JPH0543391B2 - - Google Patents

Description

[Detailed description of the invention] Background of the invention 〓Technical field〓 The present invention relates to a medical tube guide.

〓Prior art〓 Catheters inserted into blood vessels or body cavities are
It is possible to reach the target site while being guided by the guide wire.

As a method of introducing the above catheter into the blood vessel,
There are a cutdown method, a Seldinger method, a method using an introducer in the cutdown method, and a method using an introducer in the Seldinger method.

In the cut-down method, the skin is surgically incised to expose the blood vessels, and a cut is made in the exposed blood vessel wall.
A catheter with a guidewire inserted in advance is introduced through the incision, and the guidewire and catheter are advanced together to the target site in the blood vessel.

In the celling method, an outer tube with an inner needle is percutaneously punctured into a blood vessel, the outer tube is removed together with the inner needle, a catheter is introduced into the blood vessel over a guide wire, and the guide wire and catheter are inserted together. It is advanced to the target area of the blood vessel.

In the cut-down method using an introducer, a dilator and an outer tube with a check valve are introduced through an incision made in the externally exposed part of the blood vessel, the dilator is removed, and a guide wire is inserted in advance. The catheter is introduced into the blood vessel through an outer tube with a check valve, and the guide wire and catheter are advanced together to the target site in the blood vessel.

The method of using an introducer in the Seldinger method is to remove the inner needle, introduce a short guide wire to insert the introducer into the outer tube, and place the dilator and outer tube with a check valve over the short guide wire. After inserting the dilator into the blood vessel, the dilator and the short guide wire are removed, and the catheter with the guide wire inserted in advance is introduced into the blood vessel through the outer tube with a check valve, and the guide wire and catheter are inserted into the blood vessel at the target site. There are some things that go as far as

When introducing a catheter into a blood vessel using each of the above methods, the guide wire is bent at various shapes formed at the distal end of the catheter in order to facilitate the introduction of the catheter into the target blood vessel site. It is straight when inserted into the relatively rigid main body, and can be smoothly advanced through the blood vessel, and
By allowing the flexible tip of the guidewire to advance within the blood vessel before the tip of the catheter, it is possible to guide the catheter near the target blood vessel site and prevent damage to the inner wall of the blood vessel caused by the tip of the catheter. shall be.

In addition, when removing the catheter from the blood vessel after completing the prescribed medical work using the catheter inserted into the blood vessel by each of the above methods, the catheter should be inserted from the proximal hub and guided by the catheter. It is smoothly removed from the blood vessel with the bent portion at the tip being straight.

Therefore, the main body of the guide wire can be smoothly inserted into the blood vessel against the resistance generated between the outer surface of the guide wire and the tissue, and the main body portion of the guide wire can be inserted smoothly into the blood vessel against the resistance generated between the outer surface of the guide wire and the inner surface of the catheter. A certain degree of rigidity is required to withstand the resulting resistance. On the other hand, the tip of the guide wire is
It is necessary to have good shape adaptability even in tortuous blood vessels without damaging the inner wall of the blood vessel, and to have flexibility so that it can be inserted into complicated blood vessel branches.

The conventional catheter guide wire is
It is composed of an outer cylinder and an inner core, which have different lengths, and the length of the inner core is usually longer than the length of the outer cylinder. This occurs when the guide wire is bent during use, as shown in Figure 4.
This is because the spring-like outer cylinder, which is the outer cylinder, does not contract inward, so the guide wire cannot be bent smoothly unless the inner core is lengthened by a predetermined length. That is, in the portion where the guide wire is curved during use, the length of the outer tube in the inward direction does not change. However, since the inner core has a larger radius of curvature than the inner part of the outer cylinder,
The length will be substantially increased. Therefore,
It is necessary to plan for this elongation in advance and lengthen the inner core. The inner core is made up of, for example, a main body portion with a large diameter and a flexible portion with a small diameter, but play in the inner core (a portion made longer than the outer cylinder) can be provided only in the flexible portion. In other words, when an inner core that is longer than a predetermined length of the outer tube is inserted into the outer tube and its both ends are fixed, the inner core will be deformed due to the difference in length between the inner core and the outer tube, that is, distortion and deflection. , etc., such as waving occurs in the flexible portion, which has lower rigidity than the intermediate portion, and the inner core becomes wavy in the flexible portion. The greater the bending of the guidewire, the greater the tension and the harder it is to bend. In order to make it easy to bend, it is necessary to have a large amount of play (difference in length between the inner core and the outer cylinder) in the small diameter part of the inner core. However, if the play of the inner core (difference in length between the inner core and the outer tube) is made too large, the guidewire itself will be deformed at the distal end of the guidewire due to deformation of the flexible portion of the inner core.
Such deformation of the tip of the guidewire makes it impossible to smoothly guide the catheter to the target site in the blood vessel.

OBJECTS OF THE INVENTION An object of the present invention is to solve the problems of the prior art described above, to provide a medical tube guide that can be easily deformed into a curved shape when used, and that the length of the inner core and outer tube is Due to the deformation of the inner core due to the difference in
To provide a medical tube guide device which allows the medical tube guide device to be smoothly introduced into and removed from the body without deforming the end portion of the tube guide device.

Structure of the Invention The above object is achieved by: a spring-like outer cylinder having an outer diameter that can be inserted into a medical tube;
A medical tube guide device comprising an inner core housed inside the outer tube and having both ends fixed to both ends of the outer tube, and which allows the medical tube to be introduced into or removed from the body. , the inner core has a longer overall length than the outer cylinder, and the inner core further comprises:
It consists of a flexible part with a small diameter forming both ends of the inner core, and a main body part with a large diameter forming a space between the two ends,
Both end portions constituted by the outer cylinder and the inner core are made flexible, and the deformation of the inner core due to the difference in length between the inner core and the outer cylinder causes the flexible portions at both ends of the inner core to become flexible. This is a medical tube guide device designed to produce

And, the inner core is 0.5 to 0.5 to the outer cylinder.
Preferably, it has a total length that is 4% longer. Moreover, it is preferable that one end of the both ends of the medical tube guide device be a straight flexible part and the other end be a J-shaped flexible part. Further, it is preferable that the both ends of the medical tube guide are formed of straight flexible parts having mutually different lengths. Further, the both ends of the medical tube guide device are
Preferably, each of the flexible portions is composed of J-shaped flexible portions having mutually different J radii.

DETAILED DESCRIPTION OF THE INVENTION FIG. 1 is a sectional view of an embodiment in which the medical tube guiding device of the present invention is applied to a guide wire.

The guide wire 10 of the present invention includes a spring-like outer cylinder 12 having an outer diameter that can be inserted into a medical tube, and is housed inside the outer cylinder 12, and
This medical tube guide device consists of an inner core 11 whose both ends are fixed to both ends of an outer tube 12, and which allows a medical tube to be introduced into or removed from the body. Furthermore, the inner core 11 has a flexible portion with a small diameter that forms both ends of the inner core 11 and a main body portion 10A with a large diameter that forms the space between the two ends. Core 1
1 is configured to be flexible, so that deformation of the inner core 12 due to the difference in length between the inner core 11 and the outer tube 12 is caused by the flexible portions at both ends of the inner core 12. It is starting to occur.

Specifically, the guide wire 10 includes a stainless steel inner core 11 and a stainless steel spring-shaped outer tube 12.
and a plastic covering part 13 made of soft resin, etc.
A straight flexible portion 10B and a J-shaped flexible portion 10C are provided at both ends of the main body portion 10A.

The inner core 11 includes an intermediate portion 11A having a relatively thick wire diameter forming the main body portion 10A, and a straight straight portion having a relatively thin wire diameter connecting to one end of the intermediate portion 11A and forming a straight flexible portion 10B. Mold part 11B and intermediate part 1
A J-shaped part 1 connected to the other end of 1A and bent in a J-shape with a relatively thin wire diameter forming a J-shaped flexible part 10C.
1C. That is, the inner core 11 has its straight part 11B and J-shaped part 11C connected to its intermediate part 1.
It is more flexible than 1A. And the middle part 11A
The straight part 11B and the J-shaped part 11C are connected via the tapered parts 11D and 11E, and the rigidity at the connection part between the intermediate part 11A and the straight part 11B or the J-shaped part 11C is gradually changed. It is preferable that By doing this,
It is possible to prevent the guide wire 10 from bending at the connection portion.

The inner core 11 is inserted into the spring-like outer cylinder 12, and has a bulging part 1 having a substantially hemispherical end surface joined to each end of the straight part 11B and the J-shaped part 11C.
4 and 15, each end of the spring-like cylinder 12 is fixed by welding. Spring-shaped outer cylinder 12
This makes the outer diameters of the main body 10A, the straight flexible part 10B, and the J-shaped flexible part 10C of the guidewire 10 uniform, and can prevent the tip of the guidewire 10 from becoming tapered and being penetrated into the blood vessel wall. At the same time, the ability to restore the J-shaped flexible portion 10C to the J-shape after stretching is made more reliable.

Further, the entire surface of the guide wire 10 is covered with the coating portion 13, and after using the guide wire 10 once as a catheter guide, blood that has adhered to the surface of the guide wire 10 is immediately treated with physiological saline. This allows the guidewire 10 to be used again on the same patient.

Therefore, in the present invention, in order to make both ends of the guide wire 10 the flexible parts 10B, 10C, both ends 11 of the inner core located in the flexible parts 10B, 10C are provided.
By reducing the diameters of B and 11C, making the entire length of the inner core consisting of the intermediate part 11A and both end parts 11B and 11C of the inner core 11 longer than the outer cylinder 11, and fixing it to both ends of the inner core 11. The required play of the inner core 11 is borne by both ends of the inner core 11, making it possible to reduce each play to half of the conventional one.

Specifically, as shown in FIG. 5, which is a schematic diagram showing the principle structure of the medical tube guide device of the present invention, the inner core 11 due to the difference in length between the inner core 11 and the outer tube 12 Assume that the deformation occurs at both ends of the inner core 11, and by absorbing it at both ends, the difference in length between the inner core and the outer cylinder that is absorbed by one end of the inner core The amount will be halved. Therefore, it is possible to prevent the guide wire from pulsating at the narrow diameter portion of each inner core 11, that is, at each end of the guide wire, and to prevent deformation of the outer tube 12. Then,
According to this guide wire, there is no problem in guiding the catheter. Although the actual amount of undulation on the inner core is minute, it is exaggerated in FIG. 5 in order to make the effect easier to understand. In this guidewire, as shown in FIG. 5, when the left end is bent, not only the left flexible portion but also the right flexible portion of the inner core stretches.

The inner core 11 is 0.5
It is good to have a total length that is ˜4% longer, preferably 1-2% longer. When it is smaller than 0.5%, the bendability is slightly inferior, and when it is larger than 4%, it may affect the outer cylinder.

Conventionally, there are guide wires that have a straight flexible tip and a J-shaped flexible tip that has a straight flexible tip. A guidewire with a straight flexible section has a straight tip, so it is easy to insert into the outer tube of the Seldinger method, the outer tube with a check valve of an introducer, or the hub of a catheter, but it is difficult to insert it into the hub of a catheter. Difficulties may arise in smooth progression within the blood vessels. In addition, a guide wire with a J-shaped flexible part has a rounded tip, so it can be advanced smoothly even in a severely curved blood vessel, but the outer tube in the Seldinger method and the check valve of the introducer When inserting into the outer tube or the hub of the catheter, it is necessary to cover it with a special cylindrical straight and correct the distal end to a straight line before inserting.

Therefore, when inserting a catheter into a blood vessel,
It is necessary to select the guidewire to be used depending on the condition of the blood vessel.

For example, even if it is determined that a guidewire with a straight flexible section can be easily advanced into a blood vessel, it may be difficult to advance the guidewire to the target site due to the condition of the inner wall of the blood vessel. can be,
In such a case, the guidewire with the straight flexible section is replaced with a guidewire with a J-shaped flexible section and the procedure is continued. Furthermore, even if a guidewire with a J-shaped flexible section is used when inserting a catheter, it is necessary to use a strainer, etc., to reinsert the guidewire with a J-shaped flexible section into the catheter hub when the catheter is removed. However, when removing the guide wire, it is preferable to use a guide wire with a straight flexible section. That is, when inserting a catheter into or removing it from a blood vessel, two guidewires are usually prepared: one with a straight flexible section and one with a J-shaped flexible section, and the procedure is often carried out.

In addition, when guiding a catheter into small blood vessels that have branched secondary or tertiary after temporarily dividing the aorta, various guide wires with different tip shapes may be used in combination. There is.
That is, first, the distal end of the catheter is inserted using a conventional guide wire (e.g., a guide wire with a straight flexible section of 3 cm length or a guide wire with a J-shaped flexible section with a J radius of 3 mm). After introducing the guide wire close to the target site, we used a guide wire with a straight flexible part of 6 cm in length to guide the inside of the thin, branched blood vessel to the target site, and a guide wire with a straight flexible part of 6 cm in length that was more flexible, and a guide wire that guided the inside of the thin, curved blood vessel. A guide wire with a J-shaped flexible part with a J radius of 1.5 mm that allows for smooth advancement.
Furthermore, it may be necessary to use a guidewire with a different tip shape from a normal guidewire, such as a guidewire with a J-shaped flexible section with a radius of 15mm, which is approximately the same as the radius of curvature of the blood vessel (for example, 15mm). .

For this purpose, it is preferable that the shapes of the flexible parts formed at both ends of the guide wire 10, that is, the guide mechanisms, are different from each other.

Specifically, in the guide wire 10 of the embodiment shown in FIG.
A straight part 11B with a relatively small wire diameter that is connected to one end of A and forms a straight flexible part 10B, and a J-shaped flexible part 10C that is connected to the other end of the intermediate part 11A.
J bent into a J shape with a relatively thin wire diameter to form
It has a mold part 11C.

If one guide wire 10 formed in this manner is prepared, it becomes possible to selectively use the straight flexible section 10B or the J-shaped flexible section 10C as the distal guide side, depending on the patient. The use of guide wire 10 allows a wide range of procedures to be performed. Here, the guide wire 10
The bending portions of various shapes formed at the distal end of the catheter are connected to the relatively rigid body portion 10.
The catheter is kept straight under insertion of A, allowing smooth advancement of the catheter within the blood vessel. The guide wire 10 also has a flexible distal end portion 10.
By advancing B and 10C into the blood vessel before the tip of the catheter, the tip of the catheter is also prevented from damaging the inner wall of the blood vessel.

When inserting a catheter into a blood vessel with severe meandering, the J-shaped flexible section 10C is used as the tip guide side, and after guiding the tip of the catheter to the target site, the guide wire 10 is removed and angiography is performed. After completing the intended medical operation, the straight flexible part 1
By reinserting the catheter into the catheter from the catheter hub with 0B as the tip guide side, and straightening the curved tip of the catheter into a substantially straight line using the guide wire, the guide wire 10 and the catheter are removed together from the blood vessel. The catheter can be easily removed from the blood vessel. That is, in the conventional guide wire having only a J-shaped flexible section,
When removing the catheter, it is extremely difficult to insert the guidewire into the catheter.
It is necessary to use a guide wire with a separate straight flexible section. According to this guidewire 10, the single guidewire 10 allows the catheter to be quickly introduced into and removed from the blood vessel.

In addition, since the coating portion 13 as described above is formed on the surface of the guide wire 10, blood adhering to the guide wire 10 once inserted into a blood vessel can be removed immediately with physiological saline or the like. It can be wiped and reinserted into the same patient. Note that this guide wire 10 is reused for the same patient, and there is no risk of infection.

FIG. 2 is a sectional view showing a wide guide 20 according to a second embodiment of the present invention. This guide wire 20
includes a stainless steel inner core 21, a stainless steel spring-like outer cylinder 22, and a plastic covering part 23.
A first straight flexible part 20B with a length of about 3 cm and a second straight flexible part 20C with a length of about 6 cm are provided at both ends of a relatively rigid main body part 20A. There is. Here, the inner core 21 has an intermediate portion 21A having a relatively thick wire diameter forming the main body portion 20A and a first straight flexible portion, substantially similar to the inner core 11 of the guide wire 10 of the first embodiment described above. It has a first straight part 21B and a second straight part 21C with a relatively small wire diameter, which form a straight flexible part 20B and a second straight flexible part 20C, and the entire length thereof is longer than that of the outer cylinder 12. It is set. In addition, the intermediate portion 21 of the inner core 21
A and each straight part 21B, 21C are the tapered part 21
D, 21E. Furthermore, each end of the spring-shaped outer cylinder 22 is fixed by welding or the like to the bulging parts 24 and 25 that are joined to each end of the straight parts 21B and 21C.

