder notch part, 31 ... Inner cylinder main body, 32 ... Inner cylinder notch 41, tube body, 42 ... bumper (internal cavity fixing part), A ... gastrostomy (fistula).

Claims (7)

A flexible tube body whose tip is inserted into a body cavity through a fistula, and a flexible bowl-shaped body cavity that is provided at the tip of the tube body and regulates the extraction of the tube body from the body cavity An extraction assisting tool for extracting an indwelling catheter having a fixing part from the body cavity,
An outer cylinder that is inserted into the fistula, and an inner cylinder that is inserted into the outer cylinder and into which the tube body can be inserted.
The outer cylinder is provided with an outer cylinder notch portion that is notched so as to face the body cavity fixing portion at a distal end portion inserted into the body cavity,
The inner cylinder is provided with an inner cylinder notch portion that is notched so as to face the body cavity fixing portion at a distal end portion inserted into the body cavity,
In the state where the inner cylinder is inserted into the outer cylinder and the notch direction of the outer cylinder notch and the inner cylinder notch is aligned, the rear end side of the tube body is inserted from the front end side of the inner cylinder, Insert the outer cylinder and the inner cylinder so that each distal end reaches the body cavity through the fistula,
Pulling the tube body rearward causes the body cavity fixing portion to face the inner cylinder notch, and rotating either one or both of the outer cylinder or the inner cylinder about the axis and the outer cylinder notch An indwelling catheter removal assisting device characterized in that the body cavity fixing portion is sandwiched by the inner tube notch and at least the inner tube and the indwelling catheter can be removed from the body cavity through a fistula. .   The indwelling catheter removal aid according to claim 1, wherein the outer tube notch portion and the inner tube notch portion are inclined obliquely toward the distal end portions of the outer tube and the inner tube.   The indwelling catheter removal assistance tool according to claim 1 or 2, further comprising a deforming protrusion that deforms the body cavity fixing portion on an inner peripheral surface in the vicinity of the inner tube notch.   The indwelling catheter removal assistance according to any one of claims 1 to 3, wherein a guide passage for guiding a linear or rod-like temporary indwelling member is provided inside the outer peripheral surface of the outer cylinder. Ingredients.   5. The indwelling catheter according to claim 3, wherein a wall surface of the inner cylinder is linearly deformed inward in the axial direction, and the deforming protrusion and the guide passage are integrally formed. Extraction aid. The outer cylinder includes a cylindrical outer cylinder main body, and an outer cylinder flange portion that protrudes radially outward from a rear end portion of the outer cylinder main body and is capable of identifying the direction of the outer cylinder notch portion,
The inner cylinder includes a cylindrical inner cylinder main body, and an inner cylinder flange portion that protrudes radially outward from a rear end portion of the inner cylinder main body and is capable of identifying the direction of the inner cylinder notch portion,
6. The indwelling catheter removal assisting device according to any one of claims 1 to 5, wherein the outer tube and the inner tube are assembled so as to be capable of rotating 180 degrees around an axis.   7. A holding groove for holding the tube main body is provided in the inner cylinder flange portion so that the body cavity fixing portion can be held in a state of facing the inner cylinder notch portion. The indwelling catheter removal assistance tool described in 1.

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