JP2009268630A - Blood vessel expander, introducer, guide wire, and medical instrument guide device - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To perform manual operation for inserting a medical instrument in a blood vessel quickly and precisely. <P>SOLUTION: The blood vessel expander 1 includes: a main body part 2 in the long shape which is inserted in the blood vessel; and a taper-shaped expansion part 3 formed on the tip side in the insertion direction of the main body part 2. A liquid flow path 4 is formed so that the liquid reaches the expansion part 3 from a distal end side of the main body part 2. A liquid discharge port 5 linked to the liquid flow path 4 is opened to an outer surface of the expansion part 3. The liquid is poured into the liquid flow path 4 and discharged into the blood vessel from the liquid discharge port 5. <P>COPYRIGHT: (C)2010,JPO&INPIT

Description

  The present invention relates to a vascular dilator, an introducer, a guide wire, and a medical instrument introduction device that can be used when a medical instrument is inserted into a blood vessel.

  In general, for patients with cardiogenic shock, emergency treatment of the primary disease causing the shock is performed, and in parallel with this, treatment for maintaining circulatory dynamics is performed. Treatment methods for maintaining circulatory dynamics include administration of catecholamine (cardiotonic) and aortic balun pumping (IABP). ) May be used.

  When using PCPS, a blood removal cannula is inserted percutaneously from the femoral vein to the right atrium (target position) of the heart, and a blood delivery cannula is inserted percutaneously into the femoral artery. Then, the blood pump to which the blood removal cannula is connected is operated, the blood is removed from the right atrium by the blood removal cannula, the blood is oxidized by the artificial lung, and then the femoral artery by the blood delivery cannula To send blood retrogradely. As a result, the blood flow can be improved and the circulatory dynamics can be maintained.

  When the cannula as described above is inserted into a blood vessel, for example, a vascular dilator as disclosed in Patent Document 1 may be used. This vascular dilator constitutes a cannula introducing tool together with a sheath, and has a long shape inserted into the sheath and the cannula. The distal end side in the insertion direction of the vasodilator is tapered and protrudes from the distal end portion in the insertion direction of the sheath. In addition, a guide wire insertion hole is formed in the vascular dilator from the distal end side in the insertion direction to the proximal end side.

When inserting a cannula into a blood vessel percutaneously using the blood vessel dilator disclosed in Patent Document 1, first, a sheath is put on the blood vessel dilator and a guide wire previously placed in the blood vessel is dilated. The vascular dilator is inserted into the blood vessel along the guide wire together with the sheath. When the vascular dilator is inserted into the blood vessel, the blood vessel is dilated by the tapered shape of the distal end portion of the vascular dilator. Thereafter, only the vascular dilator is removed from the blood vessel with the sheath in place, the cannula is inserted into the sheath, and the cannula is introduced to the target position by the guide wire.
JP 2002-191697 A

  However, for patients with cardiogenic shock, the cannula must be inserted as soon as possible. However, the PCPS cannula insertion procedure may be urgently performed in an emergency outpatient treatment room, ICU or operating room. In this case, there is no fluoroscopic device like a catheter room in an emergency outpatient treatment room, ICU, or operating room. Therefore, the surgeon relies on the feel of the hand, including a vascular dilator as in Patent Document 1, The guide wire and cannula must be pulled out and inserted many times to advance to the target position, and quick and accurate procedures are difficult. In addition, depending on the patient's condition, the blood vessel may be crushed. In this case, the guide wire can easily enter branches other than the inferior vena cava. The blood vessel cannot be expanded accurately and sufficiently, and a quick procedure may be difficult, and the blood vessel may be damaged.

  The present invention has been made in view of such points, and an object of the present invention is to enable a procedure for inserting a medical instrument into a blood vessel quickly and accurately and without damaging the blood vessel. It is in.

  In order to achieve the above object, the present invention adopts the following configuration.

  That is, in the first invention, a vascular dilator used when inserting a medical instrument into a blood vessel, the main body having a long shape inserted into the blood vessel, and the distal end side in the insertion direction of the main body A tapered extension formed, a liquid agent flow passage formed from the base end side inside the main body portion to the inside of the extension portion, an opening on the outer surface of the extension portion, and the liquid agent flow passage It is set as the structure provided with the liquid agent discharge | release port which connects, and the liquid agent injection | pouring pipe part provided in the base end side of the said main-body part so that it may connect with the said liquid agent flow path.

  According to this configuration, by inserting the vascular dilator into the blood vessel from the expansion portion side, the blood vessel is expanded by the expansion portion, and thereby the main body portion is inserted into the blood vessel. At this time, when the blood vessel is crushed and the vascular dilator is difficult to enter, the liquid agent is injected into the liquid agent injection tube portion. The liquid agent injected into this liquid agent injection pipe part is discharged into the blood vessel through a liquid agent discharge port that flows through the liquid agent flow passage and opens on the outer surface of the expansion part. The pressure of the liquid agent released into the blood vessel makes it possible to rapidly expand the blood vessel. As a result, the expanded portion of the blood expander can easily enter the blood vessel.

  As a liquid agent injected at this time, physiological saline or a small amount of contrast agent is preferable. By using physiological saline, minimally invasive treatment is possible. In addition, when a movable fluoroscopy device can be brought into an emergency outpatient treatment room, ICU, or operating room, a vascular dilator can be confirmed under fluoroscopy by injecting a contrast medium. And more accurate treatment is possible.

  In the second invention, in the first invention, a guide wire for guiding the expansion portion in the blood vessel is inserted into the liquid agent flow passage and the liquid agent discharge port.

  According to this configuration, the liquid agent flow passage and the liquid agent discharge port can be used as the guide wire insertion hole.

  According to a third aspect, in the second aspect, a guide wire introduction pipe portion that guides the guide wire to the liquid agent flow passage is provided separately from the liquid agent injection pipe portion on the proximal end side of the main body portion.

  According to this configuration, since the guide wire is inserted into the liquid agent flow passage through the guide wire introduction tube portion separated from the liquid agent injection tube portion, the liquid agent injection tube portion can be arranged away from the guide wire. .

  In 4th invention, it is set as the structure currently formed in the 2nd invention so that the peripheral part of a liquid agent discharge port may leave | separate from the perimeter of the outer peripheral surface of the guide wire inserted.

  According to this structure, a liquid agent is discharge | released from between the outer peripheral surface whole periphery of a guide wire, and the peripheral part of a liquid agent discharge port.

  According to a fifth invention, in the first invention, a notch continuous to the liquid agent discharge port is formed in the peripheral portion of the liquid agent discharge port.

  According to this configuration, the liquid agent that has flowed through the liquid agent passage is also released from the notch.

  In the sixth invention, in the fifth invention, a plurality of notches are formed at intervals in the circumferential direction of the liquid agent discharge port.

  According to this configuration, a sufficient amount of the liquid agent is discharged from a plurality of locations separated in the circumferential direction of the liquid agent discharge port.

  According to a seventh aspect, in the first aspect, the liquid agent discharge port is positioned at a distal end portion of the expansion portion.

  According to this configuration, the liquid agent can be released from the distal end portion of the expansion portion.

  According to an eighth invention, in the first invention, the main body portion is inserted into a tubular medical device, and the expansion portion is formed so as to protrude from the distal end portion in the insertion direction of the medical device. The configuration is as follows.

  According to this configuration, the medical device can be inserted into the blood vessel while the main body portion is inserted into the medical device and the blood vessel is expanded together with the medical device while being expanded into the blood vessel.

  According to a ninth aspect, in the first aspect, the main body is configured to be inserted into a vein.

  According to this configuration, it is possible to reliably expand a vein that tends to be crushed compared to an artery.

  In the tenth invention, the introducer is used when introducing a medical instrument into a blood vessel, has a tubular shape through which a guide wire is inserted, and an insertion tube portion to be inserted into the blood vessel, and insertion of the insertion tube portion. And an enlarged portion that expands radially outward of the insertion tube portion and positions the distal end opening of the insertion tube portion closer to the radial center of the blood vessel.

  According to this configuration, when the insertion tube portion is inserted into a blood vessel and a guide wire is inserted into the insertion tube portion, the guide wire protrudes from the distal end opening of the insertion tube portion and is inserted into the blood vessel. At this time, the distal end opening of the insertion tube portion is positioned closer to the radial center of the blood vessel by the enlarged portion, so that the guide wire is positioned near the radial center of the blood vessel. Since the guide wire is positioned in the vicinity of the center in the radial direction of the blood vessel in this way, it is difficult to get into a branch opening on the inner wall of the blood vessel.

  In the eleventh invention, the enlarged portion is configured to be switched between an enlarged state in which the insertion tube portion is enlarged radially outward and a reduced state in which the insertion portion is contracted radially inward from the enlarged state.

  According to this configuration, when the insertion tube portion starts to be inserted into the blood vessel, it can be easily inserted by keeping the enlarged portion in a reduced state. And after inserting an insertion tube part deeply into a blood vessel, it becomes possible to position a guide wire in the radial direction center vicinity of the blood vessel by making an expansion part into an expansion state.

  In a twelfth aspect of the present invention, the enlarged portion is constituted by an expansion member, and a fluid intake / exhaust device is connected to the expansion member.

  According to this configuration, the degree of expansion of the expansion member can be easily changed depending on the amount of fluid supplied to the expansion member.

  In the thirteenth invention, the guide wire guides the medical instrument inserted into the blood vessel to the target position, and the distal end side in the insertion direction into the blood vessel is curved.

  According to this configuration, when the guide wire is inserted into the blood vessel, the distal end side is curved, so that it is difficult to get into a thin blood vessel such as a branch.

  In a fourteenth aspect based on the thirteenth aspect, the shape on the distal end side in the insertion direction is a pigtail shape. Moreover, it is preferable that the pigtail type guide wire is configured such that when inserted into a blood vessel, the shape of the curved portion changes so as to match the inner diameter of the blood vessel due to the elasticity of the catheter.

  A fifteenth aspect of the invention is a medical instrument introduction device including the vasodilator, the introducer, and the guide wire.

  According to this configuration, the guide wire can be inserted into a desired blood vessel without getting into the branch of the blood vessel, and the blood vessel can be quickly expanded by the blood vessel dilator.

  According to the first invention, since the liquid agent discharge port is opened on the outer surface of the extension portion formed in the elongated main body portion, the liquid agent is discharged from the liquid agent discharge port in a state where the extension portion is inserted into the blood vessel, The blood vessel can be quickly expanded by the pressure of the liquid. Thereby, the medical instrument can be inserted to the target position quickly and accurately and without damaging the blood vessel.

  According to the second invention, since the guide wire is inserted into the liquid agent flow passage and the liquid agent discharge port, it is not necessary to separately provide the insertion hole of the guide wire in the vascular dilator. Can be simple.

  According to the third invention, since the guide wire introducing tube portion is provided so as to be separated from the liquid agent injection tube portion, the liquid agent injection tube portion can be separated from the guide wire, and the liquid agent is injected into the liquid agent injection tube portion. Can be easily performed.

  According to the fourth invention, since the peripheral portion of the liquid agent discharge port is formed so as to be separated from the entire circumference of the outer peripheral surface of the guide wire, the liquid agent can be discharged from the entire periphery of the liquid agent discharge port, and the blood vessel is effectively Can be extended to Thereby, a medical instrument such as a catheter with a dilator can be quickly and accurately inserted into the blood vessel and left in place.

  According to the fifth aspect, since the notch is formed at the peripheral edge of the liquid agent discharge port, the liquid agent flowing through the liquid agent flow passage can be discharged also from the notch. As a result, a sufficient amount of the liquid agent can be secured, and the blood vessel can be expanded in a short time.

  According to the sixth invention, since a plurality of notches are provided at intervals in the circumferential direction of the liquid agent discharge port, a sufficient amount of liquid agent can be discharged from a plurality of locations separated in the circumferential direction of the liquid agent discharge port. , Blood vessels can be expanded in a much shorter time.

  According to the seventh aspect, since the liquid agent can be released from the distal end portion of the expansion portion, the blood vessel can be reliably expanded.

  According to the eighth invention, the main body portion is inserted into the medical instrument, and in this state, the extension portion is protruded from the distal end portion of the medical instrument. Therefore, while expanding the blood vessel, the medical instrument is inserted into the blood vessel. The medical instrument insertion procedure can be accelerated.

  According to the ninth aspect of the invention, it is possible to reliably expand a vein that is liable to be crushed, and the effects of the present invention become remarkable.

  According to the tenth invention, the guide wire can be positioned in the vicinity of the radial center in the blood vessel by providing the enlarged portion on the distal end side in the insertion direction of the insertion tube portion through which the guide wire is inserted. This makes it difficult for the guide wire to get into the branch of the blood vessel, and as a result, the medical instrument can be inserted to the target position quickly and accurately and without damaging the blood vessel.

  According to the eleventh aspect, the insertion tube portion can be easily inserted into the blood vessel by keeping the enlarged portion in a reduced state.

  According to the twelfth aspect, the degree of expansion of the expansion member can be easily changed according to the amount of fluid supplied to correspond to the inner diameter of the blood vessel, and the guide wire can be reliably positioned near the radial center of the blood vessel. .

  According to the thirteenth invention, since the distal end side in the insertion direction of the guide wire is curved, it becomes difficult for the guide wire to get into a thin blood vessel such as a branch. The target position can be inserted without damaging the blood vessel.

  According to the fifteenth aspect, the medical instrument can be quickly and accurately inserted to the target position using the vascular dilator and the guide wire.

  Hereinafter, embodiments of the present invention will be described in detail with reference to the drawings. It should be noted that the following description of the preferred embodiment is merely illustrative in nature, and is not intended to limit the present invention, its application, or its use.

(Embodiment 1)
FIG. 1 shows a vascular dilator 1 according to Embodiment 1 of the present invention. The vascular dilator 1 is used to expand a vein when a blood removal cannula 100 (shown in FIG. 2) of a PCPS (not shown) is percutaneously inserted into the vein. is there. In the description of this embodiment, the structure of the blood removal cannula 100 will be described before the structure of the vascular dilator 1 is described. The blood removal cannula 100 is formed by molding a flexible resin material such as polyvinyl chloride, for example, and has an opening 101 for sucking blood at the distal end in the insertion direction (left side in FIG. 2). In addition, a large number of similar openings 102 are formed on the distal end side of the peripheral wall portion of the cannula 100. On the base end side (right side in FIG. 2) of the cannula 100, a large-diameter portion 103 having a larger diameter than the distal end side is provided. A tube (not shown) extending from the heart-lung machine is connected to the large diameter portion 103. A reinforcing wire (not shown) for preventing the cannula 100 from being crushed is embedded in a portion between the distal end side and the large diameter portion 103 in the peripheral wall portion of the blood removal cannula 100. This reinforcing wire has a shape wound in a coil spring shape. The blood removal cannula 100 is guided in the vein by a guide wire G (shown in FIG. 3). Since this guide wire G has the same structure as that conventionally used for guiding the blood removal cannula 100, description of the structure of the guide wire G is omitted. The guide wire G has an outer diameter of, for example, 0.25 inch, 0.35 inch, 0.38 inch, etc., and the guide wire having an optimum outer diameter depending on the patient's physique, pathology, vein thickness, etc. G is used.

  As shown in FIG. 1, the vascular dilator 1 includes a long main body 2 and a dilator 3 for vasodilation formed on one side of the main body 2 in the center line direction (left side in FIG. 1). It is inserted in the vein from the expansion part 3 side. The main body 2 has substantially the same circular cross section throughout the insertion direction. Moreover, the expansion part 3 is made into the taper taper shape which diameter-reduces toward the insertion direction front end side. The distal end side of the extension portion 3 in the insertion direction protrudes from the opening 101 at the distal end in the insertion direction of the cannula 100 in a state where the main body portion 2 is inserted into the blood removal cannula 100. The main body 2 and the extension 3 are integrally formed using a flexible resin material such as polyvinyl chloride.

