JPH10146391A - Apparatus for inserting catheter tube - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide an apparatus for leaving a catheter tube in the body of the patient without stressing the patient, as when a catheter tube for peritoneal dialysis, for example, is passed through the abdominal wall while forming a hypodermic tunnel, is inserted into the peritoneal cavity, and left there. SOLUTION: This inserting apparatus comprises a first tubular member 10, having a side hole and in which a first plug 20 inserted from a certain position (first piercing part 200) is fitted, and a second tubular member 30 in which a second plug 40 inserted from a second piercing part 201 different from the first piercing part is fitted; from the second piercing part 201, the second tubular member 30 is pierced into the side hole 14 in the first tubular member 10 to form a passage for a catheter tube, making a catheter for peritoneal dialysis capable of being easily left in the body.

Description

DETAILED DESCRIPTION OF THE INVENTION

The present invention relates to a device for inserting a catheter tube, and more particularly to a device for inserting a catheter tube for peritoneal dialysis into the abdominal cavity.

2. Description of the Related Art In peritoneal dialysis therapy for dialysis through the peritoneum of a patient with renal failure, dialysis is continuously performed by repeatedly injecting dialysate into the peritoneal cavity and discharging dialysate waste fluid. The ambulatory pritoneal dialysis (hereinafter referred to as “CAPD”), which is capable of carrying out dialysis, is widely performed. This CAP
To start D, it is necessary to indwell a catheter tube (indwelling catheter) that communicates between the abdominal cavity and the outside of the body in order to inject and discharge the dialysate. At this time, the point where the catheter tube penetrates the peritoneum and is inserted into the peritoneal cavity is different from the point where the catheter tube penetrates the skin from outside the body for the purpose of making the infection harder or fixing the catheter tube. Forming a subcutaneous tunnel is performed. In order to form this subcutaneous tunnel, generally, the skin at a place penetrating the peritoneum (the first open part) is incised about 2 to 5 cm, and the catheter tube is inserted into the abdominal cavity. A method of connecting a guide needle having a sharp tip and puncturing the body at a location (second incision site) about 4 to 5 cm away from the first completely open site to take it out of the body is performed. Further, as another method, after inserting a catheter tube into the abdominal cavity at the first open site, an incision is made at a position (second incision site) about 4 to 5 cm away therefrom. There is a device in which forceps or the like are inserted toward the first completely open site, the catheter tube inserted through the first completely open site is grasped, and the proximal portion of the catheter tube is pulled out of the body. However, in any of the methods described above, the incision at the first open site is large, so that the invasion (specifically, postoperative pain, cosmetic problems, length of hospital stay, etc.) given to the patient is small. Grow up,
There is a problem that it can be performed only by an operator who is skilled in surgical treatment.

SUMMARY OF THE INVENTION It is an object of the present invention to provide a device for minimally invasive insertion and placement of a catheter tube, such as an indwelling catheter used in CAPD, and a method of placing the catheter tube. It is in.

