JP5150900B2 - Guide catheter - Google Patents

Description

The present invention, when replacing the existing catheter is indwelling in a living body, relates to a catheter (guide catheter) the replacement support for guiding the insertion of a new catheter.

  There is a method using a gastric fistula catheter as a method for supplying nutrition to a patient who cannot ingest food. In this method, a catheter is inserted into the stomach from the outside, and nutrition is supplied to the stomach through the catheter.

  Gastric fistula catheters are indwelling and require periodic replacement.

  In order to replace the gastrostomy catheter, an operation or the like is necessary, and the burden on the patient and the medical staff is great.

As a technique for solving such a problem, a catheter guide device is inserted along the outer edge of the indwelling catheter, the indwelling gastric fistula catheter is removed through the catheter guide device, and then exchanged through the gastrostomy catheter guide device. A technique of inserting a new gastrostomy catheter for medical use has been proposed (see Patent Document 1).
JP 2006-247087 A

  When exchanging an indwelling catheter using the gastrostomy catheter guiding instrument disclosed in Patent Document 1, a catheter guiding instrument having an outer diameter larger than that of the existing gastric fistula catheter must be inserted into the fistula. Therefore, if the diameter of the fistula is approximately equal to the diameter of the existing gastric fistula catheter and there is no room for inserting the catheter guide device, the fistula must be expanded. Moreover, when the diameter of the extracorporeal fixture (cap) of the existing gastrostomy catheter is thicker than the shaft (tube), it cannot be used.

Further, even if the catheter guide device is forcibly inserted into the fistula, the fistula will be damaged by friction.
Furthermore, it is difficult to guide the tip of the catheter guide device into the stomach. For example, even if a catheter guide device is inserted into the abdominal wall along an existing gastric fistula catheter, the tip of the catheter guide device does not always pass through the fistula of the stomach. In some cases, even if the catheter guide device is pushed in, only the stomach escapes and the catheter guide device cannot be inserted into the stomach. Even in this case, it is possible to remove the existing gastrostomy catheter. However, if a new gastrostomy catheter is introduced using this catheter guide device, the catheter is placed between the abdominal wall and the stomach.

  For this reason, in order to replace | exchange a catheter reliably using the catheter guidance instrument currently disclosed by patent document 1, a considerable exchange skill is required. Therefore, a simpler and more reliable guidance device is desired.

  The same problem occurs not only when the gastrostomy catheter is used, but also when exchanging the indwelling catheter.

The present invention has been made in view of the above circumstances, and an object thereof is to make it possible to replace an indwelling catheter easily and reliably.
Another object of the present invention is to enable replacement of an indwelling catheter by a simple operation that is less burdensome on a living body and does not depend on replacement skills.
The present invention is further directed to another object to provide a vessel device for induction to easily and reliably replaceable indwelling catheters.

In order to achieve the above object, an indwelling catheter replacement support guide catheter of the present invention comprises:
A trunk portion having a cylindrical shape and having a configuration capable of extending in the radial direction of the cylinder;
An expansion portion disposed at one end of the body portion and expandable in a radial direction of the body portion;
The trunk portion has a diameter that can be inserted into the shaft of an existing indwelling catheter in an unstretched state, and the extension portion projects from the shaft when inserted into the shaft of the existing indwelling catheter. It is characterized by having .

  For example, the body portion has a linear shape in which a cylindrical body is contracted and has rigidity capable of maintaining the shape, and the expansion portion is configured by a balloon or a bumper.

  For example, the body portion is made of a resin processed into a bellows shape.

  For example, it is desirable that the trunk portion has a diameter that allows the new indwelling catheter to be inserted in a state where the trunk portion is stretched in the radial direction, and a diameter that is smaller than the diameter of the expanded portion of the new indwelling catheter.

At least one of the trunk part and the extension part of the guide catheter for supporting indwelling catheter replacement may include a shear facilitating part for facilitating shearing or cutting. For example, the shear facilitating part may include a cut part. Further, the shear facilitating part may include a wire passed through the body part.

  According to the device invention of the present application, for example, a catheter can be reliably and easily replaced with a target body cavity.

(Embodiment 1)
Hereinafter, a guide catheter according to Embodiment 1 of the present invention and a method for exchanging an indwelling gastric fistula catheter using the guide catheter will be described with reference to FIGS. 1 to 13.

  As shown in FIG. 1A, the guide catheter 11 of the present embodiment includes a trunk part (shaft; catheter shaft; tube) 13, an intragastric holding part 15 disposed at one end of the trunk part 13, And an expansion fluid injection valve 17.

The trunk portion 13 is a linear portion that is inserted into the gastric lumen 14 through the shaft of the existing gastric fistula catheter 21.
FIG. 1B shows a cross section 13a-13a of the guide catheter 11 shown in FIG. As shown in a cross section in FIG. 1B, the body portion 13 is a cylindrical structure formed into a bellows structure having a repeating structure (star cross section) of mountain folds and valley folds. The body portion 13 is provided with rigidity that can be expanded in the radial direction and autonomously maintain a linear shape by the bellows structure, and in an unused state (unstretched state) It has an outer diameter of about 2 to 4 mm so that it can be inserted into the existing gastric fistula catheter 21, and in an expanded state, about 10 to 30 mm so that a new gastrostomy catheter 21 to be exchanged can pass through the inside. Has an inner diameter of. The trunk portion 13 is formed to be longer than the shaft of the existing gastric fistula catheter 21 and is preferably formed to be approximately 5 cm to 20 cm longer than the existing gastric fistula catheter 21. It is desirable that the body portion 13 is made of a material that is harmless to the human body, such as polyurethane resin.

A lumen (small hole) 131 is formed in the body part 13 from the other end part to the one end part and through which a fluid (such as physiological saline) for inflating the intragastric holding part 15 flows.
In addition, a cut 133 is formed at the other end portion of the body portion 13 so that the body portion 13 can be easily cut or torn.

  The intragastric holding portion 15 is a balloon that expands and expands to hold one end portion of the trunk portion 13 inside the stomach, and is disposed at one end portion of the trunk portion 13. The intragastric holding portion 15 is made of a flexible material such as polyurethane, expands when fluid is injected through the lumen 131, and contracts when fluid is extracted. The non-expanded diameter of the intragastric holding portion 15 is smaller than the inner diameter of the shaft 23 of the existing gastric fistula catheter 21 to be replaced, and the diameter at the maximum expansion is sufficiently larger than the inner diameter of the shaft of the existing gastric fistula catheter 21. Is formed.

  The expansion fluid injection valve 17 is disposed at the other end portion (root portion) of the body portion 13 that remains outside the body, is connected to the lumen 131, the tip of the fluid injection device is set, and pressurized fluid from the fluid injection device (Physiological saline or the like) is introduced into the lumen 131. Further, a check valve for preventing backflow is built in, and the fluid is retained in the lumen 131 and the stomach holding portion 15 to maintain the expanded state of the stomach holding portion 15.

  Next, a method for using the guide catheter 11 having the above-described configuration, that is, a method for exchanging a gastric fistula catheter placed using the guide catheter 11 will be described.

First, as schematically shown in FIG. 2, fistulas 35 and 37 are formed in the abdominal wall 31 and stomach wall 33 of the patient, and the shaft of the existing gastrostomy catheter 21 is formed in the fistulas 35 and 37. 23 is inserted and the intragastric holding portion 25 provided at one end of the shaft 23 is in an expanded state.
The expansion fluid injection valve 27 is disposed at the other end portion (root portion) of the body portion 23 that remains outside the body, is connected to a lumen (small hole), has a built-in check valve that prevents backflow, and allows fluid to flow through the lumen and stomach. It fastens to the inner holding part 25 and the expanded state of the intragastric holding part 25 is maintained.
It is assumed that the existing gastrostomy catheter 21 is replaced with a new gastrostomy catheter.

  First, as shown in FIG. 3, the trunk portion 13 and the intragastric holding portion 15 of the unextended guide catheter 11 are inserted into the shaft 23 of the existing gastric fistula catheter 21. The body portion 13 of the guide catheter 11 is in a state where the bellows is contracted, and the outer diameter is smaller than the inner diameter of the shaft 23 of the existing gastric fistula catheter 21.

  In addition, the body portion 13 of the guide catheter 11 is in a state where the bellows is contracted and has sufficient rigidity to maintain a linear outer shape. The insertion itself is easy.

  As shown in FIG. 4, the surgeon pushes the trunk portion 13 until the intragastric holding portion 15 of the guide catheter 11 protrudes from the distal end of the existing gastric fistula catheter 21 and is positioned in the gastric lumen 14. Since the trunk portion 13 is formed 5 to 20 cm longer than the shaft 23 of the existing gastric fistula catheter 21, the intragastric holding portion 15 can be easily positioned in the gastric lumen 14.

  Subsequently, a fluid such as physiological saline is injected into the lumen 131 from the expansion fluid injection valve 17 of the guide catheter 11, and the intragastric holding portion 15 of the guide catheter 11 is expanded and expanded as shown in FIG.

  At this time, assuming that the intragastric holding portion 15 of the guide catheter 11 is positioned within the shaft 23 of the existing gastric fistula catheter (that is, the guide catheter 11 does not reach the gastric lumen 14), the existing gastric fistula catheter 21 is provided. Since the inner diameter of the shaft 23 is small, expansion of the intragastric holding portion 15 of the guide catheter 11 is hindered. For this reason, a prescribed amount of fluid cannot be injected from the expansion fluid injection valve 17. Therefore, by confirming the amount of fluid injected, it is ensured that the distal end of the body portion 13 of the guide catheter 11 and the intragastric holding portion 15 protrude from the shaft 23 of the gastric fistula catheter 21 and reach the gastric lumen 14. It is possible to easily determine and to securely and easily arrange the intragastric holding portion 15 in the gastric cavity 14.

  Subsequently, the fluid filled in the intragastric holding portion 25 is discharged by, for example, cutting the expansion fluid injection valve 27 of the existing gastric fistula catheter 21 to be exchanged, and as shown in FIG. The part 25 is contracted.

  Next, for example, as shown in FIG. 7, the surgeon pulls the trunk portion 13 of the guide catheter 11 and locks the intragastric holding portion 15 to the stomach wall 33. Further, the surgeon extracts the existing gastric fistula catheter 21 from the body using the trunk portion 13 of the guide catheter 11 as a guide.

  Next, the surgeon tears the existing gastric fistula catheter 21 extracted using a medical scissors or the like, and removes it as shown in FIG.

  Next, the surgeon opens the bellows, which is the structure of the other end of the guide catheter 11, while maintaining the state where the intragastric holding portion 15 is locked to the stomach wall 33, and expands the diameter of the trunk portion 13. As shown in FIG. 9, the surgeon inserts a new gastric fistula catheter 21 to be exchanged from the other end of the trunk portion 13 whose diameter has been expanded, and gradually passes through the trunk portion 13 toward the gastric lumen 14. Push it in.

  The surgeon holds the new gastric fistula until the intragastric holding portion 25 of the new gastric fistula catheter 21 protrudes from one end of the trunk portion 13 of the guide catheter 11 and is positioned in the gastric lumen 14 as shown in FIG. The catheter 21 is pushed in. At this time, a new gastric fistula catheter 21 can be easily inserted into the gastric lumen 14 by tearing the expansion fluid injection valve 27 through the cut 133 so that the expansion fluid can be injected later. A fluid can be injected into the valve 27. Furthermore, the new gastric fistula catheter 21 can be easily inserted into the gastric lumen 14 by pulling the other end of the trunk 13 and pushing the new gastric fistula catheter 21 while applying tension to the whole body part 13. . Since the trunk | drum 13 is formed 5-20 cm longer than the shaft of the new gastrostomy catheter 21, it can be easily pulled and tensioned by grasping the other end.

  As shown in FIG. 10, when the intragastric holding portion 25 of the new gastrostomy catheter 21 protrudes from the trunk portion 13 and is located in the gastric lumen 14, the surgeon supplies a fluid such as physiological saline to the expansion fluid injection valve. 27, the intragastric holding part 25 of the new gastric fistula catheter 21 is expanded as shown in FIG.