  As shown in FIG. 4, a liquid agent flow passage 4 is formed in the vascular dilator 1 from the inside of the expansion portion 3 to the base end portion in the insertion direction inside the main body portion 2. The inner diameter of the liquid agent flow passage 4 is set to be larger than the outer diameter of the guide wire G so that the guide wire G can be easily inserted. The liquid agent flow passage 4 is formed so as to extend along the center line of the main body 2. The proximal end portion in the insertion direction of the liquid agent passage 4 is open at the proximal end portion of the main body portion 2. On the other hand, the distal end side in the insertion direction of the liquid agent flow passage 4 is formed so that the cross-sectional area becomes narrower toward the distal end side of the expansion portion 3. That is, the front end side of the liquid agent passage 4 is narrowed.

  Further, a liquid agent discharge port 5 communicating with the front end side of the liquid agent flow passage 4 is formed at the distal end portion of the extension portion 3 in the insertion direction. The liquid agent discharge port 5 has a circular shape larger than the outer diameter of the guide wire G, and the guide wire G is inserted into the liquid agent discharge port 5. Therefore, when the center line of the guide wire G and the center line of the liquid agent discharge port 5 are matched, the entire circumference of the outer peripheral surface of the guide wire G is separated from the peripheral portion of the liquid agent discharge port 5.

  As shown in FIG. 1, a Y-type connector 10 is connected to the other side of the main body 2 in the center line direction. The Y-shaped connector 10 includes a straight pipe portion 11 (guide wire introduction pipe portion) that extends linearly, and a branch pipe portion 12 (liquid agent injection pipe portion) that branches off from the middle of the straight pipe portion 11 and extends. As shown in FIG. 4, the straight pipe portion 11 and the branch pipe portion 13 communicate with each other. As shown in FIG. 1, one end portion of the straight pipe portion 11 is liquid-tightly connected to the main body portion 2 by a connecting member 13. As shown in FIG. 4, the center line of the straight pipe portion 11 of the Y-connector 10 in a state connected to the main body portion 2 coincides with the center line of the main body portion 2, and the straight pipe portion 11 and the liquid agent flow It communicates with the road 4.

  A guide wire G is inserted into the straight pipe portion 11 of the Y-type connector 10. On the side opposite to the main body 2 of the straight pipe portion 11, an enlarged diameter portion 14 that extends while increasing the diameter toward the opposite end portion, and a cylindrical portion 15 that continues to the larger diameter side of the enlarged diameter portion 14, Is formed. A male screw portion 15 a is formed on the outer peripheral surface of the cylindrical portion 15. An elastic member 16 made of silicone rubber or the like is inserted into the cylindrical portion 15. The elastic member 16 has a circular plate shape, and a through hole 16a through which the guide wire G is inserted is formed at the center.

  A cap member 18 is attached to the cylindrical portion 15 of the straight pipe portion 11. The cap member 18 is formed with an insertion hole 18a for the guide wire G, an outer cylindrical portion 18b having a shape covering the male screw portion 15a of the cylindrical portion 15, and an inner cylindrical portion 18c inserted into the cylindrical portion 15. And are formed. On the inner peripheral surface of the outer cylindrical portion 18b, a female screw portion 18d that is screwed into the male screw portion 15a of the cylindrical portion 15 is formed. The inner cylinder portion 18c is formed so as to be in pressure contact with the elastic member 16 in a state in which the female screw portion 18d is screwed into the male screw portion 15a and the cap member 18 is tightened (shown in FIG. 4B). When the inner cylindrical portion 18c is pressed against the elastic member 16, the elastic member 16 is crushed between the enlarged diameter portion 14 and the through hole 16a is reduced and closed, and the straight pipe portion 11 is closed. In this state, the guide wire G does not move.

  Further, a connection hole 12 a to which the distal end portion of the syringe 20 is connected is formed on the opposite side of the branch tube portion 12 of the Y-type connector 10 from the straight tube portion 11. The connection hole 12a has a tapered shape that increases in diameter toward the syringe 20 side. The syringe 20 is for injecting the liquid agent into the liquid agent flow passage 4, and a luer taper portion 20 a to be inserted into the connection hole 12 a is provided at the distal end portion. It should be noted that a lock shape may be provided on the distal end portion of the syringe 20 and the branch pipe portion 12 to prevent the syringe 20 from coming off. As this lock shape, the shape generally used for the connection part of the syringe 20 is mentioned.

  Next, the usage method of the vascular dilator 1 comprised as mentioned above is demonstrated. First, the procedure for inserting the guide wire G will be described. First, after puncturing the vein (femoral vein) of the lower limb with a cylindrical needle (not shown) and an inner needle inserted into the needle, the cylindrical needle is inserted into the vein. Pull out the inner needle while leaving it in the position. Then, the guide wire G is inserted into the cylindrical needle, and the guide wire G is inserted from the inferior vena cava to the right atrium and placed.

  Next, the main body portion 2 of the vascular dilator 1 is inserted into the cannula 100 from the large-diameter portion 103 of the blood removal cannula 100, and the expansion portion 3 is protruded from the opening 101 of the cannula 100. Further, the cap member 18 is loosened, and the through hole 16a of the elastic member 16 is enlarged as shown in FIG. Further, physiological saline as a liquid agent is placed in the syringe 20, and the luer taper portion 20 a of the syringe 20 is inserted into the connection hole 12 a of the Y-type connector 10 and connected. The syringe 20 may contain a contrast medium.

  Thereafter, as shown in FIG. 3, the proximal end side in the insertion direction of the guide wire G is inserted into the liquid agent flow passage 4 from the liquid agent discharge port 5 of the vascular dilator 1, and the cap member 18 passes through the straight pipe portion 11 of the Y-type connector 10. It protrudes outward from the insertion hole 18a. When the vascular dilator 1 and the blood removal cannula 100 are inserted into the vein through the femoral vein puncture portion together, the expansion portion 3 advances while being guided by the guide wire G, and the expansion portion 3 causes the vein. Is expanded. Thereby, the main body 2 is inserted into the vein together with the cannula 100. At this time, when it is difficult for the vascular dilator 1 to enter the vein, after confirming that the cap member 18 has been tightened, the rod (not shown) of the syringe 20 is pushed, Saline is injected into the liquid agent flow passage 4 via the branch pipe portion 12 of the Y-type connector 10. The physiological saline injected into the liquid agent flow passage 4 flows toward the distal end side through the liquid agent flow passage 4 and reaches the liquid agent discharge port 5 of the expansion portion 3. Then, the physiological saline is discharged into the vein from between the peripheral edge of the solution discharge port 5 and the outer peripheral surface of the guide wire G. The momentum of the physiological saline discharged into the vein is that the distal end side of the liquid agent flow passage 4 is narrowed, and that the guide wire G is inserted into the liquid agent discharge port 5 to reduce the effective opening area. And it becomes strong. The vein is dilated by the pressure of the physiological saline. As a result, the expansion part 3 of the blood dilator 1 can easily enter the vein, so that the vein can be dilated without pushing the vascular dilator 1 with a strong force.

In addition, when the contrast agent is put into the syringe 20, the vein is expanded by this contrast agent. In this case, it is possible to confirm the vascular dilator 1 under fluoroscopy by bringing the movable fluoroscopic device into an emergency outpatient treatment room, ICU, or operating room. As a result, it is possible to guide the vascular dilator 1 in the running direction of the vein and perform an accurate insertion procedure.
More accurate treatment is possible.

  After the blood removal cannula 100 is inserted to a desired position while the vein is expanded by the vascular dilator 1 as described above, the vascular dilator 1 is removed from the vein. Thereafter, blood removal is performed by connecting the large diameter portion 103 of the blood removal cannula 100 to the hose of the heart-lung machine.

  As described above, according to the vascular dilator 1 according to the first embodiment, the physiological saline is applied to the distal end portion in a state where the expanded portion 3 formed in the elongated main body portion 2 is inserted into the vein. The vein can be quickly expanded by discharging from the discharge port 5 and by the pressure of the physiological saline. As a result, the cannula 100 for blood removal can be quickly and accurately inserted into the right atrium.

  Further, since the vascular dilator 1 can be inserted into the vein with a small force, it is possible to suppress damage to the vein and surrounding tissue, and the vein can be reliably and minimally expanded.

  Further, since the liquid agent flow passage 4 and the liquid agent discharge port 5 are used as insertion holes for the guide wire G, the structure of the vascular dilator 1 can be simplified.

  Further, since the syringe 20 is connected to the main body 2 using the Y-type connector 10 and the guide wire G is inserted into the main body 2, the proximal end side of the guide wire G and the syringe 20 are arranged apart from each other. can do. Thereby, the physiological saline injection operation and the guide wire G operation can be easily performed.

  Moreover, since the shape of the liquid agent discharge port 5 is a circle larger than the outer shape of the guide wire G, physiological saline is discharged from between the entire outer peripheral surface of the guide wire G and the peripheral portion of the liquid agent discharge port 5. It will spread all around the inner wall of the vein. Thereby, the vein can be effectively expanded. Moreover, since the liquid agent discharge port 5 is positioned at the distal end portion of the expansion portion 3, physiological saline can be discharged from the distal end portion of the expansion portion 3 and concentratedly applied to a portion where the vein is difficult to expand. The same applies when a contrast agent is used.

  Further, since the main body 2 is inserted into the vein together with the cannula 100 for blood removal, the cannula 100 can be inserted to a desired position while the vein is expanded by the expansion unit 3. Thereby, the insertion procedure of the blood removal cannula 100 can be accelerated.

  In addition, in the said embodiment, although the shape of the liquid agent discharge port 5 is circular, it is not restricted to this, For example, like the modification shown in FIG. 5 may be formed. In Modification 1 shown in FIG. 5A, a notch 5a is provided at one place in the circumferential direction of the liquid agent discharge port 5, and the front end side of the notch 5a has an arc shape.

  Further, in Modification 2 shown in FIG. 5B, notches 5a are provided at two locations in the circumferential direction of the liquid agent discharge port 5, and in Modification 3 shown in FIG. Cutout portions 5a are provided at three locations in the circumferential direction of the outlet 5, and in the modified example 4 shown in FIG. 5 (d), cutout portions 5a are provided at four locations in the circumferential direction of the liquid agent discharge port 5. Yes. When a plurality of cutout portions 5a are provided as in the above-described modified examples 2 to 4, it is preferable to arrange the cutout portions 5a at substantially equal intervals in the circumferential direction of the liquid agent discharge port 5. Further, when a plurality of notches 5a are provided, the notches 5a may be arranged at unequal intervals. Furthermore, the shape and number of the notches 5a can be arbitrarily set.

  By providing the notch 5a as in the first to fourth modifications, a sufficient amount of physiological saline can be discharged, and the vein can be expanded in a short time.

  Moreover, in the modification 5 shown to Fig.6 (a), the shape of the liquid agent discharge port 5 is made into the star shape with five protrusion shapes, and in the modification 6 shown in FIG.6 (b), the liquid agent discharge port 5 is used. The shape is a star shape with six protruding shapes. A sufficient amount of physiological saline can be obtained by these modified examples.

  Moreover, in the said embodiment, although physiological saline was discharge | released to the vein, it is not restricted to this, For example, you may make it discharge | release chemical | medical agents, such as a liquid thrombolytic agent.

  In the above embodiment, the case where the vascular dilator 1 is inserted into the vein together with the blood removal cannula 100 has been described. However, the present invention is not limited to this, and only the vascular dilator 1 may be inserted into the vein to be expanded. Good.

  Moreover, the opening position of the liquid agent discharge port 5 is not limited to the distal end portion of the expansion portion 3, and is not particularly limited as long as it is the outer surface of the expansion portion 3.

  Further, without inserting the guide wire G into the liquid agent flow passage 4, an insertion hole dedicated to the guide wire G may be formed in the main body portion 2 and the extension portion 3 separately from the liquid agent flow passage 4.

  Further, the inner diameter of the liquid agent flow passage 4 and the inner diameter of the liquid agent discharge port 5 may be changed according to the outer diameter of the guide wire G.

  In addition, when injecting the liquid agent into the liquid agent flow passage 4, an injection device other than the syringe 20 may be used.

  Moreover, although the case where the vein was expanded was demonstrated in the said embodiment, it is applicable also when expanding an artery.

(Embodiment 2)
7 to 9 show an introducer according to Embodiment 2 of the present invention. When the blood removal cannula 100 (shown in FIG. 2) of PCPS (not shown) is inserted into the vein percutaneously, the introducer 30 guides the guide wire before the blood removal cannula 100 is inserted into the vein. It is an introducer used to insert G into the vein.

  As shown in FIG. 9, the introducer 30 includes an inner tube portion 31 through which the guide wire G is inserted and an outer tube portion 32 formed so as to cover the outer peripheral surface of the inner tube portion 31. The inner tube portion 31 and the outer tube portion 32 are inserted into the vein together. The length of the inner pipe part 31 is set in the range of 20 cm to 30 cm. The distal end portion in the insertion direction of the inner tube portion 31 protrudes from the distal end portion in the insertion direction of the outer tube portion 32. The inner diameter of the outer tube portion 32 is set slightly larger than the outer diameter of the inner tube portion 31. At the distal end in the insertion direction of the outer tube portion 32, an enlarged portion 33 is provided that expands radially outward of the outer tube portion 32 and positions the distal end opening of the outer tube portion 32 closer to the radial center of the vein. The enlarged portion 33 is composed of four rod-like portions 33a, 33a,... Protruding from the tip of the outer tube portion 32. These rod-shaped parts 33a, 33a,... Are arranged at intervals in the radial direction of the outer tube part 32. Bent portions 33b and 33b are provided at the projecting direction intermediate portion and the base end portion of each rod-shaped portion 33a, respectively. A rod-like operation portion 34 is connected to the protruding end portion of each rod-like portion 33a. Each operation portion 34 extends between the outer tube portion 32 and the inner tube portion 31 toward the proximal end portion of the outer tube portion 32, and protrudes from the proximal end portion of the outer tube portion 32. Portions protruding from the outer tube portion 32 in the four operation portions 34 are integrated. A grip 35 is provided at the proximal end of the outer tube 32.

  As shown in FIGS. 7 (a) and 9 (a), the enlarged portion 33 is in a contracted state where the rod-shaped portion 33a is positioned along the outer peripheral surface of the inner tube portion 31, and FIGS. As shown in (b), the rod-shaped portion 33a can be switched to an enlarged state. The outer diameter of the enlarged portion 33 in the enlarged state is preferably set in the range of 15 mm to 25 mm, and more preferably 20 mm.

  When the enlarged portion 33 in the reduced state is brought into the enlarged state, the portion protruding from the proximal end portion of the outer tube portion 32 in the operation portion 34 with the grip portion 35 of the outer tube portion 32 is shown in FIG. Pull in the direction of arrow X shown in a). Then, the four operation portions 34 move between the outer tube portion 32 and the inner tube portion 31 toward the proximal end side of the outer tube portion 32, and in conjunction with the movement of the operation portion 34, The rod-shaped portion 33a is bent so as to rise from the inner tube portion 31 with the bent portion 33b as a starting point, and an expanded state shown in FIG. 7B is obtained. On the other hand, when the enlarged portion 33 in the enlarged state is brought into the reduced state, a portion protruding from the proximal end portion of the outer tube portion 32 in the operation portion 34 may be pushed opposite to the X direction. As a result, the operation portion 34 moves between the outer tube portion 32 and the inner tube portion 31 toward the distal end side of the outer tube portion 32, and in conjunction with the movement of the operation portion 34, the rod-shaped portion 33 a It comes along the inner pipe part 31.

