JP2011110414A - Method for determining right/wrong indwelling state of gastrostomy catheter - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a method for determining right/wrong indwelling state of a gastrostomy catheter by which whether the gastrostomy catheter is rightly indwelled in the stomach can be easily, quickly, securely, and safely determined almost without loading physical, mental, and economical burdens on a patient so that the gastrostomy catheter can be safely used after being indwelled in the stomach. <P>SOLUTION: A pH electrode 8 is inserted into a nutrition supply path 7A of the gastrostomy catheter 7 indwelled in a stomach 5. A pH sensing portion 8B thereof is protruded from an in vivo opening part 7D of the nutrition supply path 7A and brought into contact with a mucous membrane 2C to measure the pH of the mucous membrane 2C. An obtained measurement value is compared with a pH value within a normal range in the stomach to confirm whether the measurement value is within the normal range. <P>COPYRIGHT: (C)2011,JPO&INPIT

Description

  The present invention relates to a method for determining the correctness of an indwelling state of a gastrostomy catheter.

  In addition to the use of a nasal feeding tube as a method of supplying nutrition to patients who cannot take food from the mouth due to reduced brain function or other causes of mastication, or esophageal peristalsis, In order to reduce the burden on patients, methods using a gastrostomy catheter without using a feeding tube are increasing.

  The gastrostomy catheter is inserted into and placed in a perforation that is artificially constructed in the stomach wall directly above the stomach and the stomach wall inside the stomach, so that the inside and outside of the stomach are placed at a short distance of about 50 mm. In this way, liquid food, nutrients, etc. (hereinafter referred to as “nutrients”) can be directly supplied to the stomach from outside the body through the nutrient supply channel.

  There are several types of gastrostomy catheters depending on the structure, but all of them have a shorter nutrient supply channel than the above-mentioned nasal feeding tube, so they are relatively easy to manage and less contaminated. It is thought that it will be widely used in the future because it has less mental and mental burden and does not cause a significant risk of erroneous insertion into the lung unlike a feeding tube.

  As described above, the gastrostomy catheter has many merits as a means of supplying nutrients. However, the gastrostomy catheter is newly installed in the gastrostomy or re-used for replacement when used for a certain period of time after installation. When placed and placed, it is necessary to be placed in a position where nourishment is definitely supplied to the stomach during subsequent use.

  This is because, for example, the gastrostomy catheter is in a state in which the opening inside the body of the nutrient supply channel of the gastrostomy catheter, that is, the exit part to the stomach of the nutrient or the like is not directed into the stomach, for example, in the state of being directed into the abdominal cavity. If it is placed in the gastrostoma, nutrients etc. are injected into the abdominal cavity, causing peritonitis or causing other complications in the worst case, leading to the death of the patient in the worst case. is there.

Therefore, in order to prevent such an accident, it is very important to determine whether or not the gastrostomy catheter is correctly placed in the gastrostomy, and the following methods have been conventionally performed. .
B) Observe the indwelling state of the gastrostomy catheter with an endoscope inserted in the stomach.
B) X-rays are irradiated and the indwelling state of the gastrostomy catheter is observed through fluoroscopy.
C) Observe the discolored color by inserting a litmus paper attached to the tip of the wire into the nutrient supply channel of the gastrostomy catheter, and projecting it from the opening inside the body so as to contact the mucous membrane and other objects.

For the purpose of confirming the indwelling state of the gastrostomy catheter, proposals as shown in, for example, Japanese Patent Publication No. 2005-34423 (Patent Document 1) and Japanese Patent Publication No. 2009-131470 (Patent Document 2) have been made. .
Japanese Patent Publication No. 2005-34423 Japanese Patent Publication No. 2009-131470

However, the above-described determination methods have the following problems. That is,
B) The method using an endoscope has the advantage that the indwelling state of the gastrostomy catheter can be reliably confirmed and the upper gastrointestinal tract can be observed at the same time, but it is difficult to implement when the patient is at home. In addition to suffering from the patient, there is a problem that the medical burden of the patient increases because of the high medical insurance score.
B) The method of using X-rays is suitable for more strict judgment, but there is a physical, mental, and economic burden on the patient that is impossible in practice at home. In the case of repeated use over a long period of time, such as replacement of a large gastrostomy catheter, there is a problem that the radiation exposure dose to the human body accumulates, which is not preferable.
C) The method of using litmus paper is advantageous in that it is easy to implement and low in medical costs, but it is affected by bleeding from mucous membranes and nutrients when newly installing or replacing a gastrostomy catheter. In addition, there are cases where accurate determination is difficult due to reaction with drugs, etc., and there are individual differences in observation of pH dyes, etc., so objective and precise pH measurement cannot be performed. There is also a problem that the determination of the state becomes inaccurate.

  The present invention has been made in view of the above-described problems, and the object of the present invention is to provide a gastrostomy catheter that can be used safely after being placed in the gastrostomy. It is possible to determine whether or not the gastrostomy is correctly placed inward, easily, quickly, reliably, safely and with little physical, mental and financial burden on the patient. It is to provide a method for determining whether or not an indwelling state of a gastrostomy catheter is correct.

  Secondly, in addition to the first object, the object of the present invention is to provide a method for determining the correctness of the indwelling state of the gastrostomy catheter so that the indwelling state of the gastrostomy catheter can be determined with high certainty. It is to be.

  Thirdly, in addition to the first object, an object of the present invention is to determine the indwelling state of the gastrostomy catheter with a certain degree of certainty for practical use, and to reduce the cost of the apparatus for the determination. It is intended to provide a method for determining whether the indwelling state of the gastrostomy catheter is correct so that the economic burden on the patient side can be reduced.

  Fourthly, in addition to the first, second or third object, the object of the present invention is to determine whether the gastrostomy catheter is in place or not, which facilitates the work when the pH electrode enters the gastrostomy catheter. Is to provide a method.

  Fifth, the object of the present invention is to work when the pH electrode enters the gastrostomy catheter by means other than the means in the fourth object in addition to the first, second or third object. It is an object of the present invention to provide a method for determining whether or not an indwelling state of a gastrostomy catheter is easy.

  As means for achieving the first object (hereinafter referred to as “first means”), the determination method of whether or not the indwelling state of the gastrostomy catheter according to the present invention is the nutrition supply of the gastrostomy catheter placed in the gastrostoma. The pH electrode of the mucous membrane is inserted into the tract and the pH sensing part is protruded from the opening inside the body of the nutrient supply channel to be in contact with the mucous membrane to measure the pH of the mucous membrane. It is characterized by comparing with the pH value of the normal range in the stomach and confirming whether the said measured value exists in the said range.

  As means for achieving the second object (hereinafter referred to as “second means”), the determination method of whether or not the indwelling state of the gastrostomy catheter according to the present invention is the first means, wherein the pH electrode is made of glass. It is an electrode.

  As a means for achieving the third object (hereinafter referred to as “third means”), the determination method of whether or not the indwelling state of the gastrostomy catheter according to the present invention is the first means, wherein the pH electrode is antimony. It is an electrode.

  As means for achieving the fourth object (hereinafter referred to as “fourth means”), the determination method of the indwelling state of the gastrostomy catheter according to the present invention is the first, second or third means. The pH electrode is provided with a cable for connecting to a pH meter, and scales arranged in the length direction are displayed on the surface of the cable.

  As means for achieving the fifth object (hereinafter referred to as “fifth means”), the indwelling state determination method for a gastrostomy catheter according to the present invention comprises the first, second or third means, The pH electrode includes a cable for connecting to a pH meter, and the surface of the cable is differently colored in the length direction.

  According to the present invention, as a first effect, whether or not the gastrostomy catheter is correctly placed in the gastrostomy toward the stomach by the configuration described as the first means is simple, quick, and reliable. Since it can be judged safely and with little physical, mental and economic burden on the patient, the gastrostomy catheter can be used safely after being placed in the gastrostoma, that is, definitely no nutrients etc. It can be sent into the stomach, and thus greatly contributes to the prevention of medical accidents as described above.

  According to the present invention, as a second effect, the configuration described as the second means described above can determine whether the indwelling state of the gastrostomy catheter is correct or not with a high degree of certainty in addition to the first effect. it can.

  According to the present invention, as the third effect, in addition to the first effect, the correctness of the indwelling state of the gastrostomy catheter is determined with a practically sufficient certainty by the configuration described as the third means. The cost of the apparatus for determination can be reduced and the economic burden on the patient can be reduced.

  According to the present invention, as a fourth effect, whether or not the indwelling state of the gastrostomy catheter is determined in addition to the first, second, or third effect is determined by the configuration described as the fourth means described above. Therefore, it is possible to facilitate the pH measurement operation.

  According to the present invention, as a fifth effect, whether or not the indwelling state of the gastrostomy catheter is determined in addition to the first, second, or third effect is determined by the configuration described as the fifth means described above. Therefore, it is possible to facilitate the pH measurement operation.

  DESCRIPTION OF EMBODIMENTS Embodiments of the present invention will be described below with reference to the drawings. FIG. 1 is a diagram conceptually illustrating a method for determining whether a gastrostomy catheter is indwelling according to the present invention.

  As shown in FIG. 1, a gastrostomy catheter 7 is inserted and placed in a gastrostoma 5 formed by drilling in the abdominal wall 3 immediately above the stomach 2 of the patient 1 and the gastric wall 4 inside thereof as described above. (In the figure, the stomach 2, a part of the abdominal wall 3 and the gastrostomy catheter 7 are shown broken away). There are several types of gastrostomy catheters. The gastrostomy catheter 7 shown here is a type called a bumper / button type, and is an opening outside the body of a cylindrical body 7B having a through-hole 7A as a nutrient supply path. A button portion 7E and a bumper portion 7F as stopper portions for the gastrostoma 5 are provided in the opening portion 7C and the inside body opening portion 7D, respectively, and a lid portion 7G for opening and closing the opening portion 7C is provided in the outside body opening portion 7C. This type of gastrostomy catheter 7 is optimal for the method of the present invention because the nutrient supply path through which the pH electrode is inserted is the shortest only by the cylindrical body 7B, as will be described later. Of course, the method of the present invention can be applied to other types of gastrostomy catheters. In the figure, the gastrostomy catheter 7 is placed in a correct position with its inside opening 7D directed into the stomach, and therefore, the outside of the body and the lumen 2A of the stomach 2 communicate with each other. The state in which the stomach 2 can be supplied is shown. However, if the gastrostomy catheter 7 is not placed in such a correct position for some reason, supplying a nutrient or the like causes a serious accident as described above.

  In the present invention, whether or not the gastrostomy catheter 7 is indwelled is determined as follows. That is, first, as a device for use in the determination work, a pH electrode 8, a comparison electrode 9, and a pH meter 10 as a meter for displaying and recording the value of pH are prepared.

  As the pH electrode 8, a glass electrode or an antimony electrode is used. The glass electrode has high accuracy and precision of the measurement value, whereas the antimony electrode has low accuracy and precision of the measurement value. Is practically sufficient for the implementation of In addition, since the antimony electrode is less expensive than the glass electrode, it is suitable for reducing the cost of the device itself and the medical cost for the method of the present invention. The pH electrode 8 includes a cable 12 coupled to the electrode main body portion 8A for connection to a pH meter 10 placed outside the body of the patient 1. On the other hand, the pH meter 10 is connected to a cable 13 from a reference electrode 9 attached to any part of the patient's 1 body, for example, the chest.

  As an initial procedure of the method of the present invention, the pH electrode 8 is formed from the body outer opening 7C of the through hole 7A of the cylindrical body 7B of the gastrostomy catheter 7 placed in the gastrostoma 5 in this way, and the electrode body 8A is used as the tip. The pH sensing unit 8B is inserted and further advanced from the body outside opening 7C of the through-hole 7A toward the body inside opening 7D, protrudes from the body inside opening 7D, and is located at the tip of the electrode body 8A. In contact with the mucous membrane. Speaking in the same figure, this mucous membrane is the mucous membrane 2C of the stomach wall 2B located in the lower side in the figure. In this case, the amount of penetration of the pH electrode 8 from the gastrostomy catheter 7 until the pH sensing unit 8B comes into contact with the mucous membrane is usually in the vertical direction (in the standing position) of the stomach 2 in a state where the patient 1 is supine. This corresponds to the average distance between the opposing gastric walls 2D and 2B in the body's front-rear direction), but when the electrode body 8A is advanced into the gastrostomy catheter 7, the cable 12 is grasped with a finger and fed. Therefore, the contact of the pH sensing unit 8B with the mucous membrane can be determined by the tactile sensation of the hand holding the cable 12. In addition, as shown in the examples described later, this amount of entry is displayed on the cable 12 coupled to the electrode body 8A so that the change in the amount of entry of the electrode body 8A can be visually recognized, and the display is moved. It can also be grasped by observing the amount.

  Thus, the pH of the mucous membrane is measured in a state where the pH sensing unit 8B is in contact with the mucosa (in this case, the mucosa 2C). The measurement is performed using the pH electrode 8, the comparison electrode 9 attached to a part of the body 1 as described above, and the pH meter 10 connected to both the electrodes 8 and 9. Although the measured pH value is displayed on the pH meter 10, when a glass electrode is used as the pH electrode 8, a measured value with high accuracy and high accuracy can be obtained. On the other hand, when an antimony electrode is used as the pH electrode 8, the accuracy and precision of the measured values are lower than those of the glass electrode, but sufficient practicality is obtained in the context of the present invention. In addition, as an operation procedure of the instrument for measurement, the pH meter 10 may be turned on after the state in which the pH sensing unit 8B is in contact with the mucous membrane is grasped as described above, or the pH meter 10 may be turned on. The pH sensing unit 8B may be brought into contact with the mucous membrane in a state where the power is turned on in advance. In the latter case, it is possible to continuously observe the change in pH value after the pH electrode 8 is inserted into the gastrostomy catheter 7 until it contacts the mucous membrane.

  Then, the obtained pH measurement value is compared with a normal pH value range in the human stomach to check whether the pH measurement value is within the range. The pH value inside the human stomach is usually about 1.0 to 2.5, which is extremely lower than any other part of the body, so that the pH measurement obtained should be within this range. For example, the sensing portion 8B of the pH electrode 8 means that it reaches the gastric wall 2B facing the body opening 7D of the gastrostomy catheter 7 and is in contact with the mucous membrane as shown in the figure. 7 can be determined to be placed in the correct position as shown. Therefore, in this case, after the pH electrode 8 is pulled out, the gastrostomy catheter 7 can be used safely, that is, a nutrient or the like can be supplied to the stomach.

  On the other hand, if the obtained pH measurement value is out of the above range, the pH sensing unit 8B will detect the mucous membrane of the part other than the inside of the stomach 2, that is, for example, the cross-sectional part of the perforation as the gastrostoma 5 In contact with the mucosa 5A to be formed or the intraabdominal mucosa 14, in other words, the gastrostomy catheter 7 is placed in a state where the body inner opening 7 </ b> D is not correctly directed to the inside of the stomach 2. Can be determined.

  When a nutrient solution or the like is supplied into the stomach through the gastrostomy catheter 7 in a state where the gastrostomy catheter 7 is indwelled in this manner, the nutrient solution or the like is not supplied into the stomach but is supplied to the gastrostomy tube 5. The gastric fistula catheter 7 in the indwelling state must be removed and re-installed because it is pushed by the mucous membrane 5A or supplied into the abdominal cavity 16 to cause a serious accident. Whether or not the gastrostomy catheter 7 that has been reinstalled and placed is in the correct position can be determined by the procedure of the method of the present invention as described above.

  In this way, whether or not the indwelling state of the gastrostomy catheter 7 is correct is determined based on the measurement of the pH by the pH electrode 8, and thus can be performed extremely simply, quickly, reliably and safely. In addition, since the measurement value may be read from the value displayed by the pH meter 10, the determination is reliable without any personal error. In addition, the measurement or determination in the present invention can be performed in a very short time because the pH electrode 8 only needs to be inserted through the gastrostomy catheter 7 as described above, and therefore the physical and mental burden on the patient. Hardly takes. Furthermore, since the pH electrode 8 used for the measurement can be repeatedly used for the same measurement after predetermined washing, disinfection, etc., the burden on the patient is reduced. Furthermore, since the configuration of the devices used to determine whether the indwelling state of the gastrostomy catheter 7 is correct is simple and the operation of the devices for determination is simple and easy, determination when the patient is at home is performed. Is also possible.

  These advantages in the method of the present invention are described as follows for a glass electrode or an antimony electrode that can be used as a pH electrode. That is, when a glass electrode is used as the pH electrode, the measurement error is small, so that it is possible to perform the pH measurement and thus the determination with high reliability by using this. Further, considering that the glass electrode 18 is expensive, it is very convenient and meaningful from the viewpoint of medical cost that it can be washed and used repeatedly as described above to reduce the measurement cost per time. It is. Further, the glass electrode is safe for the human body of the patient because it does not elute substances harmful to the human body even if it is placed in the stomach for measurement.

  On the other hand, even when an antimony electrode is used as the pH electrode, whether the indwelling state of the gastrostomy catheter 7 is correct or not can be easily determined. The antimony electrode cannot obtain the measurement value with high accuracy and high precision like the glass electrode, but the practicality in carrying out the method of the present invention is satisfied, so that the device is inexpensive and delicate in handling due to the structure. Combined with the fact that it is not necessary to pay special attention, it is effective for the above-described determination work. The antimony electrode can be extracted from the gastrostomy catheter 7 after completion of the pH measurement, and can be reused by performing a predetermined treatment. Therefore, the economic burden on the patient is further reduced. In addition, unlike a glass electrode, an antimony electrode elutes a very small amount of antimony during measurement, but it is said that there is no adverse effect on the human body.Therefore, even in the determination work using the antimony electrode, There is no adverse effect on the body and it is safe.

  When the inventor actually measured and determined the patient using the glass electrode as the pH electrode 8 according to the method of the present invention, the present invention determines whether or not the indwelling position of the gastrostomy catheter 7 is correct. Therefore, it has been confirmed that it is possible to reliably prevent the above-described accident when supplying nutrients or the like with the gastrostomy catheter 7 after placement.

  Next, an embodiment of the present invention will be described with reference to FIGS. In this example, the same reference numerals are given to the same elements as those shown for the description in the above embodiment, and the description is omitted. In addition, the dimensional ratios between the two figures are not shown to match.

(First embodiment)
FIG. 2 shows one embodiment of a pH electrode suitable for use in the method of the present invention. The pH electrode represented by reference numeral 18 in the figure uses a glass electrode or an antimony electrode, and includes a cable 19 for connecting to the pH meter 10. The cable 19 is preferably made of a wound stainless steel wire that gives elasticity so that the body portion 8A of the pH electrode 18 can be smoothly inserted into the gastrostomy catheter 7. And the scale 20 is arranged and displayed on the surface of the cable 19 which gave elasticity in this way in the length direction. Each scale 20 sets an interval in units of 5 millimeters (mm) or 1 centimeter (cm), for example.

  According to such a configuration, when the pH electrode 18 is inserted through the gastrostomy catheter 7 and entered, the reference of the amount of entry can be visually recognized by the above-described scale 20, which is extremely convenient in terms of work.

(Second embodiment)
FIG. 3 shows another embodiment of a pH electrode suitable for using the method of the present invention. In this embodiment, the same elements as those shown in the first embodiment are denoted by the same reference numerals, and the description thereof is omitted. In this embodiment, the pH electrode 22 is provided with a cable 23 provided with elasticity as in the case of the first embodiment, but the surface is provided with different color coding 24 in the length direction. is there. The figure shows an example of this color classification 24. For example, the colors 24A, 24B, and 24C are changed in units of 5 millimeters (mm) or 1 centimeter (cm). As the color classification 24, the density may be changed with the same color. The boundary 25 where the color or density changes performs the same function as the scale 20 in the first embodiment.

  Also in this embodiment, when the pH electrode 22 is inserted into the gastrostomy catheter 7 and entered, the guide of the amount of entry can be visually recognized by the above-described color classification 24 and the boundary 25, which is convenient for work. is there.

It is explanatory drawing which showed notionally the correct / incorrect determination method of the indwelling state of the gastrostomy catheter concerning this invention. It is a side view which shows notionally the pH electrode in the 1st Example of this invention. It is a side view which shows notionally the pH electrode in the 2nd Example of this invention.

2C mucous membrane 7 gastrostomy catheter 7A through-hole 7D internal body opening 8 pH electrode 8B pH sensing unit

Claims (5)

  A pH electrode is inserted into the nutrient supply channel of the gastrostomy catheter placed in the gastrostoma, and the pH of the mucous membrane is brought into contact with the mucous membrane by projecting its pH sensing part from the opening inside the body of the nutrient supply channel. The gastrostomy catheter is characterized in that the measured value obtained is compared with the pH value in the normal range of the human stomach to confirm whether the measured value is within the range or not. A method for determining whether a detained state is right or wrong.   The method according to claim 1, wherein the pH electrode is a glass electrode.   The method according to claim 1, wherein the pH electrode is an antimony electrode.   The said pH electrode is equipped with the cable for connecting to a pH meter, and the scale lined up in a length direction is displayed on the surface of the said cable, It is characterized by the above-mentioned. To determine the correctness of the indwelling state of the gastrostomy catheter.   The pH electrode is provided with a cable for connecting to a pH meter, and the surface of the cable is subjected to different color coding in the length direction. A method for determining the correctness of the indwelling state of the gastrostomy catheter.

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