  At this time, suppose that the intragastric holding portion 25 of the new gastric fistula catheter 21 is located in the trunk portion 13 of the guide catheter 11 (that is, the new gastric fistula catheter 21 does not reach the gastric lumen 14). Since the trunk portion 13 of the guide catheter 11 exists around the intragastric holding portion 25, expansion of the intragastric holding portion 25 of the new gastric fistula catheter 21 is limited. For this reason, a prescribed amount of fluid cannot be injected. Therefore, by confirming the injection amount of the fluid, it is confirmed that the distal end of the shaft 23 and the intragastric holding portion 25 of the new gastrostomy catheter 21 protrude from the body portion 13 of the guide catheter 11 and reach the gastric lumen 14. It is possible to reliably determine and to securely arrange the intragastric holding portion 25 in the gastric lumen 14.

  Next, as shown in FIG. 12, the expansion fluid injection valve 17 of the guide catheter 11 is cut to discharge the fluid filled in the intragastric holding portion 15 and contract the intragastric holding portion 15. .

  Next, the operator pulls out the guide catheter 11. At this time, since the intragastric holding portion 25 of the new gastric fistula catheter remains in an expanded state, there is no risk that the new gastric fistula catheter 21 will be pulled out together with the extraction of the guide catheter 11, so that the work can be performed. Easy.

Next, the body 13 of the guide catheter 11 is completely torn and the guide catheter 11 is removed.
By the above procedure, a new gastrostomy catheter 21 is placed in the gastric lumen 14, and the replacement of the indwelling gastrostomy catheter 21 is completed.

  According to such an exchange operation, since the guide catheter 11 is inserted into the gastric lumen 14 using the existing gastric fistula catheter 21 as a guide, the guide catheter 11 can be guided to the gastric lumen 14 regardless of skill. Furthermore, since the new gastric fistula catheter 21 is inserted into the gastric lumen 14 using the guide catheter 11 as a guide, the new gastric fistula catheter 21 can be reliably guided to the gastric lumen 14 regardless of skill.

  Further, since the guide catheter 11 is inserted through the shaft 23 of the existing gastric fistula catheter 21, there is no burden on the patient such as expansion of the fistula holes 35 and 37. Further, the gastric fistula catheter 21 can be easily and surely replaced by the above-described relatively simple operation regardless of skill.

As mentioned above, although embodiment of this invention was described based on the specific example, this invention is not limited to embodiment, Various deformation | transformation and application are possible.
For example, the structure, shape, and the like of the gastrostomy catheter 21 to be exchanged are arbitrary. For example, the gastrostomy catheter may include a cap.

  In addition, a so-called balloon type configuration that expands by injecting fluid has been exemplified as the intragastric holding portion 15, but another configuration, for example, a bumper type intragastric holding portion 41 as shown in FIG. 14 may be used. The intragastric holding part 41 has a configuration in which, for example, a plurality of strips 45 bent at the center are arranged in the circumferential direction of the shaft 23, and both ends of the strips are fixed to the ring 43.

  By adjusting the interval of the ring 43 by an operation from the outside, the state expanded in the radial direction shown in FIG. 14A and the state reduced in the radial direction shown in FIG. 14B are switched. If the diameter of the intragastric holding part 41 is reduced, it can be inserted into the fistula and the like, and if the diameter is increased, it can be locked to the stomach wall. The configuration of the stomach holding portion may be other configurations.

Similarly, the intragastric holding part 15 of the guide catheter 11 can adopt a bumper type or the like.
As the body portion 13 of the guide catheter 11, a cylindrical body whose cross section is processed into a bellows shape is illustrated, but the configuration thereof is arbitrary. However, when not in use, it is desirable that it is thin and rigid enough to be inserted into the shaft 23 of the gastrostomy catheter 21 to be replaced, and has a length enough to protrude into the gastric lumen 14. Furthermore, it is desirable that the cylinder is extensible in the radial direction so that a new gastrostomy catheter to be exchanged can be guided.

  Further, although the lumen 131 is formed in the body portion 13, a pipe for fluid conveyance may be provided separately.

  In addition, although the embodiment has been described focusing on a gastric fistula catheter, the present invention is not limited to a gastric fistula catheter but can be applied to indwelling catheters such as an intestinal catheter.

(Embodiment 2)
In the first embodiment, the guide catheter 11 is an instrument dedicated to the guide when the gastric fistula catheter 21 is replaced. However, the present invention is not limited to this, and the guide catheter itself can be used as an indwelling catheter.
Hereinafter, as Embodiment 2 of the present invention, a telescopic catheter 111 that can serve as a guide for exchanging a catheter and can be placed therein will be described with reference to FIGS. 15 and 16.

As shown in FIG. 15, the expandable catheter 111 according to the present embodiment includes a trunk portion 113, a body holding portion 115, and valves 117 and 119.
FIG. 15B shows a 113a-113a cross section of the expandable catheter 111 shown in FIG.
The body portion 113 has a two-layer structure including an outer cylinder 151 and an inner cylinder 153 as shown in a cross section in FIG. The outer cylinder 151 and the inner cylinder 153 each have a bellows structure and are connected to each other by a mesh member or the like.

The body holding portion 115 is disposed at one end of the body portion 113.
The valve 117 is connected to the internal body holding part 115 via a lumen (small hole) 1131 formed in the outer cylinder 151 of the body part 113, and expands and expands the internal body holding part 115.

The valve 119 is connected to a gap 155 between the outer cylinder 151 and the inner cylinder 153 of the body portion 113.
By injecting fluid from the valve 119 into the gap 155, the outer cylinder 151 and the inner cylinder 153 are connected to each other, so that they extend together and deform into a substantially circular (cylindrical) shape as shown in FIG. Further, the shape is maintained, and the flow path 157 is stably formed and maintained inside the inner cylinder 153. FIG. 16A shows a schematic diagram of the expandable catheter 111 in an expanded state, and FIG. 16B shows a cross section 113b-113b of the expandable catheter 111 shown in FIG.

Next, a method for using the expandable catheter 111 will be described.
As a premise, the existing indwelling catheter is also the expandable catheter 111 shown in FIG. 16, and the trunk portion 113 is expanded into a columnar shape by the fluid filled in the gap 155, and has a high rigidity and maintains an expanded body. The holding part 115 shall be arrange | positioned in a body cavity.

  The operation until the existing extensible catheter is replaced with a new extensible catheter 111 is basically the same as the process described with reference to FIGS.

First, a new expandable catheter 111 is inserted into the body cavity through the flow path 157 of the existing catheter 111, the in-vivo holder 115 of the new expandable catheter 111 is expanded, and then the in-vivo holder 115 of the existing expandable catheter 111 is expanded. Shrink and remove.
Subsequently, fluid is injected from the valve 119 of the new expandable catheter 111 to fill the gap 155. Thereby, the new dilatation catheter 111 is in the state shown in FIG. 16, the flow path 157 is stably secured, and the new dilatation catheter 111 becomes an indwelling catheter.

  According to such a configuration, the new catheter can be reliably and easily guided into the body cavity using the existing catheter as a guide, and the existing catheter can be easily removed, and the new catheter can be placed. This contributes to resource saving without waste and can reduce the burden on patients and medical institutions.

  The configuration and the like of the second embodiment can be applied and changed as appropriate.

(A) is a figure which shows the guide catheter which concerns on Embodiment 1 of this invention. (B) is a figure which shows 13a-13a cross section of the guide catheter shown to (a). It is a conceptual diagram for demonstrating the replacement | exchange procedure of a catheter, and is a figure which shows the state by which the gastrostomy catheter is already installed. It is a conceptual diagram for demonstrating the replacement | exchange procedure of a catheter, and is a figure which shows the state which inserted the guide catheter in the existing gastrostomy catheter. It is a conceptual diagram for demonstrating the replacement | exchange procedure of a catheter, and is a figure which shows the state which penetrated the guide catheter to the existing gastric fistula catheter. It is a conceptual diagram for explaining the exchange procedure of the catheter, and is a view showing a state where the intragastric holding portion of the guide catheter is expanded. It is a conceptual diagram for demonstrating the replacement | exchange procedure of a catheter, and is a figure which shows the state which contracted the intragastric holding part of the existing gastric fistula catheter. It is a conceptual diagram for demonstrating the replacement | exchange procedure of a catheter, and is a figure which shows the state which extracted the existing gastric fistula catheter. It is a conceptual diagram for demonstrating the replacement | exchange procedure of a catheter, and is a figure which shows the state which extracted the existing gastrostomy catheter. It is a conceptual diagram for demonstrating the exchange procedure of a catheter, and is a figure which shows the state which inserted the new gastric fistula catheter in the guide catheter. It is a conceptual diagram for explaining the exchange procedure of the catheter, and is a view showing a state in which the intragastric holding portion of a new gastric fistula catheter is inserted into the gastric lumen through the guide catheter. It is a conceptual diagram for demonstrating the replacement | exchange procedure of a catheter, and is a figure which shows the state which expanded the intragastric holding | maintenance part of the new gastric fistula catheter. It is a conceptual diagram for explaining a catheter exchange procedure, and is a view showing a state in which the intragastric holding portion of the guide catheter is contracted. It is a conceptual diagram for demonstrating the replacement | exchange procedure of a catheter, and is a figure which shows the state which extracted the guide catheter. It is a figure which shows the modification of a stomach holding | maintenance part. (A) is a figure which shows the expansion / contraction catheter which concerns on Embodiment 2 of this invention, and is a figure which shows a non-expanded state (unused state). (B) is a figure which shows the 113a-113a cross section of the expansion-contraction catheter shown to (a). (A) is a figure which shows the expansion / contraction catheter which concerns on Embodiment 2 of this invention, and is a figure which shows the expansion | extension state (use state; indwelling state). (B) is a figure which shows the 113b-113b cross section of the expansion-contraction catheter shown to (a).

Explanation of symbols

11 Guide catheter 13 Body (shaft)
DESCRIPTION OF SYMBOLS 15 Gastric holding | maintenance part 17,27 Expansion fluid injection | pouring valve 21 Gastrostomy catheter 31 Abdominal wall 33 Gastric wall 111 Telescopic catheter 113 Torso part (shaft)
115 Internal body holding part 117,119 Valve 1131 Lumen 131 Lumen 133 Cut 151 Outer cylinder 153 Inner cylinder 155 Cavity 157 Distribution path

Claims (7)

A trunk portion having a cylindrical shape and having a configuration capable of extending in the radial direction of the cylinder;
An expansion portion disposed at one end of the body portion and expandable in a radial direction of the body portion ;
The body portion is in an unstretched state and has a diameter that can be inserted through the shaft of an existing indwelling catheter.
The extension portion has a length protruding from the shaft in a state inserted into the shaft of the existing indwelling catheter.
An indwelling catheter exchange support guide catheter characterized by the above. The body portion has a linear shape in which a cylindrical body is contracted, and has a rigidity capable of maintaining the shape,
The extension is composed of a balloon or a bumper.
The indwelling catheter replacement support guide catheter according to claim 1 . The indwelling catheter replacement support guide catheter according to claim 1, wherein the body portion is made of a resin processed into a bellows shape. The trunk portion has a diameter that allows the new indwelling catheter to be inserted in a state of being radially extended, and has a diameter that is smaller than the diameter of the expanded portion of the new indwelling catheter.
The indwelling catheter replacement support guide catheter according to any one of claims 1 to 3 . At least one of the trunk portion and the extension portion of the guide catheter for assisting indwelling catheter exchange includes a shear facilitating portion for facilitating shearing or cutting.
The guide catheter for indwelling catheter replacement | exchange assistance of any one of Claim 1 thru | or 4 characterized by the above-mentioned. The shear facilitating portion includes a cut portion.
The indwelling catheter replacement support guide catheter according to claim 5 . The shear facilitating part includes a wire passed through the body part,
The indwelling catheter replacement support guide catheter according to claim 5 or 6 .

Images