JP2010213895A - Catheter for fistula - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a catheter for a fistula which has low invasion for a patient because resistance is reduced when inserted and extracted into/from an internal organ, and is inserted and removed safely and easily by a treating person. <P>SOLUTION: The catheter for a fistula includes a tubular member having a nutrition passage for transdermal supply of a liquid substance such as a nutrient and a liquid medicine from an outside of a body to the internal organ, and an intracorporeal indwelling portion formed in tip side of the tubular member and allowing indwelling fixation in an inside of an organ, and the intracorporeal indwelling portion is constituted of an organ contact portion contacting with the internal organ, and an indwelling end portion formed on a distal end side of the organ contact portion, and satisfies a relation: (A)>(B) where (B) represents a hardness of the organ contact portion, and (A) represents a hardness of the indwelling tip portion. <P>COPYRIGHT: (C)2010,JPO&INPIT

Description

  The present invention relates to a fistula catheter.

As a method for administering nutrition to a patient who cannot take nutrition orally, enteral nutrition management by percutaneous endoscopic gastrostomy (hereinafter abbreviated as “PEG”) is frequently performed. A fistula catheter is used to carry out nutritional administration using this PEG.
There are various types of fistula catheters depending on the indwelling technique, patient condition, period of use, operability of the operator, etc., but generally has a lumen for introducing nutrients or chemicals from outside the body into the stomach. A tubular member and an indwelling portion having a shape that is attached to the distal end portion of the tubular member and expands radially outward of the tubular member when no load is applied in the major axis direction.

The fistula catheter is usually replaced with a new catheter after a certain period of time due to degradation or contamination due to indwelling. However, including the initial indwelling after fistula construction, insertion and removal of the fistula catheter through the fistula Is repeatedly performed.
In particular, in a non-balloon type catheter, a technique for reducing the insertion resistance and the extraction resistance by using an extension tool or the like to apply an external force to the indwelling portion in the expanded state to linearly expand and contract the diameter is disclosed. (See, for example, Patent Document 1).
Furthermore, with a non-balloon type catheter, the thickness of the indwelling portion is gradually increased from the joining portion of the tubular member and the indwelling portion toward the distal end of the indwelling portion, so that the joining side of the tubular member and the indwelling portion is increased. Has been disclosed (see Patent Document 2, for example). Further, a technique for reducing the insertion resistance and the extraction resistance by forming an indwelling portion with a band-like portion and a membrane-like portion provided with a notch and folding the notch as a base point is disclosed (for example, Patent Documents). 3).
In addition, a fistula catheter technique in which a coil spring is embedded in a tubular member is also disclosed as a tube kink prevention (see, for example, Patent Document 4).

US Pat. No. 4,863,438 US Pat. No. 5,336,203 JP 2006-296794 A Japanese Patent No. 3675650

The conventional fistula catheter as described above uses an extension tool to apply an external force to the expanded in-vivo indwelling portion to linearly expand and contract the diameter, but at the same time, extends the in-vivo indwelling portion. Unnecessary portions and further tubular members are stretched, and external force cannot be effectively transmitted to the most bulky portion of the indwelling portion, and there is a problem that the portion cannot be sufficiently expanded and contracted.
The present invention has been made in view of the above circumstances, and is less invasive to patients by reducing resistance when a fistula catheter is inserted and removed from a body organ percutaneously from outside the body, and It is an object of the present invention to provide a fistula catheter that can be inserted and removed safely and easily for a treatment person.