  Next, the usage method of the introducer 30 comprised as mentioned above is demonstrated based on FIG.10 and FIG.11. First, the femoral vein A is incised, and the introducer 30 is inserted toward the inferior vena cava B from the distal end side. At the initial stage of insertion, as shown in FIG. 10, the enlargement unit 33 is in a reduced state. And when the front-end | tip part of the introducer 30 reaches before the branch B of the femoral vein A, insertion will be stopped and the expansion part 33 will be made into an expansion state, as shown in FIG. Whether or not the tip of the introducer 30 has reached before the branch C can be determined by the amount of insertion of the introducer 30.

  When the enlarged portion 33 is in the enlarged state, the four rod-like portions 33a come into contact with the inner wall of the femoral vein A, and both the distal end openings of the inner tube portion 31 and the outer tube portion 32 are positioned near the radial center of the femoral vein A. Thus, the guide wire G is positioned near the radial center of the femoral vein A. Since the guide wire G is positioned in the vicinity of the center of the femoral vein A in the radial direction as described above, it is difficult to get into the branch C opened on the inner wall of the femoral vein A or the contralateral femoral vein D. The procedure after inserting the guide wire G as described above is the same as the procedure described in the first embodiment. Note that when the introducer 30 is removed from the femoral vein A, the enlarged portion 33 may be in a reduced state.

  As described above, according to the introducer 30 according to the second embodiment, since the guide wire G can be positioned closer to the radial center of the femoral vein A, the guide wire G is not a target vein B other than the target vein B. It becomes difficult to get into the veins C and D, so that the cannula 100 can be quickly and accurately inserted into the right atrium.

  The number of rod-shaped portions 33a constituting the enlarged portion 33 is not limited to four, and may be three or less, or may be five or more.

  Moreover, in the said Embodiment 2, although the enlarged part 33 is comprised with the rod-shaped part 33a, it may comprise not only this but the expansion member 40 like the modification shown in FIG.12 and FIG.13, for example. Good. The expansion member 40 is configured in the same manner as a balloon provided on a general balloon catheter, and is fixed to the distal end side in the insertion direction of the inner tube portion 31. An air passage 41 is formed between the outer tube portion 32 and the inner tube portion 31, and the air passage 41 is connected to the expansion member 40. The air passage 41 extends to the proximal end side of the outer tube portion 32 and is connected to an air supply / exhaust device 45 including an air pump through a connector 43. Therefore, by injecting air into the expansion member 40 by the air supply / exhaust device 45, the expansion member 40 expands to an expanded state as shown in FIGS. By discharging the air in the member 40, as shown in FIGS. 12A and 14, the expansion member 40 is in a contracted state. In addition to air, carbon dioxide or the like may be injected into the expansion member 40, or a liquid such as physiological saline may be injected.

  Moreover, although the front-end | tip part has extended linearly in the guide wires G of the said Embodiment 1, 2, the front-end | tip part of the guide wire G is curved like the modification shown in FIG. It is good also as a pigtail shape, ie, the shape wound more than 1 round. By curving the distal end of the guide wire G, it becomes difficult for the guide wire G to get into a thin blood vessel such as the branch C of the femoral vein A. As a result, the guide wire G can be moved to the target position without being seen through. This guide wire G allows the blood removal cannula 100 to be quickly and accurately inserted to the right atrium.

  In the pigtail type guide wire G, the outer diameter of the curved portion is set to be larger than the diameter of a thick blood vessel such as the femoral vein A. Thereby, the outer diameter of the curved portion changes so as to follow the change in the thickness within the femoral vein A due to the elasticity of the guide wire G. Therefore, the intrusion into the branch C thinner than the femoral artery A is prevented. Further, in the pigtail type guide wire G, the distal end side in the insertion direction has a greatly curved shape, so that it is difficult to damage the blood vessel.

  Moreover, you may comprise the cannula introduction apparatus (medical instrument introduction apparatus) containing the vascular dilator 1 of the said Embodiment 1, the introducer 30 of Embodiment 2, and the front-end | tip curved guide wire G of a modification. By using this cannula introducing device, the guide wire G can be inserted into the inferior vena cava B without getting into the branch C of the femoral vein A, and the femoral vein A can be quickly expanded by the vascular dilator 1. Is possible. Thereby, the cannula 100 can be inserted to the right atrium quickly and accurately.

  Further, the vascular dilator 1 and the introducer 30 may be provided with an antibacterial coating. As this antimicrobial coating, for example, 2-methacryloyloxyethyl phosphorylcholine polymer (MPC polymer) coating is preferred. Examples of the MPC polymer include Lipidure-CR1701, Lipidure-CR1702, Lipidure-BG, Lipidure-CM0203, Lipidure-CM5206, Lipidure-CM5206E, and Lipidure-CM5208E manufactured by Nippon Oil & Fats Co., Ltd. These MPC polymers have good biocompatibility and high antibacterial properties. When coating the MPC polymer, it is preferable to immerse the vascular dilator 1 and the introducer 30 in an aqueous solution of the MPC polymer and perform the heat adsorption treatment. However, other methods may be used.

