JP4685149B2 - Gastrostomy catheter - Google Patents

Description

  The present invention relates to a gastrostomy catheter.

  Percutaneous Endoscopic Gastrostomy (PEG) (hereinafter referred to as PEG), which enables enteral nutrition for patients with poor or ingestion Day surgery is also possible for patients with a short period of 5 to 10 minutes, quick recovery after surgery, and relatively good general condition. For this reason, it is showing explosive spread worldwide. For example, in the United States, 180,000 cases were implemented annually in 1997, and the number is expected to increase worldwide.

Three methods are generally known for PEG: pull method, push method and introducer method, but pull method or push method is considered from the viewpoint of convenience and safety of the procedure. Many laws have been adopted. However, the pull method and the push method have the following two drawbacks.
I. Endoscopes must be inserted twice, which can be cumbersome and painful for the patient, and can damage the larynx, pharynx, and esophagus.
II. Because gastrostomy catheters (domestic gastrostomy (PEG) tubes and parts thereof) are contaminated with bacteria in the oral cavity, pharynx, and larynx, wound infection is likely to occur.

  I. The drawbacks of can be fully overcome by devising anesthesia and improving the skill of the endoscopist. However, II. Wound infections due to bacterial contamination of PEG tubes and domes in the home are highly probable. Western literature reports that 35% to 45% of wound infections were found. When wound infection occurs, antibiotics must be administered over a long period of time, delaying the onset of enteral nutrition, reducing immunity, and lengthening hospitalization. Patient distress is significant and medical costs increase. The financial burden and mental distress of not only patients but also their families are great. Although it is possible to reduce bacteria attached to PEG tubes and domes by thorough oral wiping, preoperative pharyngeal disinfection, and prophylactic antibiotic administration, this is not a fundamental countermeasure.

  It is an object of the present invention to provide a contamination prevention cover for preventing wound infection in the gastrostomy method.

  Another object of the present invention is to provide a contamination prevention kit for preventing wound infection in the gastrostomy construction method.

  Another object of the present invention is to provide a catheter kit for preventing contamination in order to prevent wound infection in the gastrostomy method.

  A further object of the present invention is to provide a gastrostomy catheter that is excellent in operability for use in gastrostomy.

  The anti-contamination cover according to the present invention includes an elongated cylindrical bag body having at least one open end, and a closing thread is sewn over substantially the entire circumference of the opening edge of the cylindrical bag body, and the closing threads are close to each other. At this point, it is separated from the stitched portion, and one end is led loosely through the tightening tube disposed near the stitched portion and led to the outside from the other end of the tightening tube.

  In a mode in which the closing thread is sewn into the opening edge of the cylindrical bag body, the opening edge of the cylindrical bag body is folded back inward or outward, and its tip is fixed to the cylindrical bag body by welding or the like. A threading bag is formed by this, and a thread for closing passes through the threading bag, or the thread for closing is placed between the inside and outside of the opening edge of the cylindrical bag body at an appropriate interval. This includes things that are stitched back and forth.

  As for the closing thread, one closing thread is folded at the opening edge of the cylindrical bag (forms a loop along the opening edge), and becomes two to pass through the inside of the tightening tube. One closing thread is folded at the opening edge of the cylindrical bag body, one end is fixed to the one end of the tightening tube, and the continuous part to the other end is tightened A part that is led to the outside through the inside of the tube, or a single closing thread is folded at the opening edge of the cylindrical bag, one end is fixed to the ring, and the other end is continuous May be guided to the outside through the ring and further through the fastening tube.

  The fastening tube is preferably provided along the cylindrical bag. It may be along the inside or the outside of the cylindrical bag. A cover may be provided on the cylindrical bag body, and the fastening tube extending in the length direction along the cylindrical bag body may be covered with this cover except at least the other end portion. Both sides of the cover are fixed, welded, or bonded to the cylindrical bag body, and a bag body into which a fastening tube is inserted is formed by the cover and the cylindrical bag body. The cover itself may be bag-shaped.

  The cylindrical bag is longer than the length of the patient's stomach to the mouth and has a length that can cover the entire gastrostomy catheter. The fastening tube may be shorter than the length of the cylindrical bag. At least the length from the patient's stomach to the mouth is sufficient.

  As a material for the pollution prevention cover (cylindrical bag), a flexible, strong material such as vinyl, rubber, etc., which is thin, airtight and watertight, is preferably used. The gastrostomy catheter can be covered with the anti-contamination cover so as to cover the elongated cylindrical bag or insert the gastrostomy catheter into the cylindrical bag. The term “cylindrical” means that when it is inflated, it becomes a cylindrical shape, and since the bag body is thin, it is not usually cylindrical. A cylindrical bag has the same meaning as an elongated bag.

  As the material for the closing thread, silk, hemp, cotton, polyester, polyethylene, other plant fiber materials, chemical fiber materials, metal materials, or the like are used.

  The anti-contamination cover according to the present invention is used as follows in the gastrostomy method.

  In gastrostomy, a guide wire is inserted into the stomach through an outer tube pierced through the patient's abdominal and stomach walls. The guide wire is pulled out from the oral cavity through the esophagus. One end (conical tip) of the gastrostomy catheter is connected to the guide wire drawn out. The gastrostomy catheter is fed into the stomach from the patient's mouth by pulling it with a guide wire (pull method) or pushing it (push method).

  Before sending the gastrostomy catheter into the stomach from the patient's mouth, cover the entire gastrostomy catheter with an anti-contamination cover that is open at least at one end and has an elongated cylindrical bag, and gastrostomy The opening of the cylindrical bag is closed in the vicinity of the connecting portion between the catheter for use and the guide wire. The gastrostomy catheter may be inserted into the cylindrical bag at the manufacturing stage, or the gastrostomy catheter may be inserted into the cylindrical bag during the operation.

  The gastrostomy catheter is covered with an anti-contamination cover and fed into the stomach from the oral cavity, and the opening of the cylindrical bag is opened in the stomach. While pulling out the gastrostomy catheter from the open opening of the tubular bag, the gastrostomy catheter is pulled out of the body along with the outer cylinder through the hole in the abdominal wall and stomach wall. Thereafter, the anti-contamination cover is taken out from the oral cavity. The distal end of the gastrostomy catheter is placed in the stomach (including the case where the distal end is separated from the catheter).

  According to the present invention, the gastrostomy catheter (and the connecting part of the gastrostomy catheter and the guide wire depending on the structure of the gastrostomy catheter) has a cylindrical bag body outside the oral cavity. Covered by a cover for the patient, and sent from the oral cavity toward the stomach. Since the opening of the anti-contamination cover is closed until it reaches the stomach, the gastrostomy catheter does not directly touch the patient's oral cavity, larynx, or pharynx. The gastrostomy catheter is kept clean.

  The opening of the anti-contamination cover is opened in the stomach of the patient, and the gastrostomy catheter is pulled out from the opening of the anti-contamination cover in the stomach and is pulled out of the body through a hole (wound) penetrating the abdominal wall and stomach wall. The gastrostomy catheter is not contaminated by bacteria because it is sent into the stomach while being kept clean. Even when a clean gastrostomy catheter comes into contact with a hole (wound) penetrating the abdominal wall and stomach wall, the hole (wound) is hardly contaminated with bacteria. It can effectively prevent wound infection.

  According to the present invention, a closing thread is sewn in advance around substantially the entire circumference of the opening edge of the cylindrical bag body, and this closing thread passes through the fastening tube from one end of the fastening tube and from the other end to the outside. Led. Pulling the closing thread led to the outside from the other end of the tightening tube and pushing the tightening tube until the one end is in strong contact with the stitched part, the tube is closed by the closing thread passing through the stitched part. The opening of the bag is tightened and the opening is closed. If the closing thread is held in a tensioned state by, for example, a locking mechanism described later, the opening of the cylindrical bag body is kept closed. If the tensioning closing thread is loosened, for example, if the loosening prevention is removed, the opening of the cylindrical bag body opens or can be opened naturally (due to the elasticity of the cylindrical bag body). When closing the opening of the tubular bag or opening the closed opening, little dexterity is required at the hand. Gastrostomy can be completed in a short time.

  The contamination prevention kit according to the present invention comprises an elongated cylindrical bag body having at least one open end, a closing thread sewn over substantially the entire periphery of the opening edge of the cylindrical bag body, A tightening tube that passes loosely and a loosening stopper for maintaining the closed state of the opening edge of the cylindrical bag body by a closing thread are provided. This contamination prevention kit is provided as a combination of the above-described cylindrical bag, a closing thread, a tightening tube, and a locking device. Therefore, if this anti-contamination kit is placed on the gastrostomy catheter before the gastrostomy method is performed or during the operation, the gastrostomy catheter may be inserted into the cylindrical bag.

  The clamping tube is preferably provided in a state of being covered by a cover (in a state of being placed between the cover and the cylindrical bag).

  By using this contamination prevention kit in the gastrostomy method as described above, it is possible to prevent wound infection. The opening and closing of the opening of the cylindrical bag can be easily performed by pulling the closing thread against the tightening tube or releasing the tension.

  In one embodiment, the loosening stopper is an elastic body through which a closing thread led to the outside from the fastening tube passes. When the closing thread is pulled to close the opening of the cylindrical bag body, the closing thread is moved by the frictional force between the closing thread and the elastic body if the loosening stopper is placed at the other end of the tightening tube. It does not move and is held in tension. For loosening prevention, a member formed with a cut (break) for sandwiching the closing thread, a clip, or the like can be used.

  The present invention provides a contamination prevention catheter kit including the contamination prevention cover or the contamination prevention kit. This anti-contamination catheter kit comprises a gastrostomy catheter, an elongated cylindrical bag having a gastrostomy catheter inserted therein, and at least one open end, and an opening edge of the cylindrical bag. Closing thread sewn over the entire circumference, a tightening tube through which the closing thread passes loosely, and a loosening stopper for maintaining the closed state of the opening edge of the cylindrical bag body by the closing thread It is equipped with.

  Since the gastrostomy catheter is already covered with the cylindrical bag, it is possible to save the trouble of covering the gastrostomy catheter with the cylindrical bag. Furthermore, gastrostomy can be completed in a short time. The opening of the cylindrical bag can be closed by the closing thread and the fastening tube, and the closed opening can be opened in the stomach.

  The present invention further provides a gastrostomy catheter. The catheter for gastrostomy according to the present invention is a catheter having a conical tip, and the conical tip is hollow, and a hole is formed in the tip, and this hole is formed in the tip of the guide wire. The diameter of the hollow inside of the conical tip is larger than the diameter of the hole, and the head of the guide wire inserted through the hole is hollow. A locking piece that allows passage of the portion and prevents withdrawal is provided.

  The hollow internal cross section of the conical tip and the hole at the tip are not limited to a circle. The inside diameter of the hollow is larger than the diameter of the hole. When the inside section of the hollow is square or other shapes, one side or diagonal of the inside section of the hollow is larger than the diameter of the hole or one side or diagonal of the hole. Also means big.

  When the gastrostomy catheter according to the present invention is used, when the guide wire pulled out from the oral cavity via the esophagus is connected to one end of the gastrostomy catheter in the above-mentioned gastrostomy method, All that is required is to place the tip into the hole in the conical tip of the gastrostomy catheter. The retaining head at the tip of the guide wire enters the hollow inside of the conical tip from the hole at the tip, and is prevented from being pulled out by the locking piece. Thus, the guide wire is connected to the conical tip of the gastrostomy catheter. Therefore, the connection between the guide wire and the gastrostomy catheter is simple and the time for gastrostomy is shortened.

  In one embodiment, the locking piece is provided obliquely with respect to the axial direction of the conical tip in the hollow interior of the conical tip, and is directed to the insertion direction of the guide wire of the locking piece. A first groove for passage wider than the head of the guide wire is formed at the end, and a first groove for preventing slipping that is narrower than the head is continuous with the first groove having a larger width. Two grooves are formed.

  The first wide passage groove formed in the locking piece provided in the hollow inside of the conical tip of the gastrostomy catheter is a retaining head formed at the tip of the guide wire. When the guide wire is inserted into the hollow in the conical tip from the hole at the tip of the conical tip, the head of the inserted guide wire passes through the first groove of the locking piece. (The other side across the locking piece). The main body of the guide wire (portion excluding the head portion) enters the second groove for preventing the narrowing formed continuously from the first groove having a large width. Since the width of the second groove is narrower than the head at the tip of the guide wire, even if the guide wire is pulled, the head does not come off from the locking piece. Since the guide wire and the gastrostomy catheter can be easily connected, the gastrostomy can be completed in a shorter time.

  FIG. 1 shows a contamination-preventing cover used in a percutaneous endoscopic gastrostomy (hereinafter referred to as PEG method). FIG. 2 is an enlarged view of one end of the contamination prevention cover.

  The contamination prevention cover 10 includes an elongated cylindrical bag (sheath) 1, and at least one end 1 a of the cylindrical bag 1 is open. The other end 1b of the cylindrical bag body 1 may be closed, opened, or perforated. The length of the cylindrical bag body 1 is longer than the length of a gastrostomy catheter (hereinafter referred to as PEG catheter) 12 described later, and its diameter is approximately the same as the diameter of the dome 13 provided at the end of the PEG catheter 12. Is or is large. When the tubular bag 1 is made of a stretchable material, the diameter may be slightly smaller than the diameter of the dome 13. In any case, it is sufficient that the PEG catheter 12 including the dome 13 passes through the cylindrical bag body 1. It is preferable to apply jelly or other lubricant to the inner surface of the cylindrical bag body 1.

  The cylindrical bag 1 is made of a flexible and strong material such as vinyl, rubber, etc., which is thin, airtight, and watertight. Preferably, the cylindrical bag body 1 is as thin as possible and has stretchability (particularly in the circumferential direction). In FIG. 1, the cylindrical bag body 1 is illustrated in a cylindrically inflated shape for easy understanding, but since the cylindrical bag body 1 is thin, it is not normally inflated into a cylindrical shape. In any case, the cylindrical bag body 1 is an elongated bag having a hollow inside.

  The peripheral edge of the open end 1a of the cylindrical bag body 1 is folded back outwardly on the opening edge 1B of the cylindrical bag body 1 over almost the entire circumference, and the end is welded (or bonded) to the bag body 1. (This fixed portion is indicated by reference numeral 1A), and a bag or a passage along the edge of the opening is formed. The opening edge 1B may be folded inward. A closing thread 2 is passed through the bag or passage. Both ends of the closing thread 2 are led out from the peripheral edge of the cylindrical bag 1 at positions close to each other.

  A cover 4 is provided on the outer surface of the cylindrical bag body 1 along the longitudinal direction of the cylindrical bag body 1. The cover 4 is also made of a flexible and strong material such as vinyl, rubber, etc., which is thin, airtight, and watertight like the cylindrical bag 1. Both sides of the cover 4 are welded (or bonded) to the outer surface of the cylindrical bag body 1 (this fixed portion is indicated by reference numeral 4A), whereby a bag or a passage along the longitudinal direction of the cylindrical bag body 1 is formed. . The cover 4 is provided from the vicinity of the opening of the one end 1a of the cylindrical bag body 1 to the vicinity of the other end 1b of the cylindrical bag body 1 or to the position of the other end 1b slightly from the center of the cylindrical bag body 1. . The length of the cover 4 may be any length from the patient's stomach to the vicinity of the oral cavity.

  An elongated fastening tube 3 is passed through a bag or passage formed by the outer surface of the cylindrical bag body 1 and the cover 4. The fastening tube 3 is longer than the length of the cover 4 in the longitudinal direction. Since the fastening tube 3 only passes through the bag or passage formed by the cover 4, it can be freely moved in the longitudinal direction of the cylindrical bag body 1. The closing thread 2 led out from the opening edge 1B of the cylindrical bag body 1 becomes two, and passes through the fastening tube 3 loosely from one end of the fastening tube 3, and the fastening tube 3 It is led out from the other end. One end of the fastening tube 3 is located near one end 1 a of the cylindrical bag body 1.

  The fastening tube 3 is made of plastic or other flexible material. For the sake of clarity, the fastening tube 3 shown in the drawing is drawn with a slightly larger diameter. In any case, the tightening tube 3 is an elongated tube having a hole formed therein, and the diameter of the hole may be such that the closing thread 2 passes loosely.

  Both ends of the closing thread 2 led out from the tightening tube 3 enter the locking device 5 from one surface, exit the other surface of the locking device 5, enter the locking device 5 from the other surface again, and loosen. Guided from one side of the stop 5. That is, the two closing threads 2 pass through the loosening stopper 5 twice.

  The loosening stopper 5 is preferably an elastic body such as silicon rubber. The closing thread 2 that has passed through the elastic body is firmly held in that state by the frictional force with the elastic body.

  For example, silk thread is used as the closing thread 2. Linen, cotton, polyester, polyethylene, or other thread or metal wire made of plant fiber or chemical fiber may be used.

  The usage method and role of the contamination prevention cover 10 having the above-described configuration will be clarified in the description of the PEG method with reference to FIGS. The example described here is called the pull method. The PEG method is generally performed by an operator, an endoscopist, and one or two nurses.

  The endoscope 24 is inserted into the stomach from the mouth of a patient who is laid in the supine position. Air is blown into the stomach of the patient through the endoscope 24 to inflate the stomach, and the stomach wall and peritoneum are brought into close contact with each other. Determine the puncture site and thoroughly disinfect the area around the puncture site. After local anesthesia in the vicinity of the puncture site, the skin at the puncture site is incised about 1 cm, and the needle 21 with the outer cylinder is inserted there (Fig. 3).

  The needle 21 with an outer cylinder is composed of a cylindrical outer cylinder 22 and a needle (inner cylinder) 23 whose tip is formed at an acute angle. The inside of the outer cylinder 22 is hollow, and the tip of the needle 23 slightly protrudes from the tip of the outer cylinder 22 in a state where the needle 23 is completely stored in the outer cylinder 22. The tip of the needle 23 formed at an acute angle pierces the abdominal wall, peritoneum and stomach wall, and the outer cylinder 22 also penetrates the abdominal wall, peritoneum and stomach wall.

  The needle 23 is extracted from the outer cylinder 22. The outer cylinder 22 is left pierced from the abdominal wall to the stomach wall. The tip of the snare forceps 25 is taken out from the tip of the endoscope 24 in the stomach (FIG. 4).

  The guide wire 11 is inserted from the outside into the stomach through the outer tube 22 (FIG. 5).

  The tip portion of the guide wire 11 fed into the stomach is grasped with the snare forceps 25. The guide wire 11 held by the snare forceps 25 is pulled out from the patient's oral cavity together with the endoscope 24. After the guide wire 11 having a sufficient length is pulled out of the oral cavity, the grip with the snare forceps 25 is released.

  The PEG catheter 12 includes a PEG tube 14, the tip of the PEG tube 14 is tapered in a conical shape (this portion is referred to as a tapered portion 16), and a dome 13 is integrally formed at the end. The tapered portion 16 of the PEG catheter 12 and the guide wire 11 drawn from the patient's oral cavity are connected (FIG. 6). This connection will be described later together with the structure of the tapered portion 16.

  The PEG catheter 12 is inserted from the dome 13 to the tapered portion 16 into the cylindrical bag body 1 of the pollution prevention cover 10, and the opening end 1a of the cylindrical bag body 1 is closed using the closing thread 2 (FIG. 7). The PEG catheter 12 is covered with the cylindrical bag body 1 including the tapered portion 16.

  FIG. 13 is an enlarged view showing a state in which the opening end 1a of the cylindrical bag body 1 of the pollution prevention cover 10 is closed by the closing thread 2. FIG.

  Both ends of the closing thread 2 led out from the other end of the fastening tube 3 are pulled, and one end of the