According to the guide wire 20, from the aorta to the
When the catheter is superselectively guided into a blood vessel that subsequently branches and becomes narrower through secondary and tertiary branching, the first straight flexible portion 20B is first inserted into the tip of the catheter. As a guide side, the distal end of the catheter is positioned closer to the distal end of the guide wire 20, and after guiding the catheter closer to the target site, the second straight flexible section 20C, which has a longer flexible section, By using the catheter as the tip guide side, it becomes possible to smoothly guide the catheter to the target site within a small blood vessel.

FIG. 3 is an explanatory diagram of a guide wire according to a third embodiment of the present invention. This guide wire 30 consists of a stainless steel inner core 31, a stainless steel spring-like outer cylinder 32, and a plastic sheathing part 33, and has a relatively rigid body part 30A with J
a first J-shaped flexible portion 30B with a radius r ₁ of 3 mm;
A second J-shaped flexible portion 30C with a J radius r ₂ of 15 mm is provided. Here, the inner core 31 is an intermediate portion 3 having a relatively thick wire diameter forming the main body portion 30A, substantially similar to the inner core 11 of the guide wire 10 of the first embodiment.
0A, has a first J-shaped part 31B and a second J-shaped part 31C bent in a J-shape with a relatively small wire diameter forming respective J-shaped flexible parts 30B and 30C,
Its overall length is set longer than the outer cylinder 32.
In addition, the intermediate portion 31A of the inner core 31 and each J-shaped portion 31
B and 31C are connected by tapered portions 31D and 31E. Furthermore, each J-shaped part 31B,
Each end of the spring-like outer cylinder 32 is fixed by welding or the like to the expansion parts 34 and 35 that are joined to each end of the spring-like outer cylinder 31C.

According to the guide wire 30, from the aorta to the
When the catheter is superselectively guided into a blood vessel that subsequently branches and becomes narrower through secondary and tertiary branching, first, the first J-shaped flexible portion 30B is inserted at the tip. On the guide side, after guiding the catheter through the curved part of the blood vessel to the vicinity of the target site, set the catheter to J, which is approximately the same as the radius of curvature of the blood vessel (for example, 15 mm) at the target site.
By using the second J-shaped flexible portion 30C with a radius of 15 mm as the tip guide side, it becomes possible to smoothly guide the catheter to the target site within the curved blood vessel.

Note that when guiding the catheter superselectively into a narrow curved blood vessel, the second J-shaped flexible portion 3
A guide wire 30 having a J radius of 0C of 1.5 mm, for example, may be used. According to such a guide wire 30 with a small J radius,
The small roundness at the tip allows the catheter to be smoothly guided to the target site without damaging the inner walls of small blood vessels.

In addition, the inner cores 11, 21, 31, the spring-like outer cylinders 12, 22, 32, and the covering parts 13, 23, 3
3, however, it is sufficient to have flexible portions at both ends of the main body portion having relatively high rigidity, and other specific configurations other than those described above may be used.

Further, the guide wire of the present invention allows a catheter to be guided to a target site within a blood vessel, and can be given a length corresponding to the task to which it is applied.

In addition to the catheters mentioned in the detailed explanation, medical tubes include balloon catheters, Trotscar catheters, endotracheal tubes, etc.
There is no particular limitation as long as it is intended to be inserted into the body.

Further, the spring-like outer cylinder may be made of metal or plastic.

Effects of the Invention The medical tube guide device of the present invention includes a spring-like outer tube having an outer diameter that can be inserted into the medical tube, and a spring-like outer tube that is housed inside the outer tube and has both ends connected to both ends of the outer tube. A medical tube guide device comprising a fixed inner core and capable of introducing or removing a medical tube from the body, wherein the inner core has a longer overall length than the outer tube, and the inner core has a longer overall length than the outer tube; The inner core consists of a small diameter part forming both ends of the inner core, and a main body part having a large diameter forming the space between the two ends, and both end parts are made up of the outer cylinder and the inner core. By making the inner core flexible, the deformation of the inner core due to the difference in length between the inner core and the outer cylinder will occur at both ends of the inner core, and by absorbing it at both ends. , the amount of the difference in length between the inner core and the outer cylinder that is absorbed by one end of the inner core is set to one half. Therefore, it is possible to prevent the medical tube guide from pulsating in the flexible portion of each inner core, that is, at each end of the medical tube guide, and to prevent deformation of the outer tube. Therefore, this medical tube guide allows the medical tube to be smoothly introduced into and removed from the body.

Further, in the medical tube guide device of the present invention, if the both ends of the medical tube guide device have a straight flexible portion at one end and a J-shaped flexible portion at the other end, the tube guide device for medical use may have a severe curve. The medical tube can be guided smoothly by using the J-shaped flexible part as the tip guide side for the blood vessel, and when the medical tube is removed, the hub provided at the rear end of the medical tube By using the insertable straight flexible part as the tip guide side, the medical tube can be quickly removed from the blood vessel.

Further, in the medical tube guide device of the present invention, if the both ends of the medical tube guide device are straight flexible portions having mutually different lengths, the medical tube can be superselectively guided into the blood vessel. When guiding the medical tube, by using straight flexible parts that better fit the shape of the blood vessel before and after the vicinity of the target site, it is possible to smoothly superselectively insert the medical tube into the blood vessel.

Further, in the medical tube guide device of the present invention, if the both ends of the medical tube guide device are each composed of J-shaped flexible portions having different J radii, the medical tube guide device can super selectively guide the medical tube. When guiding into a blood vessel, by using a J-shaped flexible part that better fits the shape of the blood vessel before and after the vicinity of the target site,
It is possible to smoothly superselectively insert a medical tube into a blood vessel.

[Brief explanation of the drawing]

FIG. 1 is a cross-sectional view of a guide wire according to a first embodiment of the present invention, FIG. 2 is a cross-sectional view of a guide wire according to a second embodiment of the present invention, and FIG. 3 is a cross-sectional view of a guide wire according to a third embodiment of the present invention. Explanatory diagram for explaining the guide wire of
The figure is a schematic diagram showing a bent state of a guide wire including an inner core and an outer tube, and FIG. 5 is a schematic diagram for explaining the basic structure of the medical tube guide device of the present invention. 10, 20, 30... Guide wire, 10A,
20A, 30A...Main body, 10B, 20B, 3
0C...straight flexible part, 10C, 30B, 30C...
...J-shaped flexible part, 11, 21, 31... Inner core, 1
2, 22, 32...Spring-like outer cylinder.

Claims (1)

[Scope of Claims] 1. A spring-like outer cylinder having an outer diameter that can be inserted into a medical tube, and an inner core housed inside the outer cylinder and having both ends fixed to both ends of the outer cylinder. A medical tube guide device that enables a medical tube to be introduced into or removed from the body, wherein the inner core has a longer overall length than the outer tube, and the inner core has a longer overall length than the outer tube. It consists of a flexible part with a small diameter forming both ends of the core, and a main body part with a large diameter forming a space between the two ends, and both end parts made up of the outer cylinder and the inner core are made flexible, A medical tube guide device, characterized in that deformation of the inner core due to the difference in length between the inner core and the outer tube occurs in flexible portions at both ends of the inner core. 2. The medical tube guide device according to claim 1, wherein the inner core has a total length that is 0.5 to 4% longer than the outer tube. 3. The both ends of the medical tube guide are:
Claim 1 or 2, wherein one end is a straight flexible part and the other end is a J-shaped flexible part.
Medical tube guide device described in section. 4. The both ends of the medical tube guide are:
The medical tube guide device according to claim 1 or 2, which comprises straight flexible portions having mutually different lengths. 5. The both ends of the medical tube guide are:
The medical tube guide device according to claim 1 or 2, which comprises J-shaped flexible portions each having a different J radius.