JP5976752B2 - Indwelling catheter exchange device - Google Patents

Description

  The present invention relates to an instrument used when exchanging an indwelling catheter placed in a body cavity such as a stomach or a bladder.

  As an instrument used for this kind of indwelling catheter, what was indicated by the following patent documents 1, for example is known. Patent Document 1 discloses an auxiliary tool for removing a fistula catheter provided with a bumper formed at a distal end portion of a tube having a larger diameter than an outer diameter of the tube as a body cavity fixing portion. The extraction assisting tool includes a cylindrical member having an inner diameter substantially the same as the outer diameter of the tube. The tube is inserted into the cylindrical member from the rear end portion, and the cylindrical member is inserted into the fistula in this state. The tip is inserted into the body cavity. By pulling the tube rearward from this state, the bumper can be deformed and pulled into the cylindrical member, and the bumper can be pulled out from the cylindrical member.

  However, in order to draw a bumper having a diameter larger than the outer diameter of the tube into a cylindrical member having an inner diameter substantially the same as the outer diameter of the tube, there is a disadvantage that a strong force is actually required.

  In particular, when the body cavity is the stomach, the bumper is deteriorated and hardened by stomach acid, so that a very strong force is required to draw the bumper into the cylindrical member. Also, in this case, when the surgeon tries to pull the bumper into the cylindrical member and pulls the tube strongly against the cylindrical member, the bumper that has deteriorated and become brittle due to gastric acid as described above comes off from the distal end of the tube. May fall into the body cavity.

  In addition, when the tube is pulled strongly, the cylindrical member must be pressed with a strong force. However, if a strong force is applied to the cylindrical member, the cylindrical member may move in the axial or radial direction of the fistula and cause pain to the patient. There is also.

  Therefore, in Patent Document 1, a plurality of slits are formed in the distal end portion of the cylindrical member along the length direction of the cylindrical member, the cylindrical member is formed between the slits, and the outer peripheral side of the cylindrical member A removal assisting tool in which an outer cylinder member is disposed is disclosed. The cylindrical member is slidable along the inner peripheral surface of the outer cylinder member, the cylindrical member is formed to be elastically deformable, and a tip end portion of the cylindrical member is separated from a tip end portion of the outer cylinder member. When projecting, the inner cylindrical member expands in the outer peripheral direction.

  According to the removal assisting tool, when the cylindrical member is inserted into the fistula and the distal end portion is inserted into the body cavity, the cylindrical member is slid along the inner peripheral surface of the outer cylindrical member, and the cylindrical member When the front end portion of the inner cylinder member is projected from the front end portion of the outer cylinder member, the cylindrical member expands in the outer peripheral direction of the inner cylinder member. When the tube is pulled backward from this state, the bumper is guided and deformed by the inclination of the cylindrical member, so that it can be easily pulled into the cylindrical member with a weak force.

  However, in the removal assisting tool provided with the cylindrical member, when the bumper is pulled into the cylindrical member, if the cylindrical member breaks, there is an inconvenience that fragments of the cylindrical member fall into the body cavity.

  Further, according to paragraph 0034, it is described that the removal assisting device described in Patent Document 1 is also used when replacing a gastrostomy catheter. The procedure involves removing the gastrostomy catheter with the gastrostomy catheter when removing the gastrostomy catheter, and inserting the replacement gastrostomy catheter into the fistula with the bumper inserted in the assisting device. It is inserted into the fistula together with the tool, and then the bumper is pushed out from the auxiliary tool, and the auxiliary tool is pulled out from the fistula.

  However, in the above method, since the assisting device is once removed from the fistula, if an attempt is made to insert the gastrostomy catheter into the stomach again, the assisting device can be easily inserted into the fistula on the body surface. And the fistula provided in the stomach wall may be misaligned, and it is difficult to insert the gastrostomy catheter into the stomach again.

  Therefore, when the replacement gastrostomy catheter is inserted into the stomach using the assisting device described in Patent Document 1, it is necessary to guide the gastrostomy catheter with a guide wire or the like as in the prior art, and the guide wire is inserted into the fistula. In addition, there is a risk of placing a burden on the patient because it is necessary to insert the assisting tool while expanding the shrinking fistula when inserting the assisting tool into the fistula along the guide wire. is there.

JP 2005-168980 A, paragraphs 0018, 0019, 0028, 0029, 0034, FIG. 5, FIG. 9, FIG.

  An object of this invention is to improve the instrument used when exchanging the indwelling catheter indwelled in a body cavity. More specifically, the present invention can securely house the body cavity fixing portion with a weak force and pull it out of the fistula without any trouble, and ensure that the member falls into the body cavity even when the member breaks. An object of the present invention is to provide an indwelling catheter exchange device that can be prevented.

  Another object of the present invention is to provide an indwelling catheter exchanging device that facilitates work when the indwelling catheter for replacement is attached to a patient.

In order to achieve the above object, an indwelling catheter exchanging device of the present invention includes a flexible tube having a distal end inserted into a body cavity through a fistula, and a tube provided in the distal end of the tube from inside the body cavity. An indwelling catheter having a flexible body cavity fixing part that regulates the withdrawal of the body is removed from the body cavity, and is an exchange device for mounting the replacement indwelling catheter on the patient, and is inserted into the fistula An outer cylinder, and an inner cylinder at least a part of which is inserted into the outer cylinder and into which the tube and the body cavity fixing portion can be inserted. The inner cylinder is formed of a flexible member, a cylindrical which is inserted into the outer cylinder, a slit which extends to the inner tube distal the base end side along the length of the is formed, the outer cylinder is expanded outward of the inner cylinder Made of an elastic member that suppresses the outer cylinder A folding portion that is folded back from the tip into the outer cylinder; and the folding portion is positioned on the inner peripheral surface of the inner cylinder from the tip of the inner cylinder when the inner cylinder is inserted. And

  According to the indwelling catheter replacement device of the present invention, the proximal end portion of the tube is inserted from the distal end portion of the outer tube and the inner tube, and the outer tube and the inner tube are inserted into the body cavity along the tube. In this state, when the tube is pulled backward, the body cavity fixing portion is pressed against the distal end portion of the inner cylinder. At this time, since the inner cylinder is made of a flexible member and a slit is formed from the distal end portion to the large diameter portion, the distal end portion of the inner cylinder extends along the outer shape of the body cavity fixing portion. Deploy in the outer circumferential direction of the tube. Further, at this time, the body cavity fixing portion is guided and deformed by the inner surface shape of the inner cylinder. Therefore, the body cavity fixing portion can be pulled into the inner cylinder with a weak force.

  In the indwelling catheter replacement device of the present invention, the outer cylinder includes a folded portion that is folded back from the tip of the inner cylinder to the inner peripheral surface of the inner cylinder, so that the inner cylinder is inserted into the fistula. At this time, turning of the outer cylinder to the outside is prevented. Further, when the body cavity fixing portion is pulled into the inner cylinder, it is possible to prevent the inner cylinder body from being bent to the inside of the distal end portion.

  Here, the inner cylinder is inserted into the outer cylinder, and since the outer cylinder is made of an elastic member, the distal end portion of the inner cylinder is restrained from being expanded outwardly by the elasticity of the outer cylinder, There is no excessive deployment. Then, when the body cavity fixing portion is completely drawn into the inner cylinder, the tip of the inner cylinder is narrowed by the elasticity of the outer cylinder, so that the body cavity fixing section is pulled into the inner cylinder. be able to.

  Next, when the operator pulls the tube of the indwelling catheter toward the near side with the outer cylinder and the inner cylinder inserted into the fistula, the indwelling catheter is removed from the fistula through the inside of the outer cylinder and the inner cylinder. At this time, since the inner cylinder is provided with slits, the inner cylinder is bent, so that the indwelling catheter can be easily removed from the fistula.

  Even if the inner cylinder is broken when the body cavity fixing part is pulled into the inner cylinder, the inner cylinder is not pressed out by the elasticity of the outer cylinder and falls off. Can be reliably prevented.

  In the indwelling catheter exchange device of the present invention, it is preferable that the inner cylinder includes a long hole portion formed in the slit along the length direction. According to this configuration, since the circumferential width of the inner cylinder is narrow at the portion where the elongated hole portion is provided, the inner cylinder is easily bent when the indwelling catheter is pulled out from the inner cylinder. Therefore, the indwelling catheter can be pulled out from the inner cylinder with a small force.

  Further, it is preferable that a cylindrical gripping member is detachably mounted on the base end side of the inner cylinder. According to this configuration, when the outer cylinder and the inner cylinder are inserted into the fistula through the tube, the operator can perform the treatment by grasping the grasping member. The outer cylinder and the inner cylinder can be inserted into the fistula.

  Moreover, since the said holding member is detachable with respect to the said inner cylinder, the length of the inner cylinder which penetrates an indwelling catheter can be shortened by removing the said holding member from the said inner cylinder. Therefore, after the indwelling catheter is removed, it is easy for the operator to insert the replacement indwelling catheter into the fistula.

  In the indwelling catheter replacement device of the present invention, the inner cylinder may be detachably attached to the outer cylinder. According to this configuration, after inserting the outer tube and the inner tube into the fistula and pulling out the indwelling catheter, only the outer tube can be placed in the fistula and the inner tube and the gripping member can be pulled out. A replacement indwelling catheter can be inserted into the fistula.

  Further, in the indwelling catheter exchange device of the present invention, the shaft is longer than the inner tube and can be inserted into the inner tube, and the engagement is provided at the distal end of the shaft and capable of locking the tube. A locking portion, the locking portion is inserted from the proximal end side of the inner cylinder and exposed from the distal end side, and the shaft portion is pulled in a state where a part of the tube is locked to the locking portion. It is preferable that a tube insertion tool for inserting the tube through the inner cylinder is further provided.

  According to the tube insertion tool, even when the difference between the inner diameter of the inner cylinder and the outer diameter of the tube is small, the tube can be easily inserted into the inner cylinder. In particular, it is suitable when the folded portion is provided in the outer cylinder and a tube needs to be inserted into the folded portion.

(A) is a side view which shows the structure of the indwelling catheter exchange instrument of this invention, (b) is the longitudinal cross-sectional view. The perspective view which shows the structure of an inner cylinder main body and a large diameter part. (A) is an exploded view of the exchange tool shown in FIG. 1 (a), and (b) is a longitudinal sectional view thereof. The perspective view which shows an example of a tube insertion tool. Explanatory drawing which shows the method of inserting a tube in an inner cylinder using a tube insertion tool. Explanatory sectional drawing which shows an example of the usage method of the exchange tool shown in FIG.

  Next, embodiments of the present invention will be described in more detail with reference to the accompanying drawings. As shown in FIGS. 1 to 3, the indwelling catheter replacement device 1 of this embodiment includes an outer cylinder 10 inserted into the fistula A and an inner cylinder 20 inserted into the outer cylinder 10.

  As shown in FIG. 4, a tube insertion tool 50 for inserting the tube 41 of the indwelling catheter 40 into the inner cylinder 20 is provided as an auxiliary tool for inserting the indwelling catheter 40 into the exchange device 1.

  The outer cylinder 10 includes an outer cylinder body 11 into which the distal end side of the inner cylinder 20 is inserted, and a folded portion 12 that is folded inside the inner cylinder 20. The outer cylinder body 11 and the folded portion 12 are integrally formed of an elastic member such as silicone rubber.

  The inner cylinder 20 has a cylindrical inner cylinder body 21 that is inserted into the outer cylinder 10, a large-diameter portion 22 that is provided at the proximal end of the inner cylinder body 21 and has a larger diameter than the inner cylinder body 21, and a large-diameter portion. And a cylindrical gripping member 23 to be attached to 22. The inner cylinder 20 is made of a flexible member such as ABS (acrylonitrile-butadiene-styrene copolymer resin), and the tube 41 of the indwelling catheter 40 can be inserted therein.

  The inner cylinder main body 21 is provided with four slits 24 (24a, 24b) in the length direction from the distal end edge toward the proximal end side. The slits 24 are formed at equal intervals in the circumferential direction of the inner cylinder 20. Further, among the four slits 24, the two slits 24a located on the left and right in FIG. 2 are formed with long holes 25 extending from the vicinity of the distal end portion of the inner cylinder main body 21 to the large diameter portion. In addition, a second elongated hole 26 is formed in the vicinity of the distal end portion of the inner cylinder main body 21 in the two slits 24b positioned vertically in FIG.

  The large-diameter portion 22 is a place where the gripping member 23 is detachably mounted, and has an outer diameter that is substantially the same as the inner diameter of the distal end portion of the gripping member 23. The grasping member 23 has a shape that is easy to grasp when the operator replaces the indwelling catheter 40.

  As shown in FIG. 4, the tube insertion tool 50 includes a shaft portion 51 that can be inserted into the inner cylinder 20, a ring-shaped locking portion 52 that is provided at the tip of the shaft portion 51 and can be inserted through the tube 41, and a shaft. And a handle portion 53 provided at the base end of the portion. In the present embodiment, the shaft portion 51, the locking portion 52, and the handle portion 53 are integrally formed of synthetic resin.

  Further, as shown in FIG. 5A, the tube insertion tool 50 is formed to be longer than the inner cylinder 20 (the inner cylinder main body 21, the large diameter portion 22, and the gripping member 23). When inserted inside, the handle portion 53 is exposed from the proximal end side of the gripping member 23, and the locking portion 52 is exposed from the distal end side of the inner cylinder 20.

  Next, a procedure for exchanging the indwelling catheter 40 using the extraction assisting tool 1 having the above configuration will be described with reference to FIG. The indwelling catheter exchange device 1 having the above-described configuration is used for removing the indwelling catheter 40 from the body cavity D and inserting the replacement indwelling catheter 40 as shown in FIGS. 6 (a) to 6 (e).

  FIG. 6 shows an example in which the fistula A is a gastric fistula provided in the stomach. The fistula (gastric fistula) A is formed through the abdominal wall B and the gastric wall C. In this case, the indwelling catheter 40 is a gastrostomy catheter, and includes a tube 41 and a saddle-like bumper (an intra-body-cavity fixing portion) 42 provided at the distal end of the tube 41, and a body cavity ( It is inserted into the inside (D) of the stomach and is prevented from coming off by a bumper 42 provided at the tip of the tube 41. Both the tube 41 and the bumper 42 are configured by members having flexibility.

  When exchanging the indwelling catheter 40, first, the tube 41 of the indwelling catheter 40 is inserted into the inner cylinder 20 of the exchange device 1. At this time, as shown in FIG. 5A, in the state where the inner cylinder 20 and the outer cylinder 10 are integrated, the locking portion 52 of the tube insertion tool 50 is connected to the proximal end of the gripping member 23 of the inner cylinder 20. It inserts from the side and protrudes outward from the tip portions of the inner cylinder 20 and the outer cylinder 10.

  In this state, the vicinity of the proximal end portion of the tube 41 is inserted into the ring-shaped locking portion 52. If the surgeon holds the handle portion 53 from this state and pulls it toward the near side (the base end direction of the inner cylinder 20), the tube 41 can be easily inserted into the inner cylinder 20 as shown in FIG. Can do.

  Next, as shown in FIG. 6A, the indwelling catheter exchange device 1 is advanced in the direction of the bumper 42. Then, as shown in FIG. 6B, the exchange device 1 is advanced until the large-diameter portion 22 of the inner cylinder 20 is positioned near the surface of the abdominal wall B.

  From this state, the surgeon grasps the grasping member 23 of the inner cylinder 20 and pulls the tube 41 toward the near side, whereby the bumper 42 is pulled into the vicinity of the distal end portion of the inner cylinder main body 21. At this time, a long hole 25 and a second long hole 26 are formed in the vicinity of the distal end portion of the inner cylinder main body 21, and a portion between them is narrowed. It can be deployed outward. Furthermore, since the periphery of the distal end portion of the inner cylinder main body 21 is suppressed by the outer cylinder 10, it does not spread outward more than necessary.

  Further, in the present embodiment, since the distal end portion of the inner cylinder main body 21 is located inside the folded portion 12 of the outer cylinder 10, the distal end portion of the inner cylinder main body 21 does not directly contact the bumper 42. Therefore, the tip of the inner cylinder main body 21 does not bite into the bumper 42 and bends inside the inner cylinder 20.

  Next, as shown in FIG. 6C, the surgeon holds the tube 41 while pulling the tube 41 while holding the grasping member 23, so that the indwelling catheter 40 is moved through the outer cylinder 10 and the inner cylinder 20. It can be extracted from the fistula A. Thus, since the indwelling catheter 40 can remove the bumper 42 from the fistula A without touching the patient's fistula A or other portions, the burden on the patient is reduced.

  At this time, since the inner cylinder main body 21 is narrowed by the provision of the long holes 25, the inner cylinder main body 21 can be forced to bulge outward along the shape of the bumper 42 by its flexibility. Can do. Moreover, since the outer peripheral surface of each inner cylinder main body 21 is covered with the outer cylinder main body 11, it is suppressed that the inner cylinder main body 21 is excessively spread due to the elasticity of the outer cylinder main body 11.

  Next, as shown in FIG. 6D, the operator removes the gripping member 23 from the large diameter portion 22 while pressing the large diameter portion 22 of the inner cylinder 20. In this embodiment, since the holding member 23 is detachably attached to the large diameter portion 22 of the inner cylinder 20, both can be easily separated.

  Next, as shown in FIG. 6 (e), the replacement indwelling catheter 40 is inserted into the body cavity D through the outer tube 10 placed in the fistula A and a part of the inner tube 20. Reference numeral 60 in FIG. 6E denotes an indwelling catheter insertion device. Since the detailed configuration of the insertion instrument 60 is described in Japanese Patent Application Laid-Open No. 2007-98123 by the applicant of the present application, detailed description thereof is omitted here.

  At this time, since the fistula A is protected by a part of the outer cylinder 10 and the inner cylinder 20, the fistula A is not blocked, and the fistula in the abdominal wall B and the fistula in the stomach wall C are not shifted. The indwelling catheter 40 can be reliably inserted into the body cavity D through the fistula A.

  That is, according to the above configuration, it is not necessary to use a guide wire, so that the indwelling catheter can be easily replaced. In addition, after the bumper 42 of the replacement indwelling catheter 40 is inserted into the body cavity D, the indwelling outer cylinder 10 and a part of the inner cylinder 20 are pulled out from the fistula A and discarded, and the normal treatment procedure is followed. The indwelling catheter 40 is fixed.

  In the above embodiment, as shown in FIG. 6 (d), after the outer cylinder 10 and the inner cylinder 20 are inserted into the fistula A, the grip member 23 is removed from the large-diameter portion 22 of the inner cylinder 20. However, the present invention is not limited thereto, and only the outer cylinder 10 may be left in the hole A and the entire inner cylinder 20 may be pulled out from the hole A. At this time, it is preferable to provide a flange on the outer periphery of the base end portion of the outer cylinder 10 so that the outer cylinder 10 is not buried in the hole A (not shown).

  Further, after the outer cylinder 10 and the inner cylinder 20 are inserted into the fistula A, the indwelling catheter 40 is inserted from the proximal end portion of the grasping member 23 of the inner cylinder 20 without removing the grasping member 23 from the large diameter portion 22 of the inner cylinder 20. May be inserted. In this case, the indwelling catheter insertion device 60 may be lengthened according to the length of the inner cylinder 20.

  The shape of the inner cylinder 20 is not limited to the above embodiment, and the shape and number of the slits 24, the long holes 25, and the second long holes 26 may be changed as appropriate. For example, the number of slits 24 may be 1 to 3 or other numbers. Further, the long hole 25 and the second long hole 26 may be omitted. The length of the slit 24 may be a length that reaches the large-diameter portion 22 as in the above embodiment, or may be a length up to the middle of the inner cylinder main body 21.

  In the above embodiment, a thin groove is provided on the surface or inner surface of the large-diameter portion 22 so as to connect to the long hole 25 from the base end portion, and the inner cylinder 20 is removed when the inner cylinder 20 is extracted from the bore A. It may be made to be able to be pulled out from the groove and separated (not shown).

  Moreover, in the said other embodiment, although the shaft part 51, the latching | locking part 52, and the handle | steering-wheel part 53 are integrally molded by the synthetic resin, the tube insertion tool 50 is not restricted to such a structure, A wire etc. It is good also as a structure with a member. Further, the shaft portion 51 does not have to be solid, and may have a hollow cylindrical shape. Further, the shaft portion 51 is provided with a ring-shaped handle portion 53. However, the shape is not limited to such a shape, and other shapes may be used, and the handle portion 53 is particularly provided with only the shaft portion 51 on the base end side. It is not necessary.

  In addition, the locking portion 52 of the tube insertion tool 50 is not formed in a ring shape as in the other embodiments, but a slit is provided in the axial direction of the shaft portion 51 so that the tube 41 is sandwiched between the slits. May be. Further, as the locking portion 52 having the outer diameter of the distal end portion of the shaft portion 51 slightly larger than the inner diameter of the tube 41, the locking portion 52 is inserted into the internal passage of the tube 41 to lock the tube 41. May be. In addition, it is good also as a structure of providing a member like a clip for office work in a latching | locking part.

  DESCRIPTION OF SYMBOLS 1 ... Exchange tool, 10 ... Outer cylinder, 11 ... Outer cylinder main body, 12 ... Folded part, 20 ... Inner cylinder, 21 ... Inner cylinder main body, 22 ... Large diameter part, 23 ... Gripping member, 24 ... Slit, 25 ... Long Hole, 40 ... Indwelling catheter.

Claims (5)

Indwelling provided with a flexible tube whose distal end is inserted into a body cavity through a fistula, and a flexible body cavity fixing portion provided at the distal end of the tube to regulate the extraction of the tube from the body cavity An exchanging device for removing the catheter from the body cavity and attaching an indwelling catheter for replacement to the patient,
An outer cylinder to be inserted into the fistula,
An inner cylinder in which at least a part is inserted into the outer cylinder and the tube and the body cavity fixing portion can be inserted therein;
The inner cylinder is formed of a flexible member, a cylindrical which is inserted into the outer cylinder, a slit which extends to the inner tube from the tip along the length direction base end side of formed,
The outer cylinder is formed of an elastic member that suppresses outward expansion of the inner cylinder, and includes a folded portion that is folded back from the tip of the outer cylinder to the inside of the outer cylinder, and the folded portion includes the inner cylinder An indwelling catheter exchange device is located on the inner peripheral surface of the inner cylinder from the tip of the inner cylinder when the is inserted.   The exchange tool according to claim 1, wherein the inner cylinder includes a long hole formed in the slit along the length direction.   The exchange tool according to claim 1 or 2, wherein a cylindrical gripping member is detachably mounted on the base end side of the inner cylinder.   The exchange tool according to any one of claims 1 to 3, wherein the inner cylinder is detachably attached to the outer cylinder. A shaft portion that is longer than the inner cylinder and that can be inserted into the inner cylinder; and a locking portion that is provided at a distal end of the shaft portion and that can lock the tube. A tube insertion tool that is inserted from the proximal end side of the tube and exposed from the distal end side, and the tube portion is inserted into the inner tube by pulling the shaft portion in a state where a portion of the tube is locked to the locking portion. The exchange device according to claim 1, further comprising: