JP2005341987A - Trocar catheter - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide a trocar catheter which can be inserted to the pleural cavity by precisely and easily positioning the direction of the distal end of a catheter body. <P>SOLUTION: In the trocar catheter 1 which comprises a tubular catheter body 2 and an inner cylinder needle 6 which can be inserted into and pulled out from the inner cavity part of the catheter body 2 and where the distal ends of both of the inner cylinder needle 6 and the catheter body 2 can be inserted integrally into the pleural cavity of a patient while the inner cylinder needle 6 is inserted into the catheter body 2, the inner cylinder needle 6 is curved through its full length. Consequently, a medical worker can insert the trocar catheter into the body at a fixed insertion angle. <P>COPYRIGHT: (C)2006,JPO&NCIPI

Description

  The present invention relates to a trocar catheter capable of discharging gas, body fluid, and the like in a thoracic cavity.

  When blood or body fluid (hereinafter referred to as body fluid) is stored in the thoracic cavity (between the wall-side pleura (costal pleura) and the visceral pleura (pulmonary pleura)), or due to symptoms such as pneumothorax, air may enter the thoracic cavity. Under circumstances such as inflow, body fluid or the like or air is generally discharged out of the body using a trocar catheter.

  The trocar catheter includes a flexible tubular catheter body and a linear inner tube needle, and disposes the body fluid through the lumen portion of the catheter body by arranging the catheter body in a state where the thoracic cavity communicates with the outside of the body. Etc. and air are discharged outside the body.

  The inner cylinder needle is used in a state where it is inserted into the lumen of the catheter body in order to guide the flexible catheter body to the thoracic cavity.

  Specifically, when puncturing a trocar catheter, a medical worker inserts an inner tube needle and stabs the catheter body, punctures the distal end of both to the chest cavity through between the ribs of the patient, By tilting the inner cylinder needle, the distal end portion of the catheter body is positioned in a target direction, and the inner cylinder needle is removed from the catheter body while inserting the catheter body in this direction.

  However, in the above trocar catheter, the inner cylinder needle is formed in a straight line, and therefore, when sandwiched between relatively narrow ribs, the angle at which the inner cylinder needle is inclined is limited. It was difficult to position the tip of the main body.

Therefore, a trocar catheter having an inner cylindrical needle whose tip is bent has been proposed (for example, Patent Document 1). According to this trocar catheter, after the inner cylinder needle and the catheter body are integrally inserted into the body, the inner cylinder needle is rotated to position the bending direction of the distal end portion, and the catheter body is inserted along the inner cylinder needle Thus, the distal end portion of the catheter body can be guided toward the bending direction.
JP-A-8-52220

  However, since the trocar catheter of Patent Document 1 is bent only at the distal end portion of the inner cylindrical needle, once the distal end portion is inserted into the body, the bending direction of the distal end portion inside the body can be confirmed from the outside. It was difficult to precisely position the guide direction of the catheter body.

  Furthermore, when puncturing the trocar catheter of Patent Document 1, the insertion direction of the trocar catheter has to be changed in the puncturing process because the insertion direction with respect to the patient differs between the distal end portion and the other portions.

  Therefore, the living tissue (for example, skin) at the puncture site is pulled in accordance with the change in the insertion angle, which may cause pain to the patient, and the distal end portion of the inner cylindrical needle in accordance with the change in the insertion angle. Since the direction of the body is displaced in the body, there is a risk that the intercostal artery and vein B (see FIG. 8) may be damaged depending on the puncture site. In order to avoid such a situation, a medical worker must carefully perform an insertion operation. Did not get.

  The present invention has been made in view of the above problems, and an object of the present invention is to provide a trocar catheter that can be precisely and easily positioned in the direction of the distal end portion of the catheter body and inserted into the thoracic cavity.

  In order to solve the above-mentioned problems, the present invention has a tubular catheter body and an inner cylindrical needle that can be inserted into and removed from the lumen of the catheter body, and the distal ends of both the inner cylindrical needle and the catheter body are inserted into the catheter body. In the trocar catheter which can be integrally inserted into the chest cavity of the patient, the inner cylindrical needle is curved over its entire length.

