JPH11309215A - Medical tube introducer - Google Patents

Abstract

PROBLEM TO BE SOLVED: To secure a safety and certain tube introducing route by crimping beforehand so as to open like a basket outwardly by dint of providing plural lengthwise slits at an periphery of a point of a catheter for tap. SOLUTION: A slit part 5 which has plural slits is formed at a lengthwise direction of a side of a point of a main body of catheter 1. The slit part 5 is crimped beforehand so as to open like a basket outwardly. A connector 2 is mounted at a rear edge of the main body of catheter 1 and fit or fixed with a stylet connector 4. And the main body of catheter 1 is inserted in a body with extending the slit part 5 by the stylet 3 which is fixed at the stylet connector 4, then fixed at an insert part by extracting the stylet 3 and broaden the slit part 5. Thereby, an introducing route can be secured safely and certainly.

Description

DETAILED DESCRIPTION OF THE INVENTION

[0001]

BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to a medical tube introduction tool for ensuring a safe and reliable route for discharging a body fluid and injecting a drug solution / nutrient.

[0002]

2. Description of the Related Art Conventionally, particularly as a method of enteral nutrition administration,
Percutaneous endoscopic gastrostomy (PEG), one of the endoscopic procedures to create a fistula in the lumen of the stomach and the skin surface of the abdominal wall using an endoscope, was performed by Gaudert, a pediatric surgeon in 1979.
And an endoscopic surgeon, Ponsky (Japanese Patent Laid-Open Publication No. Hei 6-503243), and several techniques using this technique have been developed and are being widely spread. However, because of puncture of the stomach wall and abdominal wall, it cannot be used or used in cases such as "cases with a large amount of ascites storage", "cases with liver and transverse colon between the stomach and abdominal wall", "patients with a history of gastric surgery" Have difficulty. In addition, there is also a method of placing the tube intranasally in the stomach, but with long-term placement, the pain in the nostrils, nasal cavity, pharynx becomes stronger, ulcers may be formed in the nostrils, and it may be difficult to continue placement. Furthermore, pneumonia may be complicated due to difficulty in emptying sputum. These QOLs
This is not preferred from the point of view.

Further, in 1993, Nakano et al. Developed a method for forming a cervical esophageal fistula under fluoroscopy. The indwelling method is to insert a tube with a balloon into the esophagus nasally,
Contrast is injected into the balloon at the cervical esophagus to dilate the lumen of the cervical esophagus. Next, the cervical esophagus is punctured percutaneously under fluoroscopy, a cervical esophageal fistula is prepared, and a feeding tube is placed. Although this indwelling method is simple, invasive to the patient, and has little pain, it is useful for long-term nutritional management. However, this method involves puncturing only under X-ray fluoroscopy. Could be dangerous. In addition, the tube with balloon uses a Foley catheter,
At the time of puncturing, whether the puncture needle has reached the lumen of the esophagus is determined by the rupture of the balloon, and damage to the esophageal wall due to the tip of the needle after rupture or the needle puncture is shallow and the puncture needle may be detached from the esophageal wall. I was concerned.

Further, in 1997, Oishi et al. Improved the method of forming a cervical esophageal fistula under X-ray fluoroscopy by Nakano et al. As a method of puncturing the balloon of a balloon catheter, the position of the balloon was detected from outside the body using an ultrasonic probe. A method for safely and reliably puncturing the balloon with a puncture needle while confirming the condition was devised ("Percutaneous transcervical esophageal gastrostomy, its indication and usefulness", Journal of the Japanese Surgery Society, 1997. Transcervical Esophageal Gastrostomy, its Tips and Secondary Injuries ", Journal of the Japanese Society of Gastroenterological Surgery, 1997). However, as with Nakano et al., A Foley catheter was used, and concerns about damage to the esophageal wall due to the needle tip after balloon rupture and detachment of the puncture needle from the esophageal wall still remained. Thus, Oishi et al. Studied a balloon catheter that does not break immediately even when punctured with a puncture needle as disclosed in Japanese Patent Application No. 10-017994, and established a safe and reliable procedure. However, the balloon is bulky and difficult to insert nasally. If the balloon internal pressure is low, the balloon will come off during traction. If the balloon is damaged before insertion, there remain problems such as the balloon being broken and unusable.

[0005]

SUMMARY OF THE INVENTION The present invention has been made in view of the above-mentioned circumstances, and an object of the present invention is to ensure a safe and reliable route for draining a body fluid and injecting a drug solution / nutrient. An object of the present invention is to provide a medical tube introduction tool.

