JP5018522B2 - Method for preparing insertion of indwelling catheter kit for fistula and indwelling catheter kit for fistula - Google Patents

Description

  The present invention relates to a fistula indwelling catheter kit and a method for preparing insertion of a fistula indwelling catheter kit.

  As a method of administering nutrition to a patient who cannot take nutrients orally, generally, intravenous nutrition administration, gavage administration by inserting a feeding tube nasally into the stomach or intestine, and gastrostomy There are three methods of administration for enteral nutrition. In recent years, enteral nutrition and administration thereof have been frequently used for enteral nutrition management by percutaneous endoscopic gastrostomy (PEG). In order to carry out this PEG, a fistula catheter kit including an indwelling catheter is used.

  As a fistula catheter kit, a method has been devised in which a gastric extension is extended and inserted into or removed from the body using a rod-like extender (see, for example, Patent Document 1).

JP 2005-31725 A

  The present invention provides an indwelling device for fistula that can shorten the treatment time and reduce the pain felt by the patient because the indwelling catheter can be safely and easily inserted and placed into the internal organs of the patient via the fistula. An object of the present invention is to provide a method for preparing insertion of a catheter kit and an indwelling catheter kit for fistula.

Such an object is achieved by the present inventions (1) to (7) below.
(1) A fistula indwelling catheter kit for percutaneously inserting an indwelling catheter into a body organ of a patient,
An indwelling catheter having a replenishment route portion having a lumen for replenishing a liquid substance, and an indwelling portion with an abutment portion attached to the inside of the distal end portion;
An abutment part that abuts the abutment part attached to the indwelling catheter at the distal end part and an obturator having a diameter expanding means near the distal end part,
An indwelling catheter kit for fistula, characterized in that an engaging portion that engages with the diameter expanding means of the obturator is attached to the lumen of the replenishment route portion in the vicinity of the indwelling portion of the indwelling catheter.
(2) The indwelling catheter kit for fistula according to (1), which has a plurality of diameter-expanding members that can be expanded at the distal end of the diameter-expanding means.
(3) The obturator further includes a push rod having a first guide wire insertion passage that allows the guide wire to be inserted and removed over the entire length, and an operation portion attached to the push rod base end portion. The indwelling catheter kit for fistula according to (1) or (2).
(4) Any one of (1) to (3), wherein the push rod is inserted into and removed from the indwelling catheter and has a holding portion that keeps the diameter-expanding means from expanding on the distal end side. An indwelling catheter kit for fistula according to 1.
(5) The operation unit is attached between a handle member that manually pushes the pushing bar, a holding member that can hold the pushed bar in a pushed state, and the handle member and the holding member. The indwelling catheter kit for fistula according to any one of (1) to (4).
(6) The indwelling catheter for fistula according to (1) having a second guide wire insertion passage that allows a guide wire to be inserted and removed in the vicinity of the distal end of the indwelling portion of the indwelling catheter.
(7) A fistula indwelling catheter kit insertion preparation method in which the indwelling catheter is inserted percutaneously into a body organ of a patient using the fistula indwelling catheter kit according to any one of (1) to (6). There,
Operation step 1 of inserting the obturator from the supply route proximal end of the indwelling catheter;
An operation step 2 for engaging the enlarged portion of the obturator with the engaging portion of the indwelling catheter by pushing the handle member and moving the push rod forward, and
The indwelling portion of the indwelling catheter is extended by further advancing the pushing bar, and the abutting member attached to the distal end portion of the obturator is brought into contact with the abutting portion attached in the indwelling catheter. Operation step 3 for reducing the bulk of the indwelling part;
A method for preparing for insertion of an indwelling catheter kit for fistula, comprising:

  According to the present invention, the indwelling catheter can be safely and easily inserted and indwelled into the internal organs of the patient via the fistula, so that the treatment time can be shortened and the pain felt by the patient can be reduced. It is possible to provide a preparation method for insertion of an indwelling catheter kit and a fistula indwelling catheter kit.

Next, a fistula indwelling catheter kit according to a preferred embodiment of the present invention will be described with reference to FIGS.
1 is a schematic view of an indwelling catheter and an obturator constituting an indwelling catheter kit for a fistula in a free state, FIG. 2 is a perspective view of the indwelling catheter, FIG. 3 is a longitudinal sectional view of the indwelling catheter, and FIG. Fig. 5 is a schematic view of an indwelling catheter kit for fistula with the indwelling portion extended, Fig. 5 is an enlarged perspective view of the structure in which the holding member of the operation portion of the obturator and the handle member are engaged, and Fig. 6 is an assembly of the obturator on the indwelling catheter. FIG. 7 is an enlarged sectional view of the engaging portion in a state where the enlarged portion of the obturator is engaged with the engaging portion of the indwelling catheter. FIG. 8 is an enlarged cross-sectional view of the engaging portion in a state in which the indwelling portion is extended by engaging the enlarged portion of the obturator with the engaging portion of the indwelling catheter.

As shown in FIG. 1, a fistula indwelling catheter kit 50 according to a preferred embodiment includes an indwelling catheter 10 and an obturator 20, and supplies nutrients, chemicals, and the like percutaneously to a body organ from outside the body. Is.
The indwelling catheter 10 is preferably formed of an elastic material, and has a supply route portion 11 having a lumen for supplying a liquid substance such as a nutrient or a chemical solution from outside the body to the internal organs.
As shown in FIG. 2, an indwelling portion 12 having an abutment portion 14 is provided inside the distal end portion of the indwelling catheter 10. An extracorporeal fixing part 17 that can be removed can be attached to the extracorporeal part of the supply route part 11 so that the supply route part 11 is not buried in the stomach.

  As shown in FIG. 3, an engaging portion 13 that engages with the enlarged diameter portion 24 of the obturator 20 is attached to the lumen of the supply route portion 11 in the vicinity of the indwelling portion 12 of the indwelling catheter 10. The engaging portion 13 may be formed integrally with the supply route portion 11 or may be provided as a separate part. When the engaging portion 13 is provided as a separate part, it is desirable that the engaging portion 13 be formed of a hard material such as metal or hard resin, and can be attached to the supply route portion 11 by adhesion, insert molding, or the like.

The in-vivo indwelling portion 12 has a bulky shape as shown in FIG. 3, but is inserted in an extended state from the outside of the body into the patient's organ as described later, and the in-dwelling catheter is outside the body in the patient's organ. It is necessary to return to a bulky shape so as not to be removed. For this purpose, the indwelling portion 12 is preferably made of an elastically deformable material.
Examples of the material for the indwelling portion 12 include polyurethane resin, silicone rubber, and the like. Silicone rubber that has extensibility and less tissue reactivity in the body can be preferably used. By using an extensible material, the indwelling portion 12 in the free state becomes a bulky state that is expanded radially outward of the replenishment route portion 11, and the bulk is increased when it is stretched by the action of an external force by the obturator 20. It will be reduced and it will be in the state which can be inserted in a body organ (FIG. 4).

The body indwelling portion 12 preferably has a shape that can prevent the indwelling catheter 10 from being pulled out of the body in a free state. Not limited. For example, a malecot shape as shown in FIG. 2 can be considered.
Further, as shown in FIG. 3, it is desirable that the indwelling portion 12 has a flat shape in which the diameter a in the radial direction of the supply route portion 11 is larger than the length b in the axial direction of the supply route portion 11. Thereby, in the state in which the indwelling catheter 10 was indwelled inside a patient's organ, irritation | stimulation in a patient's organ can be made small and extraction prevention property can be improved.

There is an abutting portion 14 inside the distal end portion of the indwelling catheter 10. With the abutting portion 14, the indwelling catheter 10 can be pushed inside the organ while the abutting portion 29 of the obturator 20 is abutted.
The abutment portion 14 is preferably provided with a second guide wire insertion passage 15 that is concentric with the first guide wire insertion passage 23 of the obturator 20 and serves to communicate between the outside of the body and the organ. Thus, if a guide wire 40 described later is passed through the second guide wire insertion passage 15 and the first guide wire insertion passage 23, the assembly of the indwelling catheter 10 and obturator 20 is guided by the guide wire 40 and the fistula 33 is inserted. Then, it can be reliably inserted from outside the body into the organ. (FIGS. 6 to 8)

The abutting portion 14 is preferably reinforced by a reinforcing member 16. Even if an external force is applied to the indwelling portion 12 by the obturator 20, the obturator 20 does not break through the tip of the indwelling portion 12, and the bulk of the indwelling portion 12 is maintained to be reduced and into the organ. Easy and reliable insertion.
The reinforcing member 16 has a function of communicating between the outside of the body and the inside of the organ by making the second guide wire insertion passage 15 attached to the indwelling portion 12 and the first guide wire insertion passage 23 of the obturator 20 concentric. The shape, material, and the like are not particularly limited as long as they do not hinder the material, but for example, those formed of a material such as a metal or a thermosetting resin are preferable.

The obturator 20 is detachably engaged with the replenishment route portion 11 and has an outer diameter smaller than the inner diameter of the replenishment route portion 11 and does not excessively extend the replenishment route portion 11. It is preferable to have a length that allows the acting force to be concentrated on the indwelling portion 12.
The obturator 20 has a pushing bar 21 for transmitting an external force to the indwelling part 12 and a little more than the outer diameter of the pushing bar 21, in addition to the abutting part 29 attached to the tip part and the enlarged diameter part 24 in the vicinity of the tip part. It is preferable to have a cylindrical outer cylinder 28 having a large inner diameter, and an operation portion 22 at the proximal end portion of the pushing bar 21 and the outer cylinder 28.

The pushing rod 21 has an operation portion 22 at the base end portion, and a contact portion 29 that abuts against the abutting portion 14 of the indwelling portion 12 at the distal end portion of the pushing rod material 21. The abutting portion 29 may be formed integrally with the push bar 21 or attached as a separate part. Further, the push rod 21 has a first guide wire insertion passage 23 that allows the guide wire 40 to be inserted and removed, and the first guide wire 40 is inserted through the operation portion 22 and the contact portion 29 as appropriate. An insertion path 23 can be provided.
Since the guide wire can be inserted into the fistula indwelling catheter kit, accidents such as erroneous insertion can be achieved by performing insertion / removal operations along the guide wire previously inserted when inserting / removing the indwelling catheter. It does not occur and the burden on patients and surgeons can be reduced.

  The outer cylinder 28 is slidably provided so as to house the pushing bar 21, and has an operation portion 22 at the proximal end portion of the outer cylinder 28 and a diameter-expanded portion 24 at the distal end portion. The enlarged diameter portion 24 may be formed integrally with the outer cylinder 28 or may be attached as a separate part.

  The operation unit 22 can be configured by a handle member 25 that pushes the push bar 21 by hand and moves forward, and a holding member 26 that can hold the pushed bar 21 in a pushed state. The holding member 26 can also hold the pushed-in bar 21 in a pressed state by being able to engage with the pushed-in bar 21 or the handle member 23. For example, by providing the holding member 26 with a projection and providing the handle member 25 with a recess that engages with the projection of the holding member 26, the pushed-in bar 21 can be held in a pressed state (FIG. 5). It is preferable to attach a spring material 27 between the handle member 25 and the holding member 26. By doing so, it is possible to prevent the push rod 21 from being pushed in the free state of the obturator 20, and it is possible to keep the enlarged diameter portion 24 in a state where the diameter is not enlarged. (Figure 1)

  In the free state where the obturator 20 is not acting, the diameter-expanded portion 24 is not expanded due to the presence of the small-diameter portion at the tip end portion of the pushing bar 21. (FIG. 6) It is preferable that the outer diameter of the enlarged diameter portion 24 is slightly smaller than the inner diameter of the replenishment route portion 11 of the indwelling catheter 10. When the push-in bar 21 is pushed in, the diameter-expanded portion 24 is expanded by the large-diameter portion of the push-in bar 21 and can be engaged with the engaging portion 13 attached to the indwelling catheter 10 (FIG. 7). Further, by pushing in the pushing bar 21, the replenishment route portion 11 is not excessively pushed and stretched, and the acting force by the obturator 20 is concentrated on the indwelling portion 12 so that only the indwelling portion 12 is extended. Yes (Fig. 8).

  In the obturator 20, it is preferable that the pushing bar 21 is a hard and strong material. Examples of the material of the push bar 21 include metal and hard resin, but metal is more preferable because it is thin and can have high strength. Although the connection method of the contact part 29 and the pushing bar | burr 21 is not specifically limited, Fitting, adhesion | attachment, insert molding, integral molding, etc. can be used. Moreover, the connection method of the operation part 22 and the pushing bar | burr 21 is not specifically limited, However, Fitting, adhesion | attachment, insert molding, integral molding, etc. can be used.

  In the obturator 20, the contact portion 29 is preferably made of, for example, a resin, a metal, a rubber material having high hardness, or the like. In order to effectively push in the abutting portion 14 so that the indwelling portion 12 can be reduced in bulk, it is more preferable that the resin has a moderate hardness and good workability.

  In the obturator 20, the operation unit 22 is preferably made of, for example, resin, metal, or a high-grade rubber material. Considering operability, it may be a complicated shape and high strength may be required, and therefore, a resin having strength and good workability is more preferable. Moreover, you may cover a part of operation part with soft materials, such as a rubber material.

The outer cylinder 28 used in the obturator 20 is preferably a hard and strong material such as metal or hard resin, and more preferably a metal because it is thin and can have high strength.
The enlarged diameter portion 24 at the tip of the outer cylinder 28 is preferably, for example, a metal or a hard resin. Although the connection method of the enlarged diameter part 24 and the outer cylinder 28 is not specifically limited, Fitting, adhesion | attachment, insert molding, integral molding, etc. can be used.

  As the spring material 27 attached between the handle member 25 and the holding member 26 of the operation unit 22, for example, a rubber material such as a metal material having elasticity or an elastomer can be suitably used.

  Next, the insertion preparation method of the indwelling fistula catheter kit of the present invention will be described.

  In the pre-insertion step of the fistula indwelling catheter kit 50 into the organ, the catheter currently placed under the endoscope is removed. At the time of this removal, the guide wire 40 is placed in advance through the fistula 33 and into the organ.

  The method for preparing for insertion of the indwelling catheter kit 50 for fistula according to the present invention includes an operation step 1 in which the obturator 20 is inserted from the proximal end portion of the supply route portion 11 of the indwelling catheter 10. This step 1 may be performed at the stage of shipping as a product.

  Next, the guide wire 40 placed in the fistula is passed through the second guide wire insertion passage 15 attached to the indwelling portion 12, and the first guide provided in the contact portion 29, the push rod 21, and the operation portion 22. It passes through the wire insertion passage 23.

  In the insertion preparation method for the indwelling catheter kit 50 for fistula according to the present invention, when the guide wire 40 comes out from the proximal end portion of the push-in bar 21, as shown in FIG. The operation step 2 for engaging the enlarged diameter portion 24 of the obturator 20 with the engaging portion 13 of the indwelling catheter 10 by moving the catheter forward.

  In the insertion preparation method for the fistula indwelling catheter kit 50 of the present invention, the pushing rod 21 is further advanced, and the abutting portion 29 attached to the distal end portion of the obturator 20 is attached to the indwelling catheter 10. 14, the indwelling portion 12 of the indwelling catheter 10 extends to be in contact, and has an operation step 3 for reducing the bulk of the indwelling portion 12 (FIG. 8).

  The above is the description of the insertion preparation method for the fistula indwelling catheter kit of the present invention. Next, a method for inserting the fistula indwelling catheter kit 50 into the organ percutaneously will be described.

The above operation step 3 is performed, and the assembly of the indwelling catheter 10 and the obturator 20 including the indwelling portion 12 whose bulk is reduced from the free state is inserted into the organ along the guide wire 40.
Next, the indwelling part 12 is inserted into the internal organ 32 through the fistula 33 by the guide wire 40. After confirming that it has been inserted into the organ under an endoscope, the operating state of the operating portion 22 of the 21 obturator 20 is released by pulling the push rod outward from the body, and the obturator 20 is brought into a free state. By removing the obturator 20 from the indwelling catheter 10, the indwelling catheter 10 is also restored to a free state, and the removal preventing function of the indwelling portion 12 is also restored.

  Next, if necessary, installation of the extracorporeal fixing plate 15 and connection of a connector or the like to the proximal end portion of the supply route portion 11 are performed.

The above mainly describes the preparation method for inserting the fistula indwelling catheter kit and the fistula indwelling catheter kit of the present invention. However, the catheter can be applied to the fistula indwelling catheter kit of the present invention already indwelling. Thus, the catheter can be removed safely and reliably using the indwelling catheter kit for fistula of the present invention.
As a method, the obturator used in the indwelling catheter kit for fistula of the present invention is inserted into the lumen of the indwelling catheter along the guide wire, and the indwelling portion is extended and removed by the above-described method to reduce the bulk. can do.

  According to the fistula indwelling catheter kit and the fistula indwelling catheter kit insertion preparation method according to the preferred embodiment of the present invention, the enlarged diameter portion 24 of the obturator 20 is attached in the vicinity of the indwelling portion 12 of the indwelling catheter 10. By engaging the joint portion 13 and pushing the obturator 20, the replenishment route portion 11 is not excessively stretched and the acting force by the obturator 20 is concentrated on the indwelling portion 12 only. Can be extended, and the bulk can be reduced efficiently. In addition, the assembly of the indwelling catheter 10 and obturator 20 can be reliably inserted into the organ from the outside of the body through the fistula by guiding the guide wire.

It is the schematic of the indwelling catheter and obturator which comprise the indwelling catheter for fistula in the free state of this example. It is a perspective view of the indwelling catheter of FIG. It is a longitudinal cross-sectional view of the indwelling catheter of FIG. It is the schematic of the indwelling catheter kit for fistulas which inserted the obturator in the indwelling catheter and extended the indwelling part. It is an expansion perspective view of the structure where a holding member and a handle member of an operation part of an obturator are hooked. FIG. 6 is an enlarged cross-sectional view of the engaging portion in a state where the inflated catheter is combined with the obturator and the expanded diameter portion is not expanded. It is an expanded sectional view of the engaging part in the state where the diameter expanding means of the obturator is engaged with the engaging part of the indwelling catheter. It is an expanded sectional view of the engaging part of the state which engaged and expanded the diameter expanding means of the obturator with the engaging part of the indwelling catheter.

Explanation of symbols

DESCRIPTION OF SYMBOLS 10 Indwelling catheter 11 Supply route part 12 In-body indwelling part 13 Engagement part 14 Abutting part 15 2nd guide wire insertion path 16 Reinforcement member 17 Extracorporeal fixing part 20 Obturator 21 Pushing rod 22 Operation part 23 1st guide wire insertion Passage 24 Expanded portion 25 Handle member 26 Holding member 27 Spring material 28 Outer cylinder 29 Contact portion 31 Outside the body 32 Inside the organ 33 Fistula 40 Guide wire 50 Indwelling catheter kit for fistula

Claims (7)

A fistula indwelling catheter kit for inserting an indwelling catheter into a patient's body organ via a fistula,
An indwelling catheter having a replenishment route portion having a lumen for replenishing a liquid substance, and an indwelling portion with an abutment portion attached to the inside of the distal end portion;
An abutment part that abuts the abutment part attached to the indwelling catheter at the distal end part and an obturator having a diameter expanding means in the vicinity of the distal end part,
An indwelling catheter kit for fistula, characterized in that an engaging portion that engages with the diameter expanding means of the obturator is attached to the lumen of the replenishment route portion in the vicinity of the indwelling portion of the indwelling catheter.   The indwelling catheter for fistula according to claim 1, wherein the distal end portion of the diameter expanding means has a plurality of diameter expanding members capable of expanding.   The obturator further includes a push rod having a first guide wire insertion passage that allows the guide wire to be inserted and removed over its entire length, and an operation portion attached to the proximal end of the push rod. The indwelling catheter kit for fistula according to claim 1 or 2.   The fistula bar according to any one of claims 1 to 3, wherein the push bar is inserted into and removed from the indwelling catheter so as to be freely inserted and removed, and has a holding portion that keeps the diameter-expanding means from expanding on the distal end side. Indwelling catheter kit.   The operating section includes a handle member that manually pushes the pushing bar, a holding member that can hold the pushed bar, and a spring material that is attached between the handle member and the holding member. The indwelling catheter kit for fistula according to any one of claims 1 to 4.   The indwelling catheter for fistula according to claim 1, further comprising a second guide wire insertion passage that allows a guide wire to be inserted and removed in the vicinity of a distal end of the indwelling portion of the indwelling catheter. A fistula indwelling catheter kit insertion preparation method for inserting the indwelling catheter into a patient's body organ using a fistula using the fistula indwelling catheter kit according to claim 1,
Operation step 1 of inserting the obturator from the supply route proximal end of the indwelling catheter;
An operation step 2 for engaging the enlarged portion of the obturator with the engaging portion of the indwelling catheter by pushing the handle member and moving the push rod forward, and
The indwelling portion of the indwelling catheter is extended by further advancing the pushing bar, and the abutting member attached to the distal end portion of the obturator is brought into contact with the abutting portion attached in the indwelling catheter. Operation step 3 for reducing the bulk of the indwelling part;
A method for preparing for insertion of an indwelling catheter kit for fistula, comprising:

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