Such an object is achieved by the present invention described in the following (1) to (11).
(1) A tubular member having a nutritional passage for supplying a liquid substance such as a nutrient or medicinal solution percutaneously from the outside of the body into the internal organ, and formed at the distal end side of the tubular member, and can be placed and fixed in the organ. A fistula catheter having an indwelling portion,
The indwelling part is composed of an organ contact part that comes into contact with a body organ, and an indwelling tip part formed on the tip side of the organ contact part,
A fistula catheter characterized in that the relationship between the hardness (B) of the organ contact portion and the hardness (A) of the indwelling tip is (A)> (B).
(2) The indwelling distal end portion has a convex shape from the distal end side of the tubular member toward the proximal end portion when there is no load, and a concave shape when a load is applied toward the distal end portion of the tubular member. The fistula catheter according to (1) having a concavo-convex mutation portion.
(3) The fistula catheter according to (1) or (2), wherein the relationship between the hardness (B) of the organ contact portion and the hardness (C) of the tubular member is (C)> (B).
(4) The fistula catheter according to any one of (1) to (3), wherein the durometer hardness of the organ contact portion is 30 or more and 60 or less on an A scale.
(5) The fistula catheter according to any one of (1), (3), and (4), wherein the organ contact portion is formed of a resin that exhibits an elongation at cutting of 750% or more.
(6) The fistula catheter according to any one of (1) to (5), wherein the tubular member and the organ contact portion are integrally formed.
(7) The fistula catheter according to any one of (1) to (6), wherein the organ contact portion and the indwelling distal end portion are integrally formed.
(8) The fistula catheter according to any one of (1) to (7), wherein a guide wire insertion hole for allowing a guide wire to be inserted between an external body and an internal organ is attached to the indwelling distal end portion.
(9) A contact portion is attached to the substantially inner center of the distal end portion of the indwelling tip portion, and a reinforcing member is attached directly below the contact portion. (1) to (8) The fistula catheter according to 1.
(10) The fistula catheter according to any one of (1) to (9), which has an extracorporeal fixing part that contacts a patient's body surface part at a proximal end part of the tubular member.
(11)
One of the valves according to any one of (1) to (10), wherein the nutritional passage of the tubular member is provided with a one-way valve that prevents the liquid substance from flowing back from the body organ through the lumen of the tubular member to the outside of the body. Fistula catheter.

  According to the present invention, it is possible to reduce resistance when a fistula catheter is inserted into and removed from a body organ percutaneously from outside the body, so that it is minimally invasive to a patient and safe and easy for a treatment person. A fistula catheter that can be inserted and removed can be provided.

1 is a perspective view showing a first embodiment of a fistula catheter according to the present invention. It is the schematic which shows the extensibility of the catheter for fistula by this invention, and a conventional product. It is sectional drawing which shows the state before and behind setting an extender in the catheter for fistula of 1st embodiment by this invention. It is a perspective view which shows 2nd embodiment of the catheter for fistula by this invention. It is sectional drawing which shows the state before and behind setting an extender in the catheter for fistula of 2nd embodiment by this invention.

Hereinafter, each component will be described in detail with reference to the drawings.
FIG. 1 is a perspective view showing a first embodiment of a fistula catheter according to the present invention. The fistula catheter 1 is located at the distal end of the tubular member 2 having a nutrient passage 21 for transcutaneously replenishing a liquid substance such as a nutrient or a drug from the outside of the body to the internal organ, and inside the internal organ. The indwelling part 3 for indwelling and fixing the fistula catheter 1 is integrally molded or attached. Further, the indwelling portion 3 includes an organ contact portion 32 that comes into contact with a body organ and an indwelling tip portion 31 on the distal end side thereof, and the hardness (A) of the indwelling tip portion 31 is the organ contact portion 32. The hardness (B) is higher.

Of the indwelling part of a general fistula catheter, the part that comes into contact with the internal organ is fixed in place by increasing the removal resistance of the fistula catheter in the patient's organ, so that the wall thickness is increased. Although it is configured, when exchanging this fistula catheter, it is also a part where it is desired to make it straight as much as possible and to make the bulk as small as possible so as not to apply external force to the fistula as much as possible.
As shown in FIG. 2, since the indwelling part 3 is configured with the same hardness in the conventional fistula catheter, when the indwelling part 3 in a state of being expanded in diameter using the extending tool 10 is used by the extending tool 10, Instead of extending only the length L2 of the organ contact portion 32 that the indwelling portion 3 is desired to extend, the length L3 of the indwelling distal end portion 31 that does not need to be extended so much is extended greatly. Moreover, naturally the load for extending will also become large.

On the other hand, the fistula catheter 1 of the present invention is configured such that the indwelling distal end portion 31 on the distal end side thereof is made of a resin that is hard and difficult to extend as compared with the organ contact portion 32 that contacts the internal organs in the indwelling portion 3. Since the organ contact portion 32 having a lower hardness can be sufficiently extended in the axial direction of the tubular member 2 than the indwelling distal end portion 31 having a higher hardness, the external force by the extender 10 is more effectively applied to the organ contact portion 32. Can be communicated to.
That is, when the moving distance of the extender 10 is the same setting, as shown in FIG. 2, the axial direction of the tubular member 2 of the indwelling distal end portion 31 in the configuration of the fistula catheter of the present invention is compared with the conventional fistula catheter. (L3 ″ <L3 ′), the organ contact portion 32 can be extended longer in the axial direction of the tubular member 2 (L2 ″> L2 ′), and the diameter of the indwelling portion 3 can be further reduced. (R ″ <R ′). This makes it possible to approach R ″ / R1 = 1 (during extension), which is considered to be an ideal type of fistula catheter, and the resistance to insertion and removal of the fistula catheter 1 through the patient's fistula can be significantly reduced. In addition, it is minimally invasive to the patient and can be smoothly exchanged for the treatment person, thereby realizing a safe and easy procedure.
Furthermore, since the necessary external force can be transmitted to the organ contact portion 32 which is a portion desired to be extended rather than pushing the entire indwelling portion 3 as a whole, the operability of the operator can be improved.

Furthermore, the hardness (C) of the tubular member 2 is preferably higher than the hardness (B) of the organ contact portion 32. By sandwiching the organ contact portion 32, which is a portion having low hardness and easy to extend, between the tubular member 2 having high hardness and the indwelling distal end portion 31, the external force by the extender 10 can be more effectively transmitted to the organ contact portion 32. It becomes possible.
Thus, as shown in FIG. 2, when the extension tool 10 is used to apply an external force to the in-vivo indwelling portion 3 in the expanded state to linearly reduce the diameter, the tubular member 2 is also greatly increased in the axial direction. The phenomenon seen in the conventional fistula catheter in which each member is formed with the same hardness, which is elongated (L ₁ ′ >> L ₁ ), can also be solved.
That is, when the moving distance of the extender 10 is the same setting, the structure of the fistula catheter of the present invention is longer than the conventional fistula catheter as shown in FIG. L1 ″ <L1 ′) and the length (L3 ″ <L3 ′) of the indwelling tip 31 in the long axis direction of the tubular member 2 are suppressed, and the organ contact portion 32 is greatly extended in the long axis direction of the tubular member 2 (L2 ″> L2 ′) and the diameter of the indwelling portion 3 can be further reduced (R ″ <R ′). This makes it possible to approach R ″ / R1 = 1 (during extension), which is considered to be an ideal type of fistula catheter, and the insertion / extraction resistance of the fistula catheter 1 through the patient's fistula can be significantly reduced. In addition, it is minimally invasive to the patient, and the treatment person can also perform the replacement operation smoothly, thereby realizing a safe and easy procedure.
Furthermore, since the necessary external force can be transmitted to the organ contact portion 32 which is a portion to be extended, instead of pushing and extending the entire fistula catheter 1, the operability of the operator can be improved.