  Further, a catheter other than the cannula 100 may be inserted into the blood vessel using the vascular dilator 1, the introducer 30 and the guide wire G.

  As described above, the vascular dilator, the introducer, and the guide wire according to the present invention can be used, for example, when a cannula or the like is inserted into a blood vessel.

It is a side view of the vascular dilator which concerns on Embodiment 1 of this invention. It is a side view of the catheter for blood removal. It is a figure which shows the state which inserted the main-body part of the vascular dilator into the blood removal catheter, and also penetrated the guide wire through the vascular dilator. It is sectional drawing of a vascular dilator, (a) shows the state which loosened the cap member, (b) is a figure which shows the state which tightened the cap member. It is the figure which looked at the expansion part of the vascular dilator which concerns on the modifications 1-4 of Embodiment 1 from the front end side. 6 is a diagram corresponding to FIG. 5 according to Modifications 5 and 6 of Embodiment 1. FIG. It is a side view of the introducer which concerns on Embodiment 2, (a) shows the state which the expansion part reduced, (b) shows the state which the expansion part expanded. It is the figure which looked at the introducer of the state which the expansion part expanded from the front end side. (A) And (b) is a fragmentary sectional view equivalent to (a) and (b) of Drawing 8, respectively. It is a figure explaining the use condition of an introducer. FIG. 11 is a view corresponding to FIG. 10 in a state in which an enlarged portion is enlarged. (A) And (b) concerns on the modification of Embodiment 2, respectively, and is a figure corresponded to Fig.7 (a) and (b). FIG. 9 is a view corresponding to FIG. 8 according to a modification of the second embodiment. FIG. 10 is a diagram corresponding to FIG. 10 according to a modification of the second embodiment. FIG. 12 is a view corresponding to FIG. 11 according to a modification of the second embodiment. It is a figure explaining the use condition of the guide wire which concerns on a modification.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 Vascular dilator 2 Main body part 3 Expansion part 4 Liquid agent flow path 5 Liquid agent discharge port 5a Notch part 11 Straight pipe part (guide wire introduction pipe part)
12 Branch pipe section (liquid injection pipe section)
20 Syringe 30 Introducer 31 Inner tube (insertion tube)
33 Enlarged portion 40 Expansion member 41 Air passage 43 Connector 45 Air intake / exhaust device (fluid intake / exhaust device)
100 Cannula for blood removal (medical device)
A Femoral vein B Inferior vena cava C Branch G Guide wire

Claims (15)

A vasodilator used when inserting a medical device into a blood vessel,
A main body having a long shape inserted into a blood vessel;
A tapered extension formed on the distal end side in the insertion direction of the main body,
A liquid agent flow passage formed from the base end side inside the main body portion to the inside of the extension portion;
A liquid agent discharge port that opens to the outer surface of the extension part and communicates with the liquid agent flow passage;
A vasodilator comprising a liquid agent injection tube provided on the proximal end side of the main body so as to communicate with the liquid agent flow passage. The vasodilator according to claim 1,
A vascular dilator, characterized in that a guide wire for guiding the expansion portion in the blood vessel is inserted through the liquid agent flow passage and the liquid agent discharge port. The vasodilator according to claim 2,
A vasodilator characterized in that a guide wire introduction tube portion for guiding a guide wire to a liquid agent flow path is provided separately from a liquid agent injection tube portion on the proximal end side of the main body portion. The vasodilator according to claim 2,
A vascular dilator characterized in that the peripheral edge of the liquid agent discharge port is formed so as to be separated from the entire circumference of the outer peripheral surface of the guide wire to be inserted. The vasodilator according to claim 1,
A vascular dilator characterized by forming a notch continuous with the liquid agent discharge port at the peripheral edge of the liquid agent discharge port. The vasodilator according to claim 5,
A vascular dilator, wherein a plurality of notches are formed at intervals in the circumferential direction of the liquid agent discharge port. The vasodilator according to claim 1,
A vascular dilator, wherein the liquid agent discharge port is positioned at a distal end portion of the expansion portion. The vasodilator according to claim 1,
The main body is inserted into a tubular medical device,
The dilator is formed so as to protrude from a distal end portion in the insertion direction of the medical device. The vasodilator according to claim 1,
A vasodilator, wherein the main body is inserted into a vein. An introducer used when introducing a medical device into a blood vessel,
A tubular shape through which a guide wire is inserted, and an insertion tube portion to be inserted into the blood vessel,
Provided on the distal end side in the insertion direction of the insertion tube portion, and having an enlarged portion that expands radially outward of the insertion tube portion and positions the distal end opening of the insertion tube portion closer to the radial center of the blood vessel. An introducer characterized by that. The introducer according to claim 10,
An introducer characterized in that the expanding portion is switched between an expanded state expanded radially outward of the insertion tube portion and a contracted state contracted radially inward from the expanded state. The introducer of claim 11,
The enlarged portion is composed of an expansion member,
An introducer, wherein a fluid intake / exhaust device is connected to the expansion member. A guide wire for guiding a medical device inserted into a blood vessel to a target position,
A guide wire characterized in that a distal end side in a direction of insertion into a blood vessel is curved. The guide wire according to claim 13,
A guide wire characterized in that the shape on the distal side in the insertion direction is a pigtail shape.   A medical instrument introduction device comprising the vascular dilator according to claim 1, the introducer according to claim 10, and the guide wire according to claim 13.

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