[0006]

That is, the present invention provides a puncture catheter, a puncture needle for guiding a guide wire, a guide wire for guiding a tube, a dilator with a sheath for expanding a puncturing portion, a body fluid discharging or A medical tube introduction tool comprising a combination of tubes serving as routes for injecting a drug solution or the like, wherein the puncture catheter has a plurality of slits provided in a distal end portion in a length direction, and the slit portions are directed outward in a cage. A medical tube introduction tool characterized in that the medical tube introduction tool is pre-fitted so as to open in a shape, and further, the slit inner surface of the puncture catheter is non-slip processed.

[0007]

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS The present invention will be specifically described below with reference to the drawings. FIGS. 1A, 1B and 1C are side views of a puncture catheter according to one embodiment of the present invention. FIG. 2 is a diagram showing a medical tube introduction tool and a method of using the same. FIG. 3 is a schematic diagram showing a state where an ultrasonic probe is applied during puncturing. FIG. 4 is a schematic diagram showing ultrasonic images before and after the slit portion of the puncture catheter is expanded.

The puncture catheter (19) is shown in FIG.
It is formed as shown in (b) and (c). FIG. 1A includes a catheter body (1), a connector (2), a stylet (3), and a stylet connector (4). The catheter body (1) has one lumen, the tip is rounded, the tip is sealed, and a slit (5) having a plurality of slits in the longitudinal direction of the tip. ) Is formed, and the slit portion (5) is previously formed so as to open in a cage shape outward. A connector (2) is attached to the rear end of the catheter body (1), and is fitted or locked to the stylet connector (4). The stylet (3) is a single wire or a plurality of stranded wires, and the tip is rounded. The stylet connector (4) is attached to the rear end of the stylet,
It is fitted or locked with the connector (2).

In actual use, the stylet (3) is inserted into the lumen of the catheter body (1), the slit portion (5) is extended and inserted into the body, and after the insertion, the stylet (3) is removed. The slit part (5) spreads and is fixed to the insertion part. In addition, the catheter body (1) is formed to have a length and thickness suitable for the patient's physique and insertion point, and when inserted nasally, the length is 1 to 3 m and the thickness is 2 to 6 mm. 1-2m for transanal insertion, 4
~ 6mm, 50cm ~ 1m for transurethral insertion,
1 to 3 mm. The length and spread width of the slit portion (5) may be, for example, about 3 to 10 cm for the esophagus, about 30 mm for the spread width, and about 5 mm for the stomach, depending on the size of the hollow organ at the insertion site. ~ 20cm, spread width 200m
The standard is about m. Further, the stylet (3) is formed to have an outer diameter and a length that match the dimensions of the catheter body (1).
m and a thickness of 0.5 to 4 mm.

FIG. 1B includes a catheter body (6), a connector (7), a stylet (8), a stylet connector A (9), and a stylet connector B (10). The catheter body (6) has one lumen, the tip is rounded, the tip is sealed, and a slit (12) is formed by a plurality of slits in the longitudinal direction of the tip. The slit portion (12) is formed in advance so as to open outward in a cage shape, and the tip portion (11) is further provided with a stylet (8).
It is integrated with the tip. A connector (7) is attached to the rear end of the catheter body (6), and is fitted or locked to the stylet connector A. The stylet (8) is a single wire or a plurality of strands, and the distal end is integrated with the catheter body (6). At the rear end of the stylet (8), the stylet connector A (9) and the stylet connector B (10) have a structure that can be arbitrarily moved and fixed on the stylet. The connector (7) is fitted or locked.

FIG. 1 shows an example. The stylet connector B (1) is tightened by screwing the stylet connector A (9) and the stylet connector B (10).
When the stylet (8) passes through the lumen of (0), the stylet (8) is fixed by the stylet connector B (10). By loosening the screws of the stylet connector A (9) and the stylet connector B (10), the stylet (8) becomes movable. The structure of the stylet connector is not particularly limited as long as the stylet can be moved and fixed. The embodiment of FIG. 1B is employed as a method for forcibly expanding and fixing the slit portion when the shape retaining property of the slit portion in FIG. 1A is insufficient. The size of the catheter body (6) and stylet (8) is shown in FIG.
Same as (a).

FIG. 1C shows a catheter body (13),
It comprises a connector (14), a dilator (15), a dilator connector A (16) and a dilator connector B (17). The catheter body (13) has one lumen, the tip is rounded, and the tip is open.
Connector (14) at the rear end of the catheter body (13)
Is attached and fitted or locked with the dilator connector A (16). The dilator (15) is formed by a plurality of wires, the tip side of which is pre-cursed in a basket shape, and the tip end is formed into a round shape. At the rear end of the dilator (15), a dilator connector A (16) and a dilator connector B (17) having the same mechanism as the stylet connectors A and B of FIG. 1 (b) can be freely moved on the dilator. The dilator connector A (16) and the connector (14) are fitted or locked together. In actual use, the dilator (15) is inserted with the dilator (15) inserted into the catheter body (13), and after insertion, the dilator (15) is pushed out of the catheter body (15), so that the dilator is inserted. The slit portion (18) expands to form a basket and is fixed to the insertion site.

The catheter body (13) is formed to have a length and a thickness suitable for a patient's physique and a place to be inserted, and has a length of 1 to 3 m and a thickness of 2 to 6 mm for nasal insertion. Similarly, when inserting transanally, 1-2 m, 4-
6 mm, 50 cm to 1 m for transurethral insertion, 1
３3 mm. The dilator (15) is formed to have an outer diameter and a length that match the dimensions of the catheter body (13). For example, in the case of nasal insertion, the length is 1 to 3 m and the thickness is 0.5 to 0.5. It is formed to 4 mm. In addition, slit part (5)
(12) The length and spread width of (18) depend on the size of the luminal organ at the insertion site.
Approximately 5 to 20 cm in length and approximately 200 mm in width for stomach.

The catheter body has appropriate flexibility and elasticity at ordinary room temperature and body temperature, and is usually formed of a synthetic resin such as a soft vinyl chloride resin, a polyurethane resin, a polyethylene resin, or a polyamide resin. Etc. are preferably used. Although the material of the connector is not particularly limited, hard vinyl chloride resin, polycarbonate resin,
It is preferable to use a synthetic resin such as an ABS resin. The material of the stylet and dilator is selected from materials that do not easily deform at normal room temperature or body temperature. For synthetic resins, hard vinyl chloride resin, polycarbonate resin, etc., and other metal materials such as shape memory alloys and stainless steel Is preferably used. Further, the inner surface of the slit portion of the catheter body or the slit portion of the dilator may be subjected to anti-slip processing such as rough surface treatment for the purpose of improving gripping of the guide wire.

As shown in FIG. 2, a puncture catheter (1
9) The indwelling tube (25) is safely and securely indwelled by the ultrasonic probe (20), the puncture needle (21), the guide wire (22), the dilator (23), the sheath (24), and the indwelling tube (25). It is possible to do. Hereinafter, as an example of the method of use, a method of percutaneously creating a route for excreting body fluid from the neck to the stomach and injecting a drug solution / nutrient will be described. As shown in FIG. 2 (a), a puncture catheter (19) is inserted nasally, the slit (26) is widened beyond the esophagus entrance, and the catheter is inserted to secure a wide puncture site. Towing ultrasonic probe (20)
Confirm the position of the slit portion (26) with. FIG. 3 is a schematic diagram showing a state in which the ultrasonic probe (20) is applied at the time of puncturing, and the ultrasonic probe (20) is strongly pressed against the slit (26), thyroid, trachea, artery, and vein. Etc. are shifted to the left and right, and in that state the slit part (26)
A puncture needle (21) is aimed at. FIG. 4 is a schematic diagram showing an ultrasonic image before and after the slit portion of the puncture catheter (19) is expanded.

As described above, from inside the body, the slit portion (26) is expanded in the esophagus, and from outside the body, the ultrasonic probe (20) is expanded.
By pressing strongly, a space for puncturing the puncture needle (21) is secured. While confirming that the ultrasonic probe (20) can be safely punctured while checking the slit portion (26), the puncture needle (21) is pierced toward the slit portion (26) after confirming that the puncture can be performed safely. The puncture needle (21) is pierced to penetrate the esophageal wall, and the puncture needle disappears at the moment when the puncture needle reaches the inside of the slit from between the slits, so that the insertion of the puncture needle is stopped at that point. Also, it is confirmed by an ultrasonic image that the tip of the puncture needle (21) is surely in the slit.

Next, as shown in FIG. 2B, a required amount of guide wire (22) is inserted from the end of the puncture needle, and the puncture needle (21) is pulled out. The slit of the puncture catheter (19) is contracted, the guide wire (22) is held by the slit, and the guide wire (22) is introduced into the stomach while the puncture catheter is pushed in, and is left there. The puncture catheter (19) is withdrawn. A dilator (23) with a sheath (24) is inserted from the end of the guide wire to expand the puncture site, and only the dilator (23) is withdrawn. Furthermore,
As shown in FIG. 2 (c), the indwelling tube (25) is inserted from the end of the guide wire, passed through the sheath (24), and introduced into the body. When the indwelling tube (25) reaches the inside of the stomach, remove the guide wire (22) and the sheath (24) and fix it with a fixture, etc., and fix the end of the indwelling tube (25) with a drainage bag or a nutrient / chemical solution bag. Use it by connecting to etc.

When a route for body fluid discharge from the cervix to the stomach and infusion of a drug solution / nutrient are made percutaneously, the puncture needle (21) may be about 18G. Also, a tubular needle is desirable so that the guidewire (22) can be inserted. The tip of the needle may be an obliquely cut one or a Huber needle that is designed so that the tip is at the center of the tip. However, the tip is designed so that the position can be easily confirmed by the ultrasonic probe (20). A roughened or grooved product is desirable.
The material is generally stainless steel. The guide wire (22) is about 0.035 inch, and there is no problem in any specification as long as it passes through the lumen of the puncture needle (21). It is desirable to attach wires. Dilator (2
In 3), in order to expand to about 10 to 14 Fr, several dilators (23) having different diameters may be used, or a stepped or a combination of several dilators (23) may be used. . The material is synthetic resin vinyl chloride resin,
Fluororesin or the like is used.

The sheath (24) is formed with an inner diameter of about 16 Fr and into which a dilator and an indwelling tube can be inserted, and may be a tube-shaped material. However, it is convenient to use a material that can be torn, and the material is a synthetic resin. Among them, a fluororesin or the like with good slip is used. The indwelling tube (25) may use a general drainage tube or a feeding tube, but the tip portion reaching the indwelling site is particularly flexible and has a good shape and material that does not damage the organ, and particularly the intragastric region. The indwelling device may be a device in which a balloon for fixation is attached to the distal end portion and which can be pulled and fixed at the cardia after the balloon is inflated in the stomach. The material is synthetic resin vinyl chloride resin,
Silicone rubber or the like is used, but is not particularly limited.

The site and method in which the present invention is used include not only a method for percutaneously creating a route for draining body fluid from the cervix to the stomach and injecting a medicinal solution or a nutrient, but also a puncture catheter to be appropriately used. (19), puncture needle (21), guide wire (22), dilator (23), sheath (2)
4) By changing the size and material of the indwelling tube (25), all luminal organs (esophagus, stomach, bile duct,
The indwelling tube (25) can be safely and reliably introduced into the pancreatic duct, intestine, ureter, bladder, etc.).

[0021]

EFFECTS OF THE INVENTION By using the medical tube introduction tool and the method of use of the present invention, all lumen organs (esophagus, esophagus, Stomach, bile duct, pancreatic duct, intestine, ureter, bladder, etc.), and procedures that had to be performed by many humans in operating rooms, etc. in the past because radiographs and endoscopes were used. However, by using this method, it becomes possible for two persons to perform the procedure at the bedside with an ultrasonic probe.

[Brief description of the drawings]

FIG. 1 is a side view of a puncture catheter according to one embodiment of the present invention.

FIG. 2 is a view showing a medical tube introduction tool and a method of using the same.

FIG. 3 is a schematic view showing a state where an ultrasonic probe is applied during puncturing.

FIG. 4 is a schematic view showing an ultrasonic image before and after a slit portion of a puncture catheter is expanded.

[Explanation of symbols]

 1. 1. catheter body Connector 3. Stylet 4. Stylet connector 5. Slit part 6. 6. catheter body Connector 8. Stylet 9. Stylet connector A10. Stylet connector B 11. Tip 12. Slit part 13. Catheter body 14. Connector 15. Extender 16. Dilator connector A 17. Expander connector B 18. Slit part 19. Puncture catheter 20. Ultrasonic probe 21. Puncture needle 22. Guide wire 23. Dilator 24. Sheath 25. Indwelling tube 26. Slit part

Claims (2)

[Claims] 1. A puncture catheter, a puncture needle for guiding a guide wire, a guide wire for guiding a tube,
A medical tube introduction tool comprising a combination of a dilator with a sheath for expanding the puncture portion and a tube serving as a route for discharging bodily fluids or injecting a medicinal solution. A medical tube introduction tool, characterized in that a slit is provided and the slit portion is previously formed so as to open in a cage shape outward. 2. The medical tube introduction tool according to claim 1, wherein the inner surface of the slit of the puncture catheter is non-slip.