This and other objects are achieved by the present invention which is defined below as (1) to (6). (1) a first tubular member having a slit formed on a side surface and having a lumen formed over the entire length, a first obturator which can be inserted into the lumen of the first tubular member, A second tubular member having an outer diameter capable of being inserted into a slit of one tubular member and having a lumen formed over the entire length, and a second tubular member capable of being inserted into the lumen of the second tubular member. A catheter tube insertion device comprising: an obturator. (2) a first tubular member having a slit formed on a side surface and having a lumen formed over the entire length, a first obturator which can be inserted into the lumen of the first tubular member, A second tubular member having an outer diameter capable of being inserted into a slit of one tubular member and having a lumen formed over the entire length, and a second tubular member capable of being inserted into the lumen of the second tubular member. Obturator, a guide wire, a third tubular member having a lumen formed over the entire length, and used in combination with the third tubular member,
A third obturator having a lumen through which the guidewire can be inserted, and the entire length of the guidewire is longer than the entire length of the third obturator. Appliances. (3) a first tubular member having a slit formed on a side surface and having a lumen formed over the entire length, a first obturator which can be inserted into the lumen of the first tubular member, and a proximal side A catheter tube having an outer diameter that can be inserted into the first tubular member, and a grasping instrument having a grasping portion at a distal end for grasping the grasped portion of the catheter tube. An apparatus for inserting a catheter tube, comprising: (4) A method of placing a catheter tube in the following procedure. 1) Inserting a first tubular member having a slit on the side face in which the first obturator is inserted, and removing the first obturator; 2) Second plug from a predetermined position separated by a certain distance Inserting a second tubular member with a plug into the slit of the first tubular member, and then removing the second obturator; 3) the second tubular member and the first tubular member Inserting the catheter tube through the member; 4) leaving only the catheter tube by removing the first tubular member and the second tubular member. (5) A method of placing a catheter tube in the following procedure. 1) Inserting a first tubular member having a slit on the side face in which the first obturator is inserted, and removing the first obturator; 2) Second plug from a predetermined position separated by a certain distance Inserting a second tubular member into which a plug is inserted toward a slit of the first tubular member, and then removing the second obturator; 3) the first tubular member and the second tubular member Inserting a guidewire through the member and then removing the first tubular member and the second tubular member; 4) a third plugged with a third obturator having a lumen along the guidewire. 5) Insert the catheter tube into the third tubular member and remove the third tubular member, and then remove the catheter tube by removing the third tubular member. Detain. (6) A method for placing a catheter tube in the following procedure. 1) A first tubular member having a slit is inserted into a side surface into which the first obturator is inserted, and the first obturator is removed; 2) A catheter tube having a grasped portion at a proximal end side is inserted. 3) Inserting a gripping instrument having a hook shape at the tip from a predetermined position separated by a predetermined distance toward the slit of the first tubular member, and gripping the gripped portion of the catheter tube 4) Withdraw the gripping instrument while gripping the gripped portion; 5) Withdraw the first tubular member to leave only the catheter tube.

DESCRIPTION OF THE PREFERRED EMBODIMENTS Before describing the catheter tube insertion device of the present invention, a catheter placement using the device of the present invention will be described. The surgeon makes an arbitrary position on the abdominal wall of the patient a first completely open site, and makes a small incision (about 1 cm or less) at the first completely open site. A trocar tube assembly used for laparoscopic surgery, for example, which is provided with a slit on a side surface of a trocar tube (first tubular member) from the first open position. And leave only the trocar tube (first tubular member). Since the slit is provided on the side surface of the trocar tube (first tubular member), the intrusion of the instrument from the side can be accepted. Next, the surgeon makes an arbitrary position on the abdominal wall a certain distance away from the first open site as a second incision site, and makes a small incision in the second incision site. A second tubular member having a second obturator inserted (incorporated) into the lumen from the second incision site is inserted into the subcutaneous tissue, and the distal end of the second tubular member is inserted into the first tubular member. Insert into the lumen of the first tubular member through the slit. Then, only the second obturator is removed. That is,
The second tubular member inserted from the second incision site passes through the subcutaneous tunnel, reaches the lumen through the slit of the first tubular member inserted from the first open site, and reaches the second lumen. The lumen of the tubular member is in communication with the abdominal cavity of the patient via the lumen of the first tubular member. In this state, if the indwelling tube is inserted from the proximal end of the second tubular member, the indwelling tube is inserted into the abdominal cavity through the series of lumens. Thereafter, if the first tubular member and the second tubular member are removed, the indwelling tube is indwelled with the formation of a subcutaneous tunnel, and only two small incision marks remain on the patient's body wall. . Hereinafter, the catheter tube insertion device of the present invention will be described in detail based on a preferred configuration example shown in the accompanying drawings. (First Embodiment) FIGS. 1 and 2 are perspective views showing a first embodiment of a catheter tube insertion device according to the present invention. FIG. 1 is a perspective view showing a state where a first obturator 20 is inserted into a first tubular member 10. As shown in FIG. 1, a first tubular member 10 of the present invention includes a tubular member 11 and a grip member 15 connected to a proximal end (hand side) 12 of the tubular member 11. The overall length of the tubular member 11 is
Although not particularly limited, it is preferably about 30 to 250 mm, more preferably about 50 to 200 mm, and 70 to 15 mm.
About 0 mm is more preferable. The inner diameter of the tubular member 11 is not particularly limited, but is preferably about 3 to 30 mm, more preferably about 3 to 20 mm. The material constituting the tubular member 11 is preferably a material having a strength enough to withstand the impact when puncturing the abdominal cavity or the pressure received from the body wall, for example, stainless steel,
Various metal materials such as aluminum or aluminum alloy, super elastic alloy, shape memory alloy, polyamide, polyvinyl chloride, polycarbonate, ABS resin, polyethylene, polypropylene, polystyrene, polytetrafluoroethylene, acrylic resin, polyester, polyimide, polyarylate , Polyacetal, polyphenylene sulfide (PPS), liquid crystal polymer, polyetherketone (PEK), polyetheretherketone (PEE)
K) and other various synthetic resin materials. On the side surface of the tubular member 11, a slit 14 extending along the longitudinal direction of the tubular member 11 is formed. The slit 14 communicates with the lumen of the tubular member 11 and the opening at the distal end. The length of the slit 14 is not particularly limited, but is preferably about 10 to 100% of the entire length of the tubular member 11, and more preferably about 30 to 70%. The width of the slit is not particularly limited, but may be any width as long as the second tubular member to be described later can be inserted. The smaller the influence, the smaller the effect at the time of insertion / removal. It is more preferable to set the degree. In the present invention, the slit is not limited to a rectangular slit as shown, for example, a circular, a polygon such as an ellipse, or a shape partially including these, such as a second tubular member described below Any device can be used as long as the device can pass through. Grip member 15
Is provided for the main purpose of operating the first tubular member 10 by gripping it. The grip member 15 has an outer wall member 16, and an insertion opening for inserting an obturator 20, which will be described later, is formed inside the outer wall member 16. At the distal end side of this insertion port, a tubular member 1
One base end 12 is fixed. Examples of the material forming the outer wall portion 16 of the grip member 15 include various metal materials such as stainless steel, aluminum or aluminum alloy, polyamide, polyvinyl chloride, polycarbonate, ABS resin, polyethylene, polypropylene, polyester, and polytetrafluorocarbon. Various synthetic resin materials such as ethylene and acrylic resin are exemplified. At a position corresponding to the slit 14 on the outer wall portion 16 of the grip member 15, a marker (mark) 17 indicating the forming direction of the slit 14 in the circumferential direction of the tubular member 11, is attached. Due to the presence of the marker 17, the slit 1
The direction of No. 4 can be easily grasped, and more accurate operation can be performed. The first obturator 20 is composed of a shaft 21 and a grip member 23 connected to the base end of the shaft, and a sharp puncture end (cutting edge) 22 is formed at the tip of the shaft. It is preferable that the shaft 21 and the puncture end 22 are integrally formed. In addition, the tip of the puncture end 22
It may be rounded, which further enhances the effect of preventing damage to organs and the like in the abdominal cavity during puncturing. Examples of the material constituting the shaft 21 and the grip member 23 include various metal materials such as stainless steel, aluminum or an aluminum alloy, titanium or a titanium alloy, a superelastic alloy, and a shape memory alloy, polyamide, and rigid polyvinyl chloride, respectively. , Polycarbonate, A
BS resin, polyethylene, polypropylene, polyester, polytetrafluoroethylene, acrylic resin, polyphenylene sulfide (PPS), polyetherketone (PEK), polyetheretherketone (PEE)
K), various synthetic resin materials such as liquid crystal polymers, and various ceramic materials. Hard materials such as stainless steel and hard resins are particularly preferable. The length of the shaft 21 is determined by the relationship with the overall length of the tubular member 11 of the tubular member 10 to be inserted. That is, as shown in FIG.
Is set to such a length that the puncture end 22 protrudes from the distal end opening of the tubular member 11 when the obturator 20 is inserted into the tubular member 10. Specifically, the total length of the shaft 21 is preferably about 40 to 300 mm, and 60 to 250 m
m is more preferable. FIG. 2 is a perspective view showing a state where the second obturator 40 is inserted into the second tubular member 30. The second tubular member 30 of the present invention includes a tubular member 31 and a grip member 34 connected to a proximal end (hand side) 32 of the tubular member 31. The second tubular member 30 and the second obturator 40 are the same as those of the first tubular member 1 described above.
The material is substantially the same as that of the first and second obturators 20. The overall length of the tubular member 31 is not particularly limited as long as it reaches the lumen of the tubular member 10 at the first incision site,
About 50 to 500 mm is preferable, and about 50 to 200 mm is more preferable. The inner diameter of the tubular member 31 is not particularly limited as long as it is large enough to receive a catheter tube described later, but is preferably about 2 to 25 mm, and more preferably about 2 to 15 mm. The second obturator 40 is a shaft 41
And a grip member 43 connected to the proximal end of the shaft, and a rounded puncture end (blade) 42 is formed at the distal end of the shaft. Shaft 41 and piercing end 42
Are preferably integrally formed. The puncture end 4
The tip 1 may be a sharp tip, but by making it round, the effect of preventing damage to organs and the like in the abdominal cavity at the time of puncturing is further enhanced. The length of the shaft 41 is determined in relation to the total length of the tubular member 31 of the tubular member 30 to be inserted. That is, as shown in FIG. 2, the shaft 41 is set to have a length such that the puncture end 42 protrudes from the distal end opening of the tubular member 31 with the obturator 40 inserted into the tubular member 30. Specifically, the shaft 4
The total length of 1 is not particularly limited, but is preferably about 55 to 550 mm, and more preferably about 55 to 250 mm.
Next, a catheter tube placement method using the catheter tube insertion device of the present invention will be described with reference to the drawings. FIG. 3 is a diagram showing a first stage of a method for inserting and placing catheter tubes, FIG. 4 is a diagram showing a second stage of a method for inserting and placing catheter tubes, and FIG. 5 is a diagram showing a method for inserting and placing a catheter tube. FIG. 6 is a diagram showing a third stage, and FIG. 6 is a diagram showing a fourth stage of a method for inserting and placing a catheter tube. As shown in FIG. 3, after making a small incision in the first completely open site 200 on the abdominal wall, the first tubular member 10 into which the first obturator 20 is inserted from the first completely open site 200 is inserted. And skin 20
2. It penetrates the subcutaneous tissue 203, the anterior sheath 204, the rectus abdominal muscle 205, the posterior sheath 206, and the peritoneum 207 to reach the intraperitoneal 208.
Here, a slit 14 is formed on a side surface of the first tubular member 10. Subsequently, as shown in FIG. 4, a point on the abdominal wall, which is separated from the first open site 200 by a certain distance and about 4 to 5 cm, which is generally said to prevent bacterial infection, is referred to as a second incision site 201, To the second incision site 20
The second tubular member 30 having the second obturator 40 inserted therein is inserted into the first tubular member 10 through the subcutaneous tissue 203.
, The distal end 32 of the second tubular member 30 is inserted into the lumen of the first tubular member 10 through the slit 14 of the first tubular member 10. Thereafter, the second obturator 40 is removed. Subsequently, as shown in FIG. 5, the catheter tube 50 is inserted from the proximal side 32 of the second tubular member 30, and is inserted through the lumen of the second tubular member 30 and the lumen of the first tubular member 10. , And reach the abdominal cavity 108. Subsequently, by removing the first tubular member 10 and the second tubular member 30, the catheter tube 50 is placed with the formation of the subcutaneous tunnel 51 as shown in FIG. 6. At this time,
The scar remaining on the abdominal wall is only the small incision made at the first incision site 200 and the second incision site 201. At the second incision site 201, the catheter tube 50 penetrates. Thus, the indwelling of the CAPD catheter tube is minimally invasive, and the operator can easily perform the operation. (Second Embodiment) FIGS. 7 to 9 are perspective views showing a catheter tube insertion device according to a second embodiment of the present invention. FIG. 7 shows the first obturator 70 attached to the first tubular member 60.
FIG. 8 is a perspective view showing a state in which the second tubular member 8 is inserted.
FIG. 9 is a perspective view showing a state in which the second obturator 90 is inserted into the second obturator 90.
Is a perspective view showing a state in which the third obturator 110 is inserted into the third tubular member 100, and FIG. First tubular member 60 and first obturator 70
