JP5063137B2 - Indwelling method for indwelling catheter - Google Patents

Description

  The present invention relates to an indwelling catheter used for various medical treatments or diagnostic purposes such as extracorporeal circulation for blood purification, administration of infusion / drug solution, blood collection, pulse pressure / blood flow measurement, etc. The present invention relates to an indwelling method and a catheter used for the indwelling method.

  Conventionally, for patients who need long-term infusion / medical solution administration, central vein indwelling catheters and gastrointestinal feeding catheters are used (see Non-Patent Document 1), renal failure, diabetes, drug addiction, For patients who need blood purification for diseases such as systemic inflammatory response syndrome (SIRS), acute respiratory stimulation syndrome (ARDS), multiple organ failure (MOF), hepatitis, pancreatitis, autoimmune diseases A blood access catheter is used in which a catheter is placed in a blood vessel and blood is discharged (see Non-Patent Document 2). Furthermore, for patients who need to measure central venous pressure and blood flow, a catheter for pulse pressure measurement that is placed in a blood vessel and measures venous pressure, and thermodilution that measures blood flow such as cardiac output A catheter is used (see Non-Patent Document 3).

  The above catheter is for performing some access such as administration of drug solution, blood withdrawal, measurement of in vivo information between the outside of the body and the target blood vessel, body fluid tube or organ in the body, Normally, a single catheter is inserted from outside the body through the skin and subcutaneous tissue to the target site.

  In addition, the above catheter is often left in the body for a long period of time, and during that period, bacteria are transmitted through the outer wall of the catheter through a drug administered from the lumen of the catheter or from the skin puncture site. Has entered the subcutaneous tissue, blood vessels, body fluid tubes or organs, causing infection. In particular, the frequency of bacteria entering the body through the outer wall of the catheter is high, and there are many cases that cause serious infections despite frequent disinfection and strict management by medical staff. Is also a big problem.

  For the purpose of preventing infection from the skin piercing portion of the catheter, for example, a catheter skin fixture containing an antibacterial agent (see Patent Document 1), or a catheter coated with an antibacterial agent on the surface (Patent Document 2) Have been developed).

In addition, for the purpose of long-term indwelling of the catheter, a catheter that is made of polyester cotton is attached to a part of the catheter and brought into close contact with the subcutaneous tissue, and the catheter is expected to have catheter fixation and infection prevention effect (Non-Patent Documents 4 and 5). ) Has also been developed and widely used in the medical field.
Edited by Japan Society for Parenteral and Enteral Nutrition: Guidelines for Parenteral and Enteral Nutrition for Comedies, 43, Nanedo (2000) Yuhei Hirasawa: Dialysis Therapy Manual (5th revised edition), 170, Japan Medical Center (1999) Sanae Tsuruta, Kazuko Harada: Postoperative Procedure Manual, 66, Terinsha (1991) JP-A-2-234767 Japanese Patent No. 2665399 JW Broviak, JJ Cole, BH Scribner: A silicone rubber right central venous catheter for long-term parenteral nutrition. Surgery and obstetrics and gynecology. 136: 602 (1973) (Broviac NW, Cole JJ, Scriber BH: a silicone rubber right atrial catheter for prolonged parenteralalimentation. Surg. Gynecol. Obstet, 136: 602 (1973)) RO Hickman, CD Bukner, BH Scribner: Modified silicone rubber right central venous catheter for venous access to bone marrow transplant patients. Surgery and obstetrics and gynecology. 148: 871 (1979) (Hickman RO, Buckner D, Clift RA: A modified right atrial catheter for access to the venous system in marrow transplant recipients, Surg. Gynecol. Obstet, 148: 871 (1979))

  The catheter skin fixing device containing the antibacterial agent described above is easy to handle, but has a problem in that the antibacterial activity due to the outflow of the antibacterial agent and the gap with the skin cannot be completely closed. In addition, catheters coated with antibacterial agents also have problems such as persistence due to outflow of antibacterial agents and allergies when placed in vivo.

  In this regard, the above-mentioned catheter with a cuff is considered to be superior in terms of safety because it blocks the bacteria that enter the body by the antibacterial force of the subcutaneous tissue inherent in the living body. In the event of an outbreak or infection, if an attempt is made to remove a catheter that is in close contact with the subcutaneous tissue, the entire subcutaneous tissue surrounding the catheter must be removed surgically, both physically and mentally. It was a huge burden.

  As described above, all of the conventional infection prevention means have been taken on the premise that the catheter is left in place during the period.

  The present invention proposes an infection prevention measure based on a new idea that does not assume that the catheter is left in place for a period of time, can exhibit an excellent infection prevention effect without using an antibacterial agent, and can be used for the attachment / detachment of the catheter. An object of the present invention is to provide a catheter indwelling method that can be replaced at will.

  As a result of intensive studies to solve the above-mentioned problems, the present inventors found that the subcutaneous tunnel provided in the subcutaneous tissue corresponding to the catheter indwelling route closed naturally after the catheter was removed, and the living body's original infection The present inventors have found that an extremely high infection prevention effect based on the prevention effect can be exhibited, and further, found that this subcutaneous tunnel can be easily opened when a catheter is inserted, and that various target catheters can be placed therein, and the present invention has been achieved.

  That is, in the first aspect of the present invention, a subcutaneous tunnel leading from the skin puncture portion to a target blood vessel, body fluid tube or organ is formed in advance in a subcutaneous tissue corresponding to a path for placing the indwelling catheter, and the indwelling catheter is provided. When not in use, the indwelling catheter is not inserted into the subcutaneous tunnel. When the indwelling catheter is used, a guiding catheter having a lumen through which a guide wire can be inserted is aimed through the subcutaneous tunnel. After inserting into a blood vessel, body fluid tube or organ, then inserting the guide wire into the guiding catheter, removing the guiding catheter leaving the guide wire, and then inserting the indwelling catheter along the guide wire The gist of the indwelling method of the catheter for in-vivo characterized Than is.

  In the second aspect of the present invention, a subcutaneous tunnel leading from the skin puncture portion to the target blood vessel, body fluid tube or organ is formed in advance in the subcutaneous tissue corresponding to the path for placing the indwelling catheter, and the indwelling catheter is not used. Sometimes the indwelling catheter is not inserted into the subcutaneous tunnel, and when using the indwelling catheter, the guiding catheter with the guide wire inserted is inserted into the target blood vessel, body fluid tube or organ through the subcutaneous tunnel. The gist of the indwelling method of the indwelling catheter is characterized in that the guiding catheter is removed after leaving the guide wire, and then the indwelling catheter is inserted along the guide wire.

  In the third aspect of the present invention, a subcutaneous tunnel that leads from the skin puncture portion to the target blood vessel, body fluid tube, or organ is formed in advance in the subcutaneous tissue corresponding to the path for placing the indwelling catheter, and the indwelling catheter is not used. Sometimes the indwelling catheter is not inserted into the subcutaneous tunnel, and when the indwelling catheter is used, the indwelling catheter is inserted into the target blood vessel, body fluid tube or organ through the subcutaneous tunnel. The gist of the indwelling method of the catheter for indwelling, which is characterized.

  In the first to third aspects of the present invention, preferably, the indwelling method of the indwelling catheter is in a state where the obturator is inserted into the subcutaneous tunnel when the indwelling catheter is not used.

  A fourth aspect of the present invention is the indwelling method for an indwelling catheter according to any one of the first to third aspects of the present invention, wherein a target blood vessel is inserted from a skin puncture portion into a subcutaneous tissue corresponding to a path for indwelling the indwelling catheter; A catheter for subcutaneous tunnel preparation for preliminarily forming a subcutaneous tunnel leading to a body fluid tube or organ, wherein a substance that strengthens the subcutaneous tissue exists on the surface of the catheter. Preferably, the substance that strengthens the subcutaneous tissue is a substance selected from the group consisting of chitin, chitosan, and urokinase.