In addition, as described above, in the state where the fistula catheter is indwelled in the patient's fistula, the indwelling portion 3 has a sufficient bulk for indwelling and fixing the fistula catheter in the patient's organ, When exchanging the catheter, it is preferable that the indwelling portion 3 is straightened to reduce insertion and removal resistance. That is, it is preferable that the indwelling portion 3 is deformed and straightened only when an external force from the extension device 10 is applied in the distal direction from the proximal end side of the tubular member.
Specifically, as shown in FIG. 3, when no load is applied, the tubular member 2 has a convex shape from the distal end side toward the proximal end side, and when a load is applied in the distal end direction of the tubular member 2, the concave shape is obtained. It is preferable that the uneven | corrugated variation part 311 used as a shape is attached to the said indwelling front-end | tip part 31. FIG.
In the case of no load, the unevenness variation part 311 is formed in a convex shape, but when a force is applied in the direction of being pulled out of the patient's fistula with the tubular member 2 of the fistula catheter 1 (generally In the hollow portion 314 inside the indwelling portion 3, the inside side surface portion 312 of the indwelling distal end portion 31 and the convex uneven portion 311 repel each other in the direction of the diameter reduction. It is possible to prevent the distal end portion 31 from being reduced in diameter.
On the other hand, when an external force is applied to the distal end portion of the indwelling portion 3 by the extender 10, the unevenness variation portion 311 has a concave shape, and the inner side surface portion 312 of the placement distal end portion 31 and the concave unevenness variation portion 311 The indwelling distal end portion 31 is formed using the hollow portion 314 inside the indwelling portion 3 with the root (periphery) of the uneven portion 311 having the concave shape as a base point. Folded like an umbrella and reduced in diameter.

If the said indwelling front-end | tip part 31 and the said tubular member 2 are comprised with resin higher than the hardness of the said organ contact part 32, it will not specifically limit. With this configuration, it is possible to concentrate the external force by the extender 10 on the organ contact portion 32.
As an example, the relationship of hardness when each member is made of silicone rubber will be described. The durometer hardness of the organ contact portion 32 is preferably 30 or more and 60 or less on the A scale. The durometer hardness of the tubular member 2 is preferably 50 or more and 75 or less on the A scale. Particularly preferably, the hardness difference between the tubular member 2 and the organ contact portion 32 is made larger within the above range.
If the organ contact portion 32 has a hardness exceeding the upper limit of the above range, the force required to operate the extender 10, that is, the organ contact portion 32, increases, and it is difficult for the operator to operate with one hand. It may become. If the value is less than the lower limit of the above range, the ability (anchor force) of indwelling and fixing the fistula catheter 1 in a body organ is reduced, and the risk of inadvertent removal (accident removal) from the fistula during placement is high. Become.
If the tubular member 2 has a hardness exceeding the upper limit of the above range, the portion appearing on the patient's body surface is hard, which may interfere with life and cause discomfort to the patient. If it is less than the lower limit of the above range, the risk of crushing (kinking) the tubular member 2 increases, and the possibility of affecting the passage of nutrients and the like increases.

  The elongation at the time of cutting of the organ contact portion 32 is not particularly limited as long as the organ contact portion 32 does not break when the fistula catheter 1 is extended and contracted to be removed from the patient after a certain indwelling period, but is 750% It is preferably formed of a resin exhibiting the above elongation at break. Although it fluctuates depending on the cross-sectional area of the organ contact portion 32, in order to make it closer to R ″ / R1 = 1, L2 ″ in FIG. 2 should extend about twice or more than L2 (L2 ″> 2 ×). L2). Furthermore, since a fistula catheter is generally indwelling and fixed in a patient's organ for a long period of time, there is a risk of strength reduction due to repeated contact with body fluids and the patient's body movement. By using a resin having sufficient strength such as the elongation at the time of cutting, the risk of breakage can be reduced, and a highly safe fistula catheter can be obtained.

  If the said tubular member 2 has the nutrient channel | path 21 which supplies liquid substances, such as a nutrient or a chemical | medical agent, percutaneously from an external body to a body organ, the dimension of the inner and outer diameter will not be specifically limited. The outer diameter is preferably 5 to 10 mm in accordance with the size of a general fistula of a patient.

  The indwelling portion 3 composed of the indwelling distal end portion 31 and the organ contact portion 32 may be of a non-balloon type and generally used for fistula catheters that are extended and used by the extension device 10. There is no particular limitation. Any shape such as a malecot type, pyramid type, dome type, etc., can be confirmed sufficiently by the conventional configuration of the same hardness and the configuration of the present invention when compared with the same shape.

When the load is not applied, the shape of the concave-convex variation portion 311 is convex toward the proximal end portion of the tubular member 2, and the inner side surface portion 312 of the indwelling distal end portion 31 and the convex concave-convex variation portion 311 are reduced in diameter. The function of preventing the indwelling tip 31 from being reduced in diameter by repelling in the direction, and a concave shape when a load is applied in the direction of the tip of the indwelling portion 3, and the inner side surface of the indwelling tip 31 The portion 312 and the concave-convex uneven portion 311 do not repel each other in the direction of diameter reduction, and the cavity inside the indwelling portion 3 is based on the root (periphery) of the concave-convex portion 311 having the concave shape. There are no particular limitations as long as the indwelling distal end 31 can be folded like an umbrella and reduced in diameter using the portion 314. Any shape such as a circular shape, an oval shape, a polygonal shape, or a conical shape may be used.
Preferably, the root (periphery) of the unevenness variation part 311 is formed by the thin part 313. By doing so, the effect as a base point when the indwelling distal end portion 31 is folded like an umbrella and reduced in diameter can be enhanced, and the convex-concave portion 311 by the extender 10 is changed from the convex shape to the concave shape. The external force required for mutation is small and can be mutated smoothly.

The method for attaching the tubular member 2 and the organ contact part 32 may be integral molding, insert molding, adhesion, or the like as long as the tubular member 2 and the organ contact portion 32 are not broken by an external force by the extender 10, and are not particularly limited. Preferably, it is formed integrally, can ensure a higher strength than bonding by bonding or the like that is generally performed, and is excellent in long-term use. Further, since the step can be eliminated, the discomfort of the patient during the detention can be reduced.
The method of integral molding is not particularly limited, but two-color molding or the like is practical, and can be manufactured at a lower cost than those formed by bonding or the like.

The attachment method of the organ contact portion 32 and the indwelling distal end portion 31 may be integral molding, insert molding, adhesion, or the like as long as it is not broken by an external force by the extender 10, and is not particularly limited. Preferably, it is formed integrally, can ensure a higher strength than bonding by bonding or the like that is generally performed, and is excellent in long-term use. Further, since the step can be eliminated, the discomfort of the patient during the detention can be reduced.
The method of integral molding is not particularly limited, but two-color molding or the like is practical, and can be manufactured at a lower cost than those formed by bonding or the like.

Examples of the material constituting the fistula catheter 1 of the present invention include polyurethane resin and silicone rubber. The organ contact portion 32 is not particularly limited as long as it is a material having elasticity and extensibility, but silicone rubber having a low tissue reactivity in the body is preferable.
Further, the indwelling distal end portion 31 may be made of a hard resin or metal as long as it has a higher hardness than the organ contact portion 32 and has a folding mechanism.

FIG. 3 is a cross-sectional view showing a state before and after the extension device 10 is set on the fistula catheter 1.
The unevenness variation part 311 is provided with a guide wire insertion hole 4 for inserting a guide wire connecting the outside of the body and the internal organs. As a result, the extender 10 is set on the indwelling fistula catheter 1, a guide wire (not shown) is inserted from the guide wire passage 11 of the extender 10, and the guide wire insertion hole 4 of the fistula catheter 1 is passed. As a result, the connection between the extracorporeal and internal organs by the guide wire is achieved.
In this manner, in the replacement operation of the fistula catheter 1, the fistula catheter 1 extended by the extension tool 10 is removed along the guide wire, and then a new fistula catheter 1 is inserted along the guide wire. Therefore, the deviation into the abdominal cavity can be prevented, and the fistula catheter 1 can be reliably inserted into the organ.

  The diameter of the guide wire insertion hole 4 is not particularly limited as long as it matches the diameter of the guide wire to be used. It is preferably 0.9 to 1.5 mm, particularly preferably 0.9 to 1.2 mm. If it is in the said dimension range, it is excellent in the insertability of a 0.035 'inch (inch) guide wire especially.

A contact portion 5 on which an external force by the extension tool 10 acts may be attached to the unevenness variation portion 311. The indwelling distal end portion 31 provided with the unevenness variation portion 311 and the abutting portion 5 may be a soft resin as long as it is configured with hardness that is harder than the organ contact portion 32.
It is preferable to attach a reinforcing member 51 directly below the contact portion 5 of the unevenness variation portion 311. By attaching the reinforcing member 51, when an external force is applied to the in-vivo indwelling portion 3 with the extension tool 10, the indwelling distal end portion 31 can be prevented from being damaged, and the in-vivo indwelling portion 3 is reduced from the patient's fistula in a reduced diameter state. The operation of insertion and removal can be performed safely and reliably.

  The shape and material of the reinforcing member 51 are not particularly limited as long as the reinforcing member 51 does not hinder the connection between the outside of the guide wire (not shown) and the organ by the guide wire insertion hole 4. For example, it can be formed of a material such as a metal or a thermosetting resin. In particular, it is preferably a metal mesh, and the resin wraps around in the lattice of the mesh at the time of molding, so that the contact area between the metal mesh and the resin constituting the indwelling tip 31 can be greatly increased. Strength can be improved.

  Further, it is preferable that the guide wire insertion hole 4, the contact portion 5, and the reinforcing member 51 attached to the indwelling distal end portion 31 are also integrally formed.

Next, a fistula catheter according to a second embodiment of the present invention will be described with reference to FIG.
In the fistula catheter 6 in the second embodiment, the same components as those in FIG. 1 are denoted by the same reference numerals, description thereof is omitted, and different points are mainly described. That is, the fistula catheter 6 according to the second embodiment is different from the fistula catheter 1 according to the first embodiment in that the extracorporeal fixing portion 7 is provided at a portion of the tubular member 2 located on the body surface of the patient. The point provided is that the one-way valve 8 is provided at the tip of the tubular member 2.

The extracorporeal fixation unit 7 is provided in a portion located on the surface of the patient's body when the fistula catheter 6 is embedded, and prevents the fistula catheter 6 from being embedded in the patient's body (inside the organ). The shape of the extracorporeal fixing portion 7 is not particularly limited as long as the extracorporeal fixing portion 7 is attached to the proximal end portion of the tubular member 2 and projects outward in the radial direction of the tubular member 2. For example, it can be a flat object attached around the opening of the base end of the nutrient passage 21. The extracorporeal fixation part 7 is the only part of the fistula catheter 6 that can be seen by the patient during indwelling. Therefore, a flat object is preferable in that it is less bulky and does not hinder the patient's life.
Further, a plug 71 that fits into the opening of the base end portion of the nutrient passage 21 is attached to the extracorporeal fixing portion 7 of this example via a connecting member 72. The plug 71 is fitted in the opening of the proximal end portion of the nutrient passage 21 when the nutrient catheter or the chemical solution is not supplied percutaneously from the outside of the body into the stomach in the embedded state of the fistula catheter 6. Can be kept airtight.

  Further, the fistula catheter 6 of this example is designed so that the tubular member 2 fits the length of the fistula of the patient as compared with the fistula catheter 1 of the first embodiment. That is, since the tubular member 2 of the fistula catheter 6 of this example is short, it is preferable that the one-way valve 8 is attached to prevent the liquid substance from flowing backward from the internal organs through the lumen of the tubular member. By doing so, nutrition or a chemical solution can be supplied to the patient percutaneously from the outside of the body to the inside of the body, and the liquid does not flow back out of the body.

FIG. 5 is a cross-sectional view showing a state before and after the extension device 10 is set on the fistula catheter 6 of this example.
On the other hand, the valve 8 can use a well-known valve, and the shape is not specifically limited. As an example, a duckbill valve is shown. Further, in this example, the configuration in which the one-way valve 8 is attached to the distal end portion of the tubular member 2 is illustrated. However, as long as it is within the nutrient passage 21 of the fistula catheter 6, The attachment position is not particularly limited.

  As with the fistula catheter 1, the fistula catheter 6 preferably includes the extracorporeal fixing part 7 and is integrally molded.

The fistula catheter of the present invention has been described based on the illustrated embodiment, but the present invention is not limited to this.
For example, about tubular member, organ contact part, indwelling tip part, uneven mutation part attached to indwelling tip part, thin part, guide wire insertion hole, contact part, extracorporeal fixation part, and one-way valve Any structure that can have a similar function can be substituted.

DESCRIPTION OF SYMBOLS 1 Fistula catheter 2 Tubular member 21 Nutritional passage 3 Indwelling part 31 Indwelling tip part 311 Concavity and convexity part 312 Inner side part 313 Thin part 314 Cavity part 32 Organ contact part 4 Guide wire insertion hole 5 Contact part 51 Reinforcing member 6 Fistula Catheter 7 extracorporeal fixing part 71 plug 72 connecting member 8 one-way valve 10 extender 11 guide wire passage

Claims (11)

A tubular member having a nutrient passage for transcutaneously replenishing a liquid substance such as a nutrient or a medicinal solution into the internal organ from outside the body, and an indwelling body that is formed at the distal end side of the tubular member and can be placed and fixed in the organ A fistula catheter having a portion,
The indwelling part is composed of an organ contact part that comes into contact with a body organ, and an indwelling tip part formed on the tip side of the organ contact part,
A fistula catheter characterized in that the relationship between the hardness (B) of the organ contact portion and the hardness (A) of the indwelling tip is (A)> (B).   The indwelling distal end portion has a convex shape from the distal end side to the proximal end portion side of the tubular member when there is no load, and a concave and convex variation portion that becomes concave when a load is applied toward the distal end portion of the tubular member. The fistula catheter according to claim 1.   The fistula catheter according to claim 1 or 2, wherein a relationship between the hardness (B) of the organ contact portion and the hardness (C) of the tubular member is (C)> (B).   The fistula catheter according to any one of claims 1 to 3, wherein a durometer hardness of the organ contact portion is 30 or more and 60 or less on an A scale.   The fistula catheter according to any one of claims 1, 3, and 4, wherein the organ contact portion is formed of a resin that exhibits an elongation at the time of cutting of 750% or more.   The fistula catheter according to any one of claims 1 to 5, wherein the tubular member and the organ contact portion are integrally formed.   The fistula catheter according to any one of claims 1 to 6, wherein the organ contact part and the indwelling distal end part are integrally formed.   The fistula catheter according to any one of claims 1 to 7, wherein a guide wire insertion hole for inserting a guide wire between an external body and an internal body organ is attached to the indwelling distal end portion.   9. The fistula according to claim 1, wherein a contact portion is provided at a substantially inner center of the distal end portion of the indwelling tip portion, and a reinforcing member is provided immediately below the contact portion. catheter.   The fistula catheter according to any one of claims 1 to 9, further comprising an extracorporeal fixing portion that comes into contact with a patient's body surface portion at a proximal end portion of the tubular member.   11. The fistula according to claim 1, wherein a one-way valve for preventing the liquid substance from flowing backward from the body organ through the nutrient passage of the tubular member to the outside of the body is attached to the nutrition passage of the tubular member. catheter.

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