  In the trocar catheter, when the central angle of the arc formed by the inner cylindrical needle is θ and the total length is L, the central angle θ is preferably 57 ° or more and the total length L is preferably 20 to 40 cm.

  In the trocar catheter, the central angle θ is preferably 230 ° or less.

  In the trocar catheter, it is preferable that the catheter body bends over the entire length thereof with substantially the same radius of curvature as the inner cylindrical needle.

  According to the present invention, since the inner needle is curved over its entire length, even when the tip is inserted into the body, the tip in the body can be confirmed by confirming the bending direction of the portion exposed outside the body. The direction in which the catheter body is guided can be precisely positioned.

  Furthermore, in the present invention, the inner cylindrical needle and the catheter body can be inserted into the body at a constant insertion angle along the curve of the inner cylindrical needle, so that the living tissue at the puncture site is pulled by changing the insertion angle in the middle. It is possible to easily puncture the inner tube needle and the catheter body while suppressing the situation such as being injured or damaging the intercostal artery and vein.

  In particular, according to the configuration in which the central angle θ is set to 57 ° or more and the total length L is set to 20 to 40 cm, the radius of curvature of the inner cylinder needle can be made relatively large. The distal end portion of the catheter body can be positioned in the target direction.

  On the other hand, when the central angle θ is set to be larger than 230 °, the radius of curvature of the inner cylindrical needle is reduced, and the distal end portion of the inner cylindrical needle comes into contact with the intercostal artery or vein during the insertion process, or the distal end of the inner cylindrical needle Since the U-turns in the thoracic cavity may cause various situations such as damaging the wall-side pleura from the inside, the central angle θ is set to 230 ° or less for the purpose of suppressing these situations It is more preferable.

  According to the configuration in which the catheter body is curved with substantially the same radius of curvature as the inner cylinder needle, the catheter body inserted into the thoracic cavity is prevented from being deformed by its own weight after the inner cylinder needle is removed, and the position is stabilized. Can be made.

  Hereinafter, preferred embodiments of the present invention will be described with reference to the drawings.

  FIG. 1 is a plan view showing an overall configuration of a trocar catheter 1 according to an embodiment of the present invention. 2 is a plan view showing a state in which the trocar catheter 1 of FIG. 1 is disassembled, in which (a) shows the catheter body 2 and (b) shows the guide needle 3. 3 is a cross-sectional view taken along line III-III in FIG.

  Referring to the drawings, the trocar catheter 1 includes a flexible catheter main body 2 and a guide needle 3 that can be inserted into and removed from the lumen of the catheter main body 2.

  The catheter body 2 is a tubular member made of a synthetic resin such as vinyl chloride or urethane, and formed in a straight line. The catheter body 2 has a proximal end formed to be widened and can be connected to a connector such as a drainage tube (not shown), while a distal end thereof is tapered to be inserted into a patient. It is designed to relieve the frictional resistance.

  The lumen 4 of the catheter body 2 is concentrically connected to the distal end of the large-diameter cavity 4a via a shoulder 4b and a relatively large-diameter cavity 4a extending from the proximal end side. And a small-diameter cavity 4c.

  Furthermore, two side holes 5 communicating with the lumen 4 are formed at the distal end of the catheter body 2.

  The guide needle 3 includes a relatively rigid inner cylinder needle 6 made of metal or the like, and a grip 7 for operating the inner cylinder needle 6.

  The inner cylinder needle 6 includes a main body portion 6a that can be inserted into and removed from the large-diameter cavity 4a, and a needle portion 6c concentrically connected to the distal end portion of the main body portion 6a via a shoulder portion 6b, and is curved over the entire length. It is made into a shape.

  Specifically, the inner cylindrical needle 6 of the present embodiment has an angle θ when the central angle of the arc formed from the base end portion of the main body portion 6a to the tip end portion of the needle portion 6c is θ and the total length is L, = 60 °, L = 24 cm. At this time, the radius of curvature R of the arc is about 23 cm.

  The needle portion 6c is set to have a diameter that can be inserted into and removed from the small-diameter cavity 4c of the catheter body 2, and is formed at a puncture end portion 6d having a sharp tip.

  On the other hand, the grip 7 is a member made of synthetic resin or the like attached to the proximal end portion of the inner cylindrical needle 6 and has a relatively round shape so as to fit the palm of a medical worker.

  Hereinafter, with respect to the method of using the trocar catheter 1, blood and body fluid (hereinafter referred to as body fluid, etc.) stored in the thoracic cavity K [between the wall-side pleura (costal pleura) J4 and the visceral pleura (pulmonary pleura) J5: see FIG. 7) And the case where the air flowing into the chest cavity K is discharged will be described as an example.

<When draining bodily fluids from the chest cavity>
First, a medical worker inserts the inner cylindrical needle 6 into the lumen portion 4 of the catheter body 2.

  In this state, when the shoulder portion 6 b of the inner cylindrical needle 6 abuts against the shoulder portion 4 b of the inner cavity portion 4, the movement of the catheter body 2 toward the proximal end side with respect to the inner cylindrical needle 6 is restricted. At this time, the puncture end 6d of the inner cylindrical needle 6 is in a state of protruding from the distal end of the catheter body 2.

  Next, the medical staff incises the skin of the patient at any of the puncture points on the axillary line indicated by reference numerals P1 to P6 in FIG. 5 and widens the incision using a tool called a mush, Insert the tip of the trocar catheter 1 (puncture end 6d).

  The puncture points P1 to P6 are set between the patient's ribs RI, and when the trocar catheter 1 is inserted from these points P1 to P6, the medical staff, as shown in FIG. The trocar catheter 1 is inserted along the upper edge of the rib RI at the lower part of the point.

  At this time, as shown by the solid line in FIG. 5, the medical staff positions the distal end of the trocar catheter 1 after positioning the bending direction so that the plane including the axis of the inner cylindrical needle 6 can enter the gap between the ribs RI. Part is inserted into the incision. Thereby, at the time of insertion of the trocar catheter 1, it can suppress as much as possible that the front-end | tip part interferes with the rib RI.

  Then, as shown in FIG. 7A, the medical staff inserts the trocar catheter 1 through the incision in the order of the skin J1, the subcutaneous tissue J2, and the latissimus dorsi muscle J3, and further penetrates the wall side pleura J4. The distal end portion (puncture end portion 6d) of the trocar catheter 1 is made to reach the chest cavity K.

  Here, the medical staff confirms the direction in which the distal end portion is directed from the bending direction of the trocar catheter 1 outside the body, and rotates the trocar catheter 1 so as to direct this direction to a target position (downward). As indicated by reference numeral 1A (two-dot chain line) in FIG. 5, the orientation of the tip is adjusted, and the catheter body 2 is further inserted as shown in FIG. 7B.

  Next, as shown in FIG. 7C, the medical staff pulls out the inner cylindrical needle 6 while further inserting the catheter body 2, thereby placing the distal end portion of the catheter body 2 below the chest cavity K.

<When exhausting air from the chest cavity>
Similarly to the above method, first, a medical worker inserts the inner cylindrical needle 6 into the lumen portion 4 of the catheter body 2.

  Next, the medical staff incises the patient's skin at any of the puncture points on the clavicle midline indicated by reference numerals P7 and P8 in FIG. 6, and widens the incision using the above-mentioned mush, and there is a trocar catheter there. 1 tip (puncture end 6d) is inserted.

  Like the puncture points P1 to P6, the puncture points P7 and P8 are also set between the ribs RI of the patient. At these points P7 and P8, the intercostal arterial vein B is respectively connected to the ribs as shown in FIG. Projects inside the RI. Therefore, the medical worker positions the trocar catheter 1 at the center position between the ribs RI (between the intercostal artery and vein B) and inserts the puncture end 6d.

  At this time, as shown by the solid line in FIG. 6, the medical staff positions the trocar catheter 1 after positioning the bending direction so that the plane including the axis of the inner cylindrical needle 6 can enter the gap between the ribs RI. The tip is inserted into the incision. Thereby, at the time of insertion of the trocar catheter 1, it can suppress as much as possible that the front-end | tip part interferes with the rib RI.

  Then, as shown in FIG. 8 (a), the medical staff punctures the trocar catheter 1 from the incision through the skin J1, the subcutaneous tissue J2, and the pectoral muscle J6 in this order, and further penetrates the wall side pleura J4. The distal end portion (puncture end portion 6d) of the trocar catheter 1 is made to reach the chest cavity K.

  Here, the medical worker confirms the direction in which the distal end portion is directed from the bending direction of the trocar catheter 1 outside the body, and rotates the trocar catheter 1 so that this direction is directed to the target position (upward). As shown by reference numeral 1B (two-dot chain line) in FIG. 6, the direction of the tip is adjusted, and the catheter body 2 is further inserted as shown in FIG. 8B.

  Next, as shown in (c) of FIG. 8, the medical staff places the distal end portion of the catheter main body 2 on the upper portion of the chest cavity K by further pulling out the inner cylindrical needle 6 while inserting the catheter main body 2.

  The trocar catheter 1 does not necessarily need to be inserted into the body from the puncture points P7 and P8 (see FIG. 6) when the air is discharged because the inner cylinder needle 6 is curved over the entire length. You may insert from P6.

  That is, first, similarly to (a) of FIG. 7 described above, the distal end portion of the trocar catheter 1 is inserted from an incision portion formed at any of the puncture points P1 to P6, and is shown in (a) of FIG. State.

  Then, the medical staff confirms the direction in which the distal end portion is directed from the bending direction of the trocar catheter 1, and rotates the trocar catheter 1 so that this direction is directed upward. As indicated by a chain line), the direction of the tip is adjusted, and the catheter body 2 is further inserted as shown in FIG. 9B.

  Next, as in the above method, as shown in FIG. 9 (c), the distal end portion of the catheter body 2 can be placed above the chest cavity K by pulling out the inner cylindrical needle 6 while inserting the catheter body 2. .

  Thus, when inserting from the puncture points P1 to P6, since it is released from the restriction of passing the trocar catheter 1 between the intercostal arteries and veins B like the puncture points P7 and P8, the burden on the medical staff is further reduced. be able to.

  Moreover, in the said embodiment, although only the inner cylinder needle 6 is curved and formed, it is not limited to this, The catheter main body 2 can also be curved with the same curvature radius R as the inner cylinder needle 6. FIG. That is, the catheter body 2 can be formed in advance in the shape shown in FIG.

  As described above, according to the trocar catheter 1, since the inner cylindrical needle 6 is curved over the entire length, even when the distal end portion is inserted into the body, the bending direction of the portion exposed outside the body is confirmed. By doing so, the direction of the tip in the body can be recognized, and the direction in which the catheter body 2 is guided can be precisely positioned.

  Furthermore, in the trocar catheter 1, the inner tube needle 6 and the catheter body 2 can be inserted into the body at a constant insertion angle along the curve of the inner tube needle 6, so that the puncture site can be changed by changing the insertion angle in the middle. It is possible to easily puncture the inner cylindrical needle 6 and the catheter body 2 while suppressing such a situation that the living tissue (for example, skin J1) is pulled or the intercostal arteriovenous vein B is damaged.

  In particular, by setting the central angle θ to 57 ° or more and the total length L to 20 to 40 cm, the radius of curvature R of the inner cylindrical needle 6 can be made relatively large. Meanwhile, the distal end portion of the catheter body 2 can be positioned in a target direction.

  On the other hand, when the central angle θ is set to be larger than 230 °, the radius of curvature R of the inner cylindrical needle 6 is decreased, and the distal end portion of the inner cylindrical needle 6 comes into contact with the intercostal artery and vein B in the insertion process, or Since the distal end portion of the inner cylindrical needle 6 makes a U-turn in the chest cavity K and may cause various situations such as damaging the wall-side pleura J4 from the inside, each central θ is 230 for the purpose of suppressing these situations. It is more preferable that the angle is set to ° or less.

  According to the configuration in which the catheter body 2 is curved with the same radius of curvature R as the inner tube needle 6, the catheter body 2 inserted into the thoracic cavity K is prevented from being deformed by its own weight after the inner tube needle 6 is removed. The position can be stabilized.

  By the way, the trocar catheter 1 can suppress as much as possible the occurrence of complications during pneumothorax treatment called subcutaneous emphysema because the inner cylinder needle 6 is curved over its entire length.

  Subcutaneous emphysema is a disease in which air accumulates between the skin J1 and the wall side pleura J4 (subcutaneous tissue J2: see FIG. 7). The catheter body is inserted into the body when pneumothorax is treated. This occurs when air in the thoracic cavity K leaks along the outer peripheral portion of No. 2.

  In the treatment of pneumothorax, when a trocar catheter having an inner cylindrical needle with only the distal end bent is used, the living tissue is once expanded when the distal end of the inner cylindrical needle is inserted, from which air In the case where a trocar catheter having a linearly formed inner cylinder needle is used, the wall side pleura is inclined by tilting the inner cylinder needle when positioning the direction of the distal end portion of the catheter body. There is a risk that J4 may be pulled and air may leak therefrom, and any of these trocar catheters may cause subcutaneous emphysema.

  On the other hand, in the trocar catheter 1, the inner cylindrical needle 6 can be inserted from the inside of the body at a constant angle along the bending direction, so that it is possible to suppress the spread of the living tissue, and further the inner cylindrical needle 6 is rotated. As a result, the orientation of the distal end portion of the catheter body 2 can be adjusted, so that the pulling of the wall-side pleura J4 can be suppressed. As a result, leakage of air in the thoracic cavity K can be suppressed, and the occurrence of subcutaneous emphysema It can be suppressed as much as possible.

  In the above-described embodiment, an example in which the central angle θ is 60 ° is described. However, it is not always necessary to limit the central angle θ, and at least the inner cylindrical needle 6 and / or the catheter body 2 is gently curved. If it is a structure, the effect similar to the above can be acquired.

  Moreover, although the said embodiment demonstrated the example in which the inner cylinder needle 6 or / and the catheter main body 2 curved with the fixed curvature radius R, the curvature radius R does not necessarily need to be constant and the curvature radius R is gradually. If, as a result, the inner cylindrical needle 6 and / or the catheter body 2 are gently curved, the same effect as described above can be obtained.

It is a top view which shows the whole structure of the trocar catheter which concerns on embodiment of this invention. It is a top view which shows the state which decomposed | disassembled the trocar catheter of FIG. 1, (a) has shown the catheter main body, (b) has each shown the guide needle. It is the III-III sectional view taken on the line of FIG. It is a cross-sectional schematic diagram of a human body showing a state where the catheter body is placed in the body. 2 is a partial schematic side view of a human body showing a puncture point when body fluid or the like is discharged. It is a partial perspective view of a human body showing a puncture point when air is discharged. FIG. 6 is an enlarged partial cross-sectional view showing a state in which the tip of the trocar catheter is inserted from the puncture point of FIG. 5, (a) is a state of puncturing between ribs, (b) is a state of reaching the thoracic cavity, (c ) Shows a state in which the inner cylinder needle is pulled out while the catheter body is inserted. FIG. 7 is a partial schematic cross-sectional view showing an enlarged state in which the tip portion of the trocar catheter is inserted from the puncture point of FIG. 6, (a) is a state of puncture between ribs, (b) is a state of reaching the chest cavity, (c ) Shows a state in which the inner cylinder needle is pulled out while the catheter body is inserted. FIG. 6 is a partial cross-sectional view illustrating a method of discharging air using the puncture point of FIG. 5, (a) is a state of puncture between ribs, (b) is a state of reaching the thoracic cavity, and (c) is a catheter body. The state in which the inner cylinder needle is pulled out while inserting is shown.

Explanation of symbols

1 Trocar catheter 2 Catheter body 6 Inner tube needle K Thoracic cavity θ Center angle L Total length R Curvature radius

Claims (4)

It has a tubular catheter main body and an inner cylindrical needle that can be inserted into and removed from the lumen of the catheter main body, and the distal end of both can be integrally inserted into the chest cavity of the patient with the inner cylindrical needle inserted into the catheter main body. In the trocar catheter,
A trocar catheter characterized in that the inner cylindrical needle is curved over its entire length.   The trocar catheter according to claim 1, wherein when the central angle of the arc formed by the inner cylindrical needle is θ and the total length is L, the central angle θ is 57 ° or more and the total length L is 20 to 40 cm. A trocar catheter characterized by.   The trocar catheter according to claim 2, wherein the central angle θ is 230 ° or less.   The trocar catheter according to any one of claims 1 to 3, wherein the catheter body is curved with substantially the same radius of curvature as the inner cylindrical needle over the entire length thereof.

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