  5th of this invention is a guiding catheter used when using the indwelling catheter in the indwelling method of the indwelling catheter of 1st or 2 of this invention, Comprising: The shore hardness of a catheter is the range of 65D-93A. The gist of the present invention is a guiding catheter.

  A sixth aspect of the present invention is the guiding catheter used when the indwelling catheter is used in the indwelling method of the indwelling catheter according to the first or second aspect of the present invention, wherein the outer diameter of the guiding catheter is a subcutaneous tunnel. The gist of the present invention is a guiding catheter characterized in that it is 0.5 to 0.8 times the outer diameter of a catheter for preparing a subcutaneous tunnel used to form the catheter.

  According to the present invention, the subcutaneous tunnel naturally closes in a state where the indwelling catheter is not inserted, and the infection prevention action of the subcutaneous tissue inherent in the living body is exhibited. Therefore, excellent infection without using an antibacterial agent It can have a preventive effect. In addition, it is possible to selectively attach a catheter suitable for various purposes through a subcutaneous tunnel, there are few restrictions on the outer diameter, and the choice of the outer diameter, length, number, type, etc. of the catheter is greatly expanded. Become. Furthermore, even with a catheter once placed, the outer diameter, length, number, etc. of the placed catheter can be easily changed by means for exchanging the catheter through a subcutaneous tunnel. Such a catheter is extremely excellent as a long-term continuous access route because it is safe for patients and can easily cope with troubles during indwelling such as occlusion by means of catheter replacement. .

  Hereinafter, the present invention will be described in detail.

  In the present invention, first, it is necessary to preliminarily form a subcutaneous tunnel that leads from the skin puncture portion to the target blood vessel, body fluid tube, or organ in the subcutaneous tissue corresponding to the path for placing the indwelling catheter. Here, the subcutaneous tunnel refers to a void formed by using an expander such as a puncture needle or a dilator in the dermis, muscle tissue, adipose tissue, etc., which are subcutaneous tissues existing inside the skin. The length and the inner diameter of the subcutaneous tunnel in the present invention vary depending on the part of the body where the indwelling catheter is placed, the type of the intended indwelling catheter, and the outer diameter, and cannot be generally limited. As a subcutaneous tunnel to be formed when a vascular access catheter for blood purification with an outer diameter of 4 mm is placed in the internal jugular vein, the subcutaneous tunnel between the skin insertion part of the upper front chest and the right internal jugular vein in the neck part is used. The tissue has a length of 2 to 20 mm, preferably 5 to 15 cm, more preferably 8 to 10 cm, and an inner diameter of 2 to 4.8 mm, preferably 3 to 4 mm, more preferably 3.2 to 4 mm. It is. In addition, as a subcutaneous tunnel formed when a central vein injection catheter having an outer diameter of 2 mm is placed in the right femoral vein, a length of 2 to 2 is placed in the subcutaneous tissue between the skin insertion part at the upper knee and the thigh groin part. It is 30 cm, preferably 5 to 25 cm, more preferably 10 to 15 cm, and the inner diameter is 1 to 2.4 mm, preferably 1.4 to 2 mm, and more preferably 1.6 to 2 mm.

  As the shape of the subcutaneous tunnel in the present invention, it is preferable that it extends from the skin puncture portion to the target blood vessel, body fluid tube or organ almost linearly, but it is prepared for placing the catheter in the internal jugular vein of the neck. In the case of a subcutaneous tunnel, it may extend in a gently curved shape. The cross-sectional shape of the subcutaneous tunnel is preferably a shape in which there is no hindrance to close contact and close when the catheter is not placed, and no gap is formed between the subcutaneous tissue when the catheter is placed. An elliptical shape close to a circular shape or a perfect circular shape is preferable.

  In the present invention, the means for forming the subcutaneous tunnel is not particularly limited, and any method may be used as long as it can form the subcutaneous tunnel as described above in the subcutaneous tissue. . As a preferred method, a conventional method for placing a catheter can be employed. That is, a cannula mantle type puncture needle is inserted between the skin puncture portion and a blood vessel or the like, and only the puncture needle is immediately removed to leave only the cannula in the blood vessel, and a guide wire is inserted into the lumen. Next, the cannula is removed while leaving the guide wire, and a dilator for expansion is inserted along the guide wire to expand the skin insertion portion, the subcutaneous tissue, and the blood vessel insertion portion. Finally, the dilator for dilation is removed and placed through a so-called Seldinger method, which is a method of placing a catheter for forming a subcutaneous tunnel along the guide wire, or a sheath through which the catheter is inserted into the lumen. And the like (for details, see Yoshifumi Inoue, “TPN Lecture”, p. 80, Nanedo, 2004).

  FIG. 1A shows a state in which a subcutaneous tunnel production catheter 1 which is a catheter for forming a subcutaneous tunnel is placed in a blood vessel 8 through a subcutaneous tunnel 10 from a skin insertion part 11 in a skin 6 into a subcutaneous tissue 7. An example is shown, and a subcutaneous tunnel 10 is formed in the subcutaneous tissue 7. FIG. 1B is a cross-sectional view of the A-A ′ portion shown in FIG.

The subcutaneous tunnel preparation catheter 1 includes a catheter main body 21 inserted between the skin insertion portion 11 and the blood vessel 8 through the blood vessel puncture portion 12 in the blood vessel wall 9, and a subcutaneous tunnel preparation catheter from the body. Connected to a thread hook 25 for suturing the skin to prevent it from coming off, an extension tube 22 for clamping made of a soft material for temporarily blocking the lumen of the catheter by a clamp 24, a syringe, etc. In order to confirm that the catheter has been placed in the blood vessel, or to inject and fill an anticoagulant such as heparin to prevent the blood in the blood vessel from flowing backward and coagulating during placement 23.
The catheter 21 has a lumen 27 extending to the distal end portion 26 for insertion along the guide wire.

  In the present invention, by inserting the above-described subcutaneous tunnel manufacturing catheter and leaving it in place for a predetermined period of time, it is possible to stabilize the surrounding tissue of the subcutaneous tunnel so as not to be easily blocked. During the indwelling period, the thread hook 25 may be used to suture and fix the skin. Examples of the period for the detention include 1 to 15 days, preferably 2 to 10 days, and more preferably 2 to 7 days. Indwelling conditions such as body temperature, wetness and body movement during the indwelling period are not particularly limited.

  Further, it is preferable that a substance that firmly hardens the introduced subcutaneous tissue is present on the surface of the catheter for preparing the subcutaneous tunnel. Examples of such a substance include plasminogen activators such as urokinase and antiparin such as heparin. Examples thereof include biocompatible substances such as coagulants, chitin, and chitosan. As a method for allowing such a substance to exist, a method of immobilizing on a catheter surface of a base material by a chemical bonding method (for details, refer to Japanese Patent No. 1406830), a method of coating the catheter surface, or a fibrous form of chitin or chitosan, A method of introducing by various methods such as a sponge shape, a sheet shape, and a fine particle shape has been developed, but is not limited to a specific method. The range of the anticoagulant treatment may be the outer surface, the inner surface, or both of the catheter as long as it is a part that contacts the subcutaneous tissue or blood.

  Further, the catheter 1 for making a subcutaneous tunnel is provided with a lubrication treatment such as coating the surface of a base material with a hydrophilic polymer compound in order to facilitate insertion into the subcutaneous tissue 7 or blood vessel 8 (for example, Japanese Patent Laid-Open No. 10-248919). Many methods have been developed for the lubricity treatment, and any method may be selected. The range of the lubrication treatment may be any part as long as it is a part that comes into contact with the human body or a part that comes into contact with a tool or the like for placing the catheter. Furthermore, it may be performed simultaneously with the anticoagulant treatment.

  FIG. 2 shows the situation of the subcutaneous tunnel 10 formed in the subcutaneous tissue 7 after the catheter for subcutaneous tunnel preparation is left in place as described above and the catheter is removed after a certain period of time. FIG. 2B is a cross-sectional view of the A-A ′ portion in FIG. Usually, the formed subcutaneous tunnel 10 is thinner than the outer diameter of the main body 21 of the catheter 1 for making a subcutaneous tunnel due to the contraction of the subcutaneous tissue 7, but the subcutaneous tissue 7 is not completely in close contact with and obstructed. Various bacteria that enter from the outside through the skin piercing part 11 can be killed by the antibacterial action of the subcutaneous tissue itself.

  In the indwelling method according to the first to third aspects of the present invention, after the subcutaneous tunnel is formed as described above, when the indwelling catheter is not used, the indwelling catheter as shown in FIG. 2 is not inserted. Alternatively, as shown in FIG. 5, the obturator 5 is inserted into the lumen of the subcutaneous tunnel 10. In the state of the subcutaneous tunnel shown in FIG. 2, the lumen is not blocked, but insertion of the obturator 5 facilitates insertion of the guiding catheter or indwelling catheter described below. Can be expected.

  The obturator 5 has a rod-shaped obturator body 36 having a thickness that does not block the lumen of the subcutaneous tunnel, a thread hook 25 for fixing to the skin, and a handle portion 35 for insertion. The material may be the same as the catheter for making the subcutaneous tunnel and the guiding catheter.

  In the indwelling method of the indwelling catheter of the present invention, there are the following three methods as modes when using the indwelling catheter. First, after inserting a guiding catheter having a lumen through which a guide wire can be inserted into a target blood vessel, body fluid tube or organ through the subcutaneous tunnel, and then inserting the guide wire into the guiding catheter. In this method, the guiding catheter is removed while leaving the guide wire, and then the indwelling catheter is inserted along the guide wire. The second method is to insert the guiding catheter with the guide wire inserted into the subcutaneous tunnel. Is inserted into the target blood vessel, body fluid tube or organ through the guide catheter, leaving the guide wire, and then inserted into the body catheter along the guide wire, the third method, Without using the guiding catheter used in the first and second methods, The ether, vessels of interest through The subcutaneous tunnel, a method of inserting a fluid tube or organ.

  FIG. 3 shows that in the first method described above, the guiding catheter 2 is inserted from the skin puncture portion 11 in the blood vessel wall 9 and reaches the inside of the blood vessel 8 through the subcutaneous tissue 7 and the blood vessel puncture portion 12. The situation when the guide wire 3 is inserted through the lumen 30 of the ding catheter body 28 is shown. The lumen 30 of the guiding catheter 2 leads from the connection portion 23 to the catheter tip portion 29, and the guide wire 3 reaches the target position in the blood vessel 8. The catheter is provided with a clamp 24 and an extension tube 22 for temporarily closing the lumen when blood in the blood vessel flows backward as necessary, and a thread hook 25 for temporarily fixing the catheter to the skin. It has been. Also in the above-described second method, when the guiding catheter 2 having the guide wire 3 inserted therein is inserted from the skin puncture portion 11 and reaches the inside of the blood vessel 8 through the subcutaneous tissue 7 and the blood vessel puncture portion 12, FIG. The state shown in FIG.

  In the above first and second methods, the guiding catheter 2 is then removed with the guide wire 3 left.

  Here, the guiding catheter 2 used in the present invention will be described. The hardness of the guiding catheter 2 is important. If it is too soft, it is difficult to insert the subcutaneous tunnel 10 from the skin insertion part 11, and if it is too hard, there is a risk of damaging the tissue and blood vessels. The guiding catheter 2 preferably has a Shore hardness in the range of 60D to 85A, and more preferably a Shore hardness in the range of 65D to 93A.

  Further, in the guiding catheter 2 used in the present invention, the ratio of the formed subcutaneous tunnel 10 to the outer diameter greatly affects the insertion property of the subcutaneous tunnel 10. Although it is difficult to define the outer diameter of the subcutaneous tunnel 10 formed in the subcutaneous tissue 7 as the subcutaneous tissue 7 contracts, the outer diameter of the catheter 1 for preparing the subcutaneous tunnel for forming the subcutaneous tunnel 10 is specified. It is possible. The outer diameter of the guiding catheter 2 is preferably 0.4 to 0.9 times, more preferably 0.5 times the outer diameter of the subcutaneous tunnel manufacturing catheter 1 used when the subcutaneous tunnel 10 is manufactured. ~ 0.8 times.

  In the first and second methods described above, the intended indwelling catheter 4 is then inserted into the subcutaneous tunnel 10 from the skin insertion part 11 along the guide wire. FIG. 4 shows a state in which the distal end portion 32 of the target indwelling catheter 4 advances along the subcutaneous tissue 7 along the guide wire 3 placed in the blood vessel 8, and finally the blood vessel wall 9. Passes through the blood vessel puncture portion 12 and reaches the blood vessel 8. FIG. 4 shows a double lumen catheter for intravascular placement as an example of the indwelling catheter 4. The structure of the double-lumen catheter is usually divided into two layers of lumen 34, and from the catheter body to the outside of the body, it is divided into two extension tubes 22 with a branching portion 31 as a boundary and connected to an extracorporeal circuit or an infusion circuit. The connection part 23 to perform and the clamp 24 which interrupts | blocks a flow path temporarily are provided.

  Regarding the shape of the clamp 24 in the catheter 1 for making a subcutaneous tunnel and the guiding catheter 2 used in the present invention, there is a pinch type in which the tube is closed by pressing with a finger, or a slit whose width is gradually reduced. There is a slit type shape that enters and closes the tube by sliding the slit, but the shape is not limited as long as it has a function of closing the tube.

  The material of the catheter 1 for making a subcutaneous tunnel and the guiding catheter 2 used in the present invention may be any material that is safe and elastic when placed in the body, particularly in a blood vessel. For example, polyurethane, silicone, polyvinyl chloride , Polybutadiene, polyamide, ethylene-vinyl acetate copolymer, and the like, and polyurethane having a property of maintaining hardness and flexibility in the body is preferable.

It is the schematic which shows the state which inserted the catheter for subcutaneous tunnel preparation to the blood vessel. (A) Cross section in depth direction from skin, (B) Cross section of A-A 'portion in (A) It is the schematic which shows an example when a catheter for indwelling is not used after a subcutaneous tunnel is formed. (A) Cross section in depth direction from skin, (B) Cross section of A-A 'portion in (A) It is the schematic which shows the state by which the guiding catheter and the guide wire were inserted to the blood vessel through the subcutaneous tunnel. (A) Cross section in depth direction from skin, (B) Cross section of A-A 'portion in (A) It is the schematic which shows the state in the middle of insertion of the catheter for indwelling along a guide wire. (A) Cross section in depth direction from skin, (B) Cross section of A-A 'portion in (A) It is the schematic which shows the state which has detained the obturator in the subcutaneous tunnel. (A) Cross section in depth direction from skin, (B) Cross section of A-A 'portion in (A)

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 Subcutaneous tunnel preparation catheter 2 Guiding catheter 3 Guide wire 4 Extracorporeal catheter (double lumen catheter)
DESCRIPTION OF SYMBOLS 5 Obturator 6 Skin 7 Subcutaneous tissue 8 Blood vessel 9 Blood vessel wall 10 Subcutaneous tunnel 11 Skin insertion part 12 Blood vessel insertion part 21 The catheter tip part 22 for making a subcutaneous tunnel Extension tube 23 Connection part 24 Clamp 25 Skin fixing thread hook part 26 Subcutaneous tunnel fabrication catheter tip hole 27 Subcutaneous tunnel fabrication catheter body lumen 28 Guiding catheter tip 29 Guiding catheter tip hole 30 Guiding catheter body lumen 31 Double lumen catheter branch 32 Double lumen catheter tip 33 Double Lumen catheter tip side hole 34 Double lumen catheter lumen 35 Obturator handle 36 Obturator body

Claims (3)

In the indwelling method for an indwelling catheter according to any one of (1) to (3) below, the skin puncture part leads to a target blood vessel, body fluid tube, or organ in a subcutaneous tissue corresponding to a path for indwelling the indwelling catheter. A catheter for preparing a subcutaneous tunnel for forming a subcutaneous tunnel in advance, wherein a substance for strengthening the subcutaneous tissue is present on the surface of the catheter.
  (1) A subcutaneous tunnel leading from the skin puncture part to the target blood vessel, body fluid tube or organ is formed in the subcutaneous tissue corresponding to the path for placing the indwelling catheter in advance, and when the indwelling catheter is not used, When the indwelling catheter is not inserted and the indwelling catheter is used, a guiding catheter having a lumen through which a guide wire can be inserted is used as a target blood vessel, body fluid tube or organ through the subcutaneous tunnel. And then inserting the guide wire into the guiding catheter, removing the guiding catheter leaving the guide wire, and then inserting the indwelling catheter along the guide wire Indwelling method of catheter.
  (2) A subcutaneous tunnel leading from the skin puncture part to the target blood vessel, body fluid tube or organ is formed in the subcutaneous tissue corresponding to the path for placing the indwelling catheter in advance, and when the indwelling catheter is not used, When the indwelling catheter is not inserted and the indwelling catheter is used, after inserting the guiding catheter with the guide wire inserted into the target blood vessel, body fluid tube or organ through the subcutaneous tunnel An indwelling method for an indwelling catheter, wherein the guiding catheter is removed while leaving the guidewire, and then the indwelling catheter is inserted along the guidewire.
  (3) A subcutaneous tunnel leading from the skin puncture portion to the target blood vessel, body fluid tube or organ is formed in the subcutaneous tissue corresponding to the path for placing the indwelling catheter, and the subcutaneous tunnel is used when the indwelling catheter is not used. The indwelling device, wherein the indwelling catheter is not inserted, and when the indwelling catheter is used, the indwelling catheter is inserted into the target blood vessel, body fluid tube or organ through the subcutaneous tunnel. Catheter placement method. The catheter for preparing a subcutaneous tunnel according to claim 1, wherein the substance that strengthens the subcutaneous tissue is a substance selected from the group consisting of chitin, chitosan, and urokinase. In the indwelling method of an indwelling catheter according to (1) or (2) below, the guiding catheter is used when the indwelling catheter is used, and the outer diameter of the guiding catheter is used to form a subcutaneous tunnel. A guiding catheter characterized by being 0.5 to 0.8 times the outer diameter of the subcutaneous tunneling catheter.
  (1) A subcutaneous tunnel leading from the skin puncture part to the target blood vessel, body fluid tube or organ is formed in the subcutaneous tissue corresponding to the path for placing the indwelling catheter in advance, and when the indwelling catheter is not used, When the indwelling catheter is not inserted and the indwelling catheter is used, a guiding catheter having a lumen through which a guide wire can be inserted is used as a target blood vessel, body fluid tube or organ through the subcutaneous tunnel. And then inserting the guide wire into the guiding catheter, removing the guiding catheter leaving the guide wire, and then inserting the indwelling catheter along the guide wire Indwelling method of catheter.
  (2) A subcutaneous tunnel leading from the skin puncture part to the target blood vessel, body fluid tube or organ is formed in the subcutaneous tissue corresponding to the path for placing the indwelling catheter in advance, and when the indwelling catheter is not used, When the indwelling catheter is not inserted and the indwelling catheter is used, after inserting the guiding catheter with the guide wire inserted into the target blood vessel, body fluid tube or organ through the subcutaneous tunnel An indwelling method for an indwelling catheter, wherein the guiding catheter is removed while leaving the guidewire, and then the indwelling catheter is inserted along the guidewire.