The first tubular member 10 and the second obturator 20 of the first embodiment, and the second tubular member 80 and the second obturator 90, the third tubular member 100 and the third tubular member The member 110 is substantially the same in configuration, material, and the like as the first tubular member 30 and the second obturator 40 of the first embodiment, and thus description thereof is omitted, and only different points will be described. The slit 64 formed on the side surface of the first tubular member 60 shown in FIG. 7 may be any slit that is large enough to insert the second tubular member 80, and can be formed smaller than in the first embodiment. . This is due to a difference in a procedure to be described later, and the second tubular member can be formed to have a size having a lumen through which the guide wire 120 can be inserted, thereby reducing the insertion resistance. Here, the width of the slit is not particularly limited, but is preferably 1 to 15 mm, more preferably 2 to 10 mm. The length of the slit is not particularly limited, but is preferably about 10 to 100% of the entire length of the tubular member 61, and more preferably about 30 to 70%. Also,
The total length of the second tubular member 80 is not particularly limited.
It is preferably from 500 to 500 mm, more preferably from 50 to 200 mm. The inner diameter of the second tubular member is not particularly limited, but is preferably 0.5 to 10 mm, more preferably 1 to 5 mm. The third tubular member 100 and the third tubular member 110 only need to have a lumen large enough to insert the catheter 50, and have a length capable of reaching the abdominal cavity 308 from the second incision site 301. Should be fine. Further, the third obturator 110 has a lumen 111 formed from the distal end to the proximal end, through which a guide wire can be inserted, and is guided by the guide wire to insert the third tubular member into the third obturator. It is possible to puncture with. Here, the total length of the third tubular member 100 is preferably from 50 to 700 mm, more preferably from 50 to 500 mm. The inner diameter is preferably 2 to 25 mm, more preferably 2 to 15 mm. FIG. 10 shows a guide wire 120,
The guide wire 120 is formed of a wire having such a rigidity that it can be advanced by being pushed into the subcutaneous tissue. Specifically, a core wire made of a superelastic alloy or a core wire having an outer periphery formed with a coating layer made of, for example, polyurethane may be used. Here, guide wire 1
The total length of 20 may be longer than the third tubular member, and is preferably about 100 to 10000 mm,
It is more preferably about 0 to 700 mm. Next, a method of placing a catheter using the catheter insertion device of the present invention will be described with reference to the drawings. FIG. 11 is a diagram showing a first stage of a method of inserting and placing catheter tubes, FIG. 12 is a diagram showing a second stage of a method of inserting and placing catheter tubes, FIG.
3 is a diagram showing a third stage of the method of inserting and placing a catheter tube, FIG. 14 is a diagram showing a fourth stage of the method of inserting and placing a catheter tube, and FIG. 15 is a diagram showing a fourth stage of the method of inserting and placing a catheter tube. FIG. 16 is a diagram showing a fifth stage, FIG. 16 is a diagram showing a sixth stage of the insertion and placement method of catheter tubes, and FIG. 17 is a diagram showing a seventh stage of the insertion and placement method of catheter tubes. As shown in FIG. 11, after making a small incision in the first totally open site 300 on the abdominal wall, the first tubular member 60 in which the first obturator 70 is inserted from the first completely open site 300 is inserted. Skin 302, subcutaneous tissue 303, anterior sheath 30
4. It reaches the abdominal cavity 308 through the rectus abdominal muscle 305, the posterior sheath 306, and the peritoneum 307. Here, a slit 64 is formed on the side surface of the first tubular member 60. Subsequently, FIG.
As shown in FIG. 2, a point on the abdominal wall about 4 to 5 cm away from the first open part 300 is defined as a second incision part 301, a small incision is made, and the second obturator 90 is crowned from the second incision part 301. The inserted second tubular member 80 is advanced in the direction of the first tubular member 60 through the subcutaneous tissue 303, and
0 is inserted through the slit 64 of the first tubular member 60 into the lumen of the first tubular member 60. Thereafter, the second obturator 90 is removed. Subsequently, as shown in FIG. 13, the guide wire 120 is inserted from the proximal side 83 of the second tubular member 80, and is inserted through the lumen of the second tubular member 80 and the lumen of the first tubular member 60. To reach the abdominal cavity 308. Subsequently, by removing the first tubular member 60 and the second tubular member 80, the guide wire 120 is in a state of being penetrated as shown in FIG. Subsequently, as shown in FIG. 15, the third tubular member 100 is inserted through the second incision site 301, is advanced along the guide wire 120, and reaches the abdominal cavity 308. At this time, the third obturator 110 is provided with a lumen through which the guide wire 120 can penetrate, and the third tubular member can be inserted to the target site with the third obturator 110 inserted therein. is there. Subsequently, after removing the third obturator 110 and the guide wire 120, as shown in FIG.
0, the catheter tube 50 is inserted from the proximal side 103, and through the lumen of the third tubular member 100, into the abdominal cavity 30.
Reach 8. At this time, with the obturator stylet (not shown) inserted into the lumen of the catheter 50,
It is also possible to guide the catheter to the target site.
Subsequently, by removing the third tubular member 100,
As shown in FIG. 16, the catheter tube 50 is placed with the formation of the subcutaneous tunnel 51. Here, the third tubular member is in a state of being inserted straight, but the abdominal wall is in a distorted state, and is returned to the original state by removing the third tubular member, and the catheter tube 50 as shown in the figure is indwelled. become. At this time, the scar remaining on the abdominal wall is only the small incision wound made at the first incision site 300 and the second incision site 301. At the second incision site 301, the catheter tube 50 penetrates. As described above, in the second embodiment, the third tubular member is inserted straight, whereby the catheter is also inserted straight, so that the catheter tip can be easily guided to the target site, the Douglas fossa (in the small pelvic cavity). . (Third Embodiment) FIGS. 18 to 20 show a third embodiment of the catheter tube insertion device and catheter tube of the present invention. The material and configuration of the first tubular member 130 in which the first obturator 140 of FIG. 18 is inserted are substantially the same as those of the first embodiment, and therefore description thereof is omitted. However, in the third embodiment, the size of the first tubular member only needs to have an inner diameter into which a catheter tube 160 described later can be inserted, and is preferably about 2 to 25 mm, and more preferably about 2 to 15 mm. As a result, the diameter of the tubular member can be reduced, so that invasion to the body is reduced. FIG. 19 shows a gripping device 150 of the present invention.
2, a grip portion 154 having a hook shape and a grip member 155 connected to the proximal end 153 of the shaft tube. As for the material of the shaft 151, for example, various metal materials such as stainless steel, aluminum or aluminum alloy, superelastic alloy, shape memory alloy, polyamide, polyvinyl chloride, polycarbonate, ABS
Resin, polyethylene, polypropylene, polystyrene,
Polytetrafluoroethylene, acrylic resin, polyester, polyimide, polyarylate, polyacetal,
Polyphenylene sulfide (PPS), liquid crystal polymer,
Various synthetic resin materials such as polyetherketone (PEK) and polyetheretherketone (PEEK) are exemplified. The total length of the shaft 151 is not particularly limited,
About 50 to 700 mm is preferable, and about 50 to 500 mm is more preferable. The outer diameter of the shaft 151 is not particularly limited, but is preferably about 1 to 10 mm, and more preferably about 2 to 5 mm. Further, in the present invention, the grip portion 154 is formed in a hook shape. However, the shape is not limited to the hook shape as long as the catheter tube can be gripped. FIG. 20 shows a catheter tube 160,
The catheter tube 160 has a grasped portion 162 formed of a thread or rubber or the like and a distal end portion 16 formed of a thread or rubber so that the catheter tube 160 can be grasped by the grasping portion 154 shown in FIG.
3 has a plurality of holes for injection and discharge. The plurality of holes of the distal end portion 163 are preferably formed on the entire circumference in order to inject and discharge the peritoneal dialysate efficiently. Here, the total length of the catheter tube is not particularly limited.
About 1500 mm, preferably 150 to 1000 mm
The degree is more preferred. Next, a method of placing a catheter using the catheter insertion device of the present invention will be described. FIG.
1 is a diagram showing a first stage of a method of inserting and placing a catheter tube, FIG. 22 is a diagram showing a second stage of a method of inserting and placing a catheter tube, and FIG. FIG. 24 is a diagram showing three stages, FIG. 24 is a diagram showing a fourth stage of a method of inserting and placing catheter tubes, and FIG. 25 is a diagram showing a fifth stage of a method of inserting and placing catheter tubes. As shown in FIG. 21, after making a small incision in the first totally open site 400 on the abdominal wall, the first tubular member 130 in which the first obturator 140 is inserted from the first completely open site 400 is used as a skin. 402, subcutaneous tissue 403, anterior sheath 40
4. Penetrate the rectus abdominis muscle 405, posterior sheath 406, and peritoneum 407 to reach the abdominal cavity 408. At this time, a slit 134 is formed on a side surface of the first tubular member 130. Subsequently, as shown in FIG. 22, after the first obturator 140 is removed, the catheter tube 160 is connected to the first tubular member 13.
The catheter tube 160 is inserted into the abdominal cavity 408 through the lumen 0, and the thread 162 connected to the proximal side (proximal side) 161 of the catheter tube 160 is positioned in the lumen of the first tubular member 130. . Subsequently, as shown in FIG. 23, a point on the abdominal wall about 4 to 5 cm away from the first totally open site 400 is defined as a second incision site 401, and a small incision is made.
The gripping instrument 150 is inserted. Inserted gripping instrument 15
0 through the subcutaneous tissue 403 in the direction of the first tubular member 130, and the hook-shaped grip 154 formed at the distal end (distal end) 152 of the gripping instrument 150 is inserted into the slit of the first tubular member 130. 134 through the first tubular member 13
0 lumen. Then, the hook-shaped gripping portion 15
4 grasps the thread 162 of the catheter tube 160. Subsequently, as shown in FIG. 24, the grasping device 150 is retracted, and the grasped portion 162 of the catheter tube 160 and the proximal side portion 161 of the catheter tube 160 are advanced through the subcutaneous tissue 403 toward the second incision site 401. ,
The proximal side 161 of the catheter tube 160 is pulled out of the body. Subsequently, the first tubular member 130 is removed, the catheter tube 160 is cut at an arbitrary position on the proximal side (base end side) 161 of the catheter tube 160, and the grasped portion 162 is removed. The catheter tube 160 is deployed with the formation of a subcutaneous tunnel 164 as shown in FIG. At this time, the scar remaining on the abdominal wall is only the small incision made at the first incision site 400 and the second incision site 401. At the second incision site 401, the catheter tube 160 penetrates. As described above, in the third embodiment, when forming a subcutaneous tunnel from the second puncture site to the trocar tube, it is not necessary to insert a tubular body having a diameter larger than the outer diameter of the catheter. Has an advantageous effect that it is easy to adhere.

As described above, according to the catheter tube insertion device of the present invention, since the incision at the first totally open site can be small, invasion to the patient, specifically,
It has the effect of reducing postoperative pain, cosmetic problems, and length of hospital stay. In addition, there is an effect that the procedure can be performed even if the user is not necessarily skilled in surgical treatment.

[Brief description of the drawings]

FIG. 1 is a view showing a first tubular member in which a first obturator of a first embodiment of a catheter tube insertion device of the present invention is inserted.

FIG. 2 is a view showing a second tubular member in which a second obturator is inserted in the first embodiment of the catheter tube insertion device of the present invention.

FIG. 3 is a view showing a first stage of an insertion and placement method using the catheter tube insertion device according to the first embodiment of the present invention.

FIG. 4 is a view showing a second stage of the insertion and indwelling method using the catheter tube insertion device according to the first embodiment of the present invention.

FIG. 5 is a view showing a third stage of an insertion and placement method using the catheter tube insertion device according to the first embodiment of the present invention.

FIG. 6 is a view showing a fourth stage of the insertion and placement method using the catheter tube insertion device according to the first embodiment of the present invention.

FIG. 7 is a view showing a first tubular member in which a first obturator is inserted in a catheter tube insertion device according to a second embodiment of the present invention.

FIG. 8 is a view showing a second tubular member in which a second obturator is inserted, according to a second embodiment of the catheter tube insertion device of the present invention.

FIG. 9 is a view showing a second tubular member having a third obturator inserted therein according to the second embodiment of the catheter tube insertion device of the present invention.

FIG. 10 is a view showing a guide wire of a catheter tube insertion device according to a second embodiment of the present invention.

FIG. 11 is a view showing a first stage of an insertion and placement method using the catheter tube insertion device according to the second embodiment of the present invention.

FIG. 12 is a view showing a second stage of the insertion and placement method using the catheter tube insertion device according to the second embodiment of the present invention.

FIG. 13 is a view showing a third stage of an insertion and placement method using the catheter tube insertion device according to the second embodiment of the present invention.

FIG. 14 is a diagram showing a fourth stage of an insertion and placement method using the catheter tube insertion device according to the second embodiment of the present invention.

FIG. 15 is a view showing a fifth stage of an insertion and placement method using the catheter tube insertion device according to the second embodiment of the present invention.

FIG. 16 is a view showing a sixth stage of the insertion and placement method using the catheter tube insertion device according to the second embodiment of the present invention.

FIG. 17 is a diagram showing a seventh stage of the insertion and placement method using the catheter tube insertion device according to the second embodiment of the present invention.

FIG. 18 is a view showing a first tubular member and a first obturator according to a third embodiment of the catheter tube insertion device of the present invention.

FIG. 19 is a view showing a grasping device according to a third embodiment of the catheter tube inserting device of the present invention.

FIG. 20 is a view showing a catheter tube according to a third embodiment of the catheter tube insertion device of the present invention.

FIG. 21 is a diagram showing a first stage of an insertion and indwelling method using the catheter tube insertion device according to the third embodiment of the present invention.

FIG. 22 is a diagram showing a second stage of the insertion and placement method using the third embodiment of the catheter tube insertion device of the present invention.

FIG. 23 is a view showing a third stage of the insertion and indwelling method using the third embodiment of the catheter tube insertion device of the present invention.

FIG. 24 is a diagram showing a fourth stage of the insertion and placement method using the third embodiment of the catheter tube insertion device of the present invention.

FIG. 25 is a diagram showing a fifth stage of the insertion and placement method using the catheter tube insertion device according to the third embodiment of the present invention.

[Explanation of symbols]

 200, 300, 400 First open site 201, 301, 401 Second incision site 202, 302, 402 Skin 203, 303, 403 Subcutaneous tissue 204, 304, 404 Anterior sheath 205, 305, 405 Muscle layer 206, 306, 406 Posterior sheath 207, 307, 407 Peritoneum 208, 308, 408 Intraperitoneal 10, 60, 130 First tubular member 20, 70 Second tubular member 14, 64, 134 Slit 50, 170 Catheter tube 100 Third tube Member 120 Guide wire 150 Gripping instrument 154 Gripping part 162 Grasped part

Claims (3)

[Claims] 1. A first tubular member having a slit formed on a side surface and having a lumen formed over the entire length, a first obturator which can be inserted into a lumen of the first tubular member, A second tubular member having an outer diameter that can be inserted into the slit of the first tubular member and having a lumen formed over the entire length; and a second tubular member that can be inserted into the lumen of the second tubular member. A catheter tube insertion device comprising a second obturator. 2. A first tubular member having a slit formed on a side surface and having a lumen formed over the entire length, a first obturator which can be inserted into a lumen of the first tubular member, A second tubular member having an outer diameter that can be inserted into the slit of the first tubular member and having a lumen formed over the entire length; and a second tubular member that can be inserted into the lumen of the second tubular member. A second obturator, a guide wire, a third tubular member having a lumen formed over the entire length, and used in combination with the third tubular member to allow the guide wire to pass therethrough. A third obturator having a simple lumen, wherein the entire length of the guide wire is longer than the entire length of the third obturator. 3. A first tubular member having a slit formed on a side surface and having a lumen formed over the entire length, a first obturator capable of being inserted into a lumen of the first tubular member, A catheter tube having a grasped portion on the hand side and having an outer diameter that can be inserted into the first tubular member, and a grasping instrument having a grasping portion at a distal end for grasping the grasped portion of the catheter tube. An apparatus for inserting a catheter tube, comprising: