WO2021031615A1

WO2021031615A1 - Triad trocar device and method for deep tissue puncture

Info

Publication number: WO2021031615A1
Application number: PCT/CN2020/088741
Authority: WO
Inventors: 曹丰; 陶博; 刘峻松; 李苏雷; 樊景阳
Original assignee: 中国人民解放军总医院; 曹丰
Priority date: 2019-08-20
Filing date: 2020-05-06
Publication date: 2021-02-25
Also published as: CN110339435B; CN110339435A

Abstract

A triad trocar device for deep tissue puncture, comprising: a thick puncture needle (10), a puncture cannula (20), and a fine puncture needle (30). In a puncture process, when shallow tissue is punctured, tips of the thick puncture needle (10), the puncture cannula (20), and the fine puncture needle (30) are aligned; when deep tissue is punctured, the puncture cannula (20) and the fine puncture needle (30) extend out of a first end of the thick puncture needle (10) and pierce into the deep tissue together, then the fine puncture needle (30) is withdrawn, and a channel is established between the deep tissue and the exterior of the body of a subject by means of the puncture cannula (20). By means of the puncturing device and method, important tissue organ damage can be reduced when the deep tissue is punctured, the sensitivity of the deep tissue during puncturing is increased, and the success rate of puncturing is improved, so that clinical prognosis is improved, and the device and method can be applied to clinical practice such as pericardial effusion puncture drainage and subclavian vein puncture catheterization, and have a high clinical application value.

Description

Triple trocar device and method for deep tissue puncture

Technical field

This application relates to deep tissue puncture technology, and in particular to a triple trocar and method for puncturing deep tissue without ultrasound guidance.

Background technique

In clinical work, it is often necessary to puncture deep tissues, such as pericardiocentesis and drainage during acute pericardial tamponade, daily subclavian vein puncture and catheterization, and 18G or 20G thick puncture needles (outer diameters of 1.2mm and 0.9mm, respectively) are used for direct puncture and then use The seldinger technology exchanges the guide wire and sheath. The thick puncture needle punctures into the target location such as the pericardial cavity or the vascular cavity of the subclavian vein, which is the first step of successful puncture. The steel needle structure of the thick puncture needle tube wall is conducive to penetrating the superficial hard tissues and many surrounding bones. Fix one channel in the case of structure. However, the problem is that the direct puncture of the deep tissue with the thick needle increases the direct damage of the deep tissue, especially when multiple punctures are unsuccessful, and it may be that the penetration of the deep structure is not obvious when the pericardium is punctured. , Directly penetrate the left/right ventricular wall, and further insert the guide wire and sheath without timely detection, causing irreversible consequences and life-threatening.

Conventional puncture of the pericardium or subclavian vein sometimes uses a common trocar for puncture. The built-in steel needle is drawn out and then moved forward slightly to ensure that the puncture cannula enters the pericardium or blood vessel, and the cannula is pushed into the pericardial cavity or without resistance. In the blood vessel, withdraw the steel needle, and then use the seldinger technique to exchange the guide wire and sheath. The problem is that when puncturing deep tissues, the cannula is easily squeezed and deformed by the shallow tissues, and even the tip position moves out of the pericardium or vascular cavity, resulting in puncture failure, and even the guide wire or sheath strayed into the false cavity, causing adverse consequences. Therefore, conventional trocar puncture is more suitable for superficial tissue puncture, such as superficial vein puncture and radial artery puncture.

Ultrasound-guided puncture can see the entire puncture process, which is equivalent to the operation under direct vision, especially when the technique is skilled, but the clinical situation is sometimes very critical, such as acute pericardial tamponade, which can only be blind puncture to save lives in a race against time. Intubation through the subclavian vein is a routine clinical operation. It is mostly blind puncture based on the experience of the surgeon. Only a few complicated, difficult or high-risk patients will try ultrasound-guided puncture, which is difficult to apply in a wide range of routines.

Disclosure of invention

In view of the above-mentioned problems, the present application aims to propose a triple trocar device for deep tissue puncture, which can easily penetrate shallow tissues and puncture deep tissues. This application also aims to propose a method for deep tissue puncture using the triple trocar device of this application.

A triple trocar device for deep tissue puncture of the present application, which includes: a thick puncture needle, a puncture sleeve, and a fine puncture needle;

The thick puncture needle is formed in a tube shape, and the first end of the thick puncture needle is formed as a tip including a bevel;

The puncture sleeve is formed in a tube shape, the first end of which is formed as a tip including a bevel, and the second end of which is formed as an end seat;

The fine puncture needle is formed in a tube shape, the first end of which is formed as a tip including a bevel, and the second end of which is formed as an end seat;

The length of the puncture sleeve and the thin puncture needle is greater than the length of the thick puncture needle;

The puncture sleeve is inserted into the thick puncture needle, and the gap between the puncture sleeve and the thick puncture needle is airtight;

The fine puncture needle is inserted into the puncture sleeve, and the gap between the fine puncture needle and the puncture sleeve is airtight;

During the puncture process, when puncturing shallow tissue, the tips of the thick puncture needle, puncture sleeve, and fine puncture needle are aligned; when puncturing deep tissue, the puncture sleeve and fine puncture needle extend from the first end of the thick puncture needle. They pierce the deep tissue together, then withdraw the fine puncture needle, and establish a channel between the deep tissue and the subject’s body through the puncture cannula.

Preferably, the inclined surfaces of the tips of the thick puncture needle, the puncture sleeve, and the fine puncture needle are aligned to form a flat inclined surface.

Preferably, the end seat of the second end of the fine puncture needle is used to connect a negative pressure suction device.

Preferably, a scale is formed on the outside of the thick puncture needle; a scale is formed on the outside of the puncture catheter.

Preferably, the end seat of the fine puncture needle and the end seat of the puncture sleeve are detachably combined together.

Preferably, the second side of the end seat of the puncture sleeve forms a recess; the first side of the end seat of the thin puncture needle forms a protrusion; the protrusion is clamped in the recess.

A method for deep tissue puncture of the present application, which is performed by using the above-mentioned triple trocar device;

Use the thick puncture needle to carry the puncture cannula and the fine puncture needle to puncture the shallow tissue, and a channel through the shallow tissue is recommended;

Under the condition of continuous negative pressure suction by the external syringe, further push the puncture sleeve and the fine puncture needle;

Use a fine puncture needle to carry the puncture cannula into the target deep tissue, and when the blood is drawn out, it indicates that the puncture cannula is in place; fix the thin puncture needle and push the puncture cannula directly without resistance, so that the puncture cannula further enters the target tissue;

Using the seldinger technique, the guide wire is used to exchange the fine puncture needle, and the sheath or drainage tube is inserted.

Preferably, the target deep tissue is the pericardial cavity or the subclavian vein.

The deep tissue puncture device and application method of the present application can reduce the damage of important tissues and organs when puncturing deep tissues, increase the sensitivity to deep tissues during puncture, and improve the success rate of puncture, thereby improving the clinical prognosis. Clinical practice, such as puncture and drainage of pericardial effusion and subclavian vein puncture and catheterization, has strong clinical application value.

Brief description of the drawings

Fig. 1 is a schematic cross-sectional structure diagram of each component of the triple trocar device for deep tissue puncture of the present application;

2 is a schematic diagram of the structure of the triple trocar device for deep tissue puncture when used for puncturing shallow tissue;

Fig. 3 is a schematic structural diagram of the triple trocar device for deep tissue puncture of the present application when it is used to puncture deep tissue;

Figure 4 is a schematic structural diagram of the triple trocar device for deep tissue puncture of the present application with the fine puncture needle being withdrawn;

Figure 5 is an anatomical diagram of the subclavian vein;

Figure 6 is a schematic diagram of pericardial effusion.

The best way to implement the invention

Hereinafter, the application will be described in detail with reference to the drawings.

A triple trocar device for deep tissue puncture of the present application includes: a thick puncture needle 10 puncture cannula 20 puncture needle 30.

The thick puncture needle 10 is formed in a tube shape, and the first end 11 thereof is formed as a tip including a bevel; the puncture sleeve 20 is formed in a tube shape, the first end 21 is formed as a tip including a bevel, and the second end is formed as an end seat 22; The fine puncture needle 30 is formed in a tubular shape, the first end 31 thereof is formed as a tip including a bevel, and the second end thereof is formed as an end seat 32.

The length of the puncture sleeve 20 and the thin puncture needle 30 is greater than the length of the thick puncture needle 10.

The puncture cannula 20 is inserted into the thick puncture needle 10, and the puncture cannula 20 and the thick puncture needle 10 are formed to be airtight; the gas tightness can be formed by close contact between the puncture cannula 20 and the thick puncture needle 10, for example, The outer diameter of the puncture sleeve 20 is equal to the inner diameter of the thick puncture needle 10, or a sealing ring or gasket is arranged between the puncture sleeve 20 and the thick puncture needle 10.

The fine puncture needle 30 is inserted into the puncture sleeve 20, and the thin puncture needle 30 and the puncture sleeve 20 are formed to be airtight; the airtightness can be formed by close contact between the fine puncture needle 30 and the puncture sleeve 20, for example, The inner diameter of the puncture sleeve 20 is equal to the outer diameter of the thin puncture needle 30, or a sealing ring or gasket is arranged between the puncture sleeve 20 and the thin puncture needle 30.

During the puncture process, when puncturing shallow tissues, the tips of the thick puncture needle 10, puncture sleeve 20, and fine puncture needle 30 are aligned and pass through the shallow tissue together; when deep tissue puncture, the puncture sleeve 20 and the fine puncture needle 30 extends from the first end of the thick puncture needle 10, pierces the deep tissue together, and then exits the fine puncture needle, and establishes a channel in the deep tissue and outside the subject's body through the puncture sleeve.

The bevels of the

tips

11, 21, and 31 of the thick puncture needle, puncture sleeve, and fine puncture needle are aligned to form a flat bevel to facilitate the puncture of shallow tissues.

The end seat 32 at the second end of the fine puncture needle 30 is used to connect a negative pressure suction device, such as a syringe. The end seat 32 can form a socket 33 for connecting the nipple of the syringe.

The second end of the thick puncture needle may also be formed with an end seat 12 to facilitate the operation of the thick puncture needle 10, for example, by holding the end seat 12 to push the thick puncture needle to carry the puncture sleeve and the fine puncture needle to puncture the front tissue.

A scale is formed on the outer side of the thick puncture needle 10 to facilitate the judgment of the depth of the thick puncture needle; a scale is formed on the outer side of the puncture catheter 20 to facilitate the judgment of the depth of the puncture cannula.

The end block 32 of the fine puncture needle and the end 22 block of the puncture sleeve are detachably combined together. The second side of the end seat 22 of the puncture sleeve 20 forms a recess 23; the first side of the end seat 32 of the thin puncture needle 30 forms a protrusion; the protrusion is caught in the recess 23.

Use a fine puncture needle to carry the puncture cannula into the target tissue, such as the pericardial cavity or subclavian vein. When the blood is drawn out, the puncture cannula is in place; the thin puncture needle is fixed and the puncture cannula is directly pushed without resistance to make the puncture cannula further Enter the target organization;

Example 1: Puncture the subclavian vein

1. The patient is in the supine position, the pillow is removed, and the drape is routinely disinfected. The puncture cannula and the fine puncture needle are carried with a thick puncture needle, keeping the tip level, and puncture the superficial subclavian tissue at the middle and outer 1/3 of the right clavicle. Use the tip of the thick puncture needle to the clavicle, and then create a channel through the superficial tissue in the suture under the clavicle to control the depth of the needle, and fix the thick puncture needle before puncturing the subclavian vein.

2. Under the condition of continuous negative pressure suction by the external syringe, the puncture sleeve and the fine puncture needle are further pushed, and the needle depth is controlled by the scale on the surface of the puncture sleeve. Use the fine puncture needle to carry the puncture cannula into the subclavian vein, and draw out the blood return, indicating that the puncture cannula is in place, fix the thin puncture needle, and directly push the puncture cannula without resistance, prompting the puncture cannula to accurately enter the target position, which can be appropriate Go deeper to avoid falling off.

3. Then withdraw the fine puncture needle, pass through the puncture cannula, and then use the seldinger technique to exchange the guide wire, and insert the sheath or drainage tube.

Example 2: Puncture of pericardial effusion

1. Patients with acute pericardial tamponade or patients with chronic massive pericardial effusion, take the supine position, routinely sterilize the drape, carry the puncture cannula and fine puncture needle with a thick puncture needle, keep the tip level, under the xiphoid process or the apex of the heart To puncture the shallow tissues of the chest wall, first use a thick puncture needle to establish a passage through the shallow tissues of the chest wall, control the depth of the needle, and fix the thick puncture needle before puncturing the pericardium.

2. Under the condition of continuous negative pressure suction by the external syringe, the puncture sleeve and the fine puncture needle are further pushed, and the needle depth is controlled by the scale on the surface of the puncture sleeve. Use a fine puncture needle to carry the puncture cannula into the pericardium, draw out the blood return, prompting that the puncture cannula is in place, fix the thin puncture needle, and directly push the puncture cannula without resistance, prompting the puncture cannula to accurately enter the target position, and you can go deeper Avoid falling off.

3. The fine puncture needle only needs to pass through the parietal pericardium, the resistance is small, the blood can be drawn back, and the force of the needle is better controlled. When the fine puncture needle touches the wall of the chamber, because the wall has a certain thickness and contracts and relaxes continuously, the risk of penetrating the wall of the chamber with limited needle insertion force is greatly reduced, making the operation safer.

4 Then withdraw the fine puncture needle, pass through the puncture cannula, and then use the seldinger technique to exchange the guide wire, and insert the sheath or drainage tube.

Industrial applicability

Compared with the prior art, the present invention has the following advantages and effects:

1. Instead of relying on ultrasound guidance, but using the structural characteristics of the puncture needle itself, a fine puncture needle is used to carry the puncture cannula to puncture deep tissues. The sense of breakthrough is stronger than that of the thick puncture needle, and the puncture cannula is further pushed without resistance to verify that the cannula is located Targeting the cavity is the first crucial step to complete the puncture catheter placement. The full access of the puncture cannula into the target space such as the subclavian vein also reduces the failure of guidewire exchange. Optimize clinical operation and have good clinical translation value.

2. When puncturing the pericardium, the fine puncture needle only needs to pass through the parietal pericardium, and with less resistance, the blood can be drawn back, and the force of the needle is better controlled. When the fine puncture needle touches the wall of the chamber, because the wall has a certain thickness and contracts and relaxes continuously, the risk of penetrating the wall of the chamber with limited needle insertion force is greatly reduced, making the operation safer.

3. Use a thick puncture needle to guide and penetrate shallow tissues, such as the chest wall or subclavian area, and build a channel in the middle of the surrounding bony structures, which is more stable than the whole plastic sleeve, and significantly reduces the puncture sleeve The possibility of tube shifting or falling off increases the success rate of puncture.

4. Use a fine puncture needle to carry the puncture cannula to puncture deep tissues, and the direct tissue damage is reduced, especially when multiple punctures, which is very important when puncturing the subclavian vein.

Claims

A triple trocar device for deep tissue puncture, which is characterized by comprising: a thick puncture needle, a puncture sleeve, and a fine puncture needle;

The thick puncture needle is formed in a tube shape, and the first end of the thick puncture needle is formed as a tip including a bevel;

The puncture sleeve is formed in a tube shape, the first end of which is formed as a tip including a bevel, and the second end of which is formed as an end seat;

The fine puncture needle is formed in a tube shape, the first end of which is formed as a tip including a bevel, and the second end of which is formed as an end seat;

The length of the puncture sleeve and the thin puncture needle is greater than the length of the thick puncture needle;

The puncture cannula is inserted into the thick puncture needle, and the puncture cannula and the thick puncture needle are formed to be airtight; the fine puncture needle is inserted into the puncture cannula, and the thin puncture needle and the puncture cannula are formed to be airtight; During the puncture process, when puncturing shallow tissue, the tips of the thick puncture needle, puncture sleeve, and fine puncture needle are aligned; when puncturing deep tissue, the puncture sleeve and fine puncture needle extend from the first end of the thick puncture needle. They pierce the deep tissue together, then withdraw the fine puncture needle, and establish a channel between the deep tissue and the subject’s body through the puncture cannula.
The triple trocar device for deep tissue puncture according to claim 1, characterized in that:

The inclined surfaces of the tips of the thick puncture needle, the puncture sleeve, and the fine puncture needle are aligned to form a flat inclined surface.
The triple trocar device for deep tissue puncture according to claim 1, characterized in that:

The end seat at the second end of the fine puncture needle is used to connect a negative pressure suction device.
The triple trocar device for deep tissue puncture according to claim 1, characterized in that:

A scale is formed on the outside of the thick puncture needle; a scale is formed on the outside of the puncture sleeve.
The triple trocar device for deep tissue puncture according to claim 1, characterized in that:

The end seat of the fine puncture needle and the end seat of the puncture sleeve are detachably combined together.
The triple trocar device for deep tissue puncture according to claim 5, characterized in that:

The second side of the end seat of the puncture sleeve forms a recess; the first side of the end seat of the fine puncture needle forms a protrusion; the protrusion is clamped in the recess.
A method for deep tissue puncture, which is performed by using the triple trocar device according to any one of claims 1-6;

Use the thick puncture needle to carry the puncture cannula and the fine puncture needle to puncture the shallow tissue, and a channel through the shallow tissue is recommended;

Under the condition of continuous negative pressure suction from the external syringe, the puncture cannula and fine puncture needle are further pushed; the puncture cannula is carried by the thin puncture needle into the target deep tissue, and the blood return indicates that the puncture cannula is in place; the thin puncture needle is fixed without resistance Push the puncture cannula directly below, so that the puncture cannula further enters the target tissue;

Using the seldinger technique, the guide wire is used to exchange the fine puncture needle, and the sheath or drainage tube is inserted.
The method for deep tissue puncture according to claim 1, wherein:

The target deep tissue is the pericardial cavity or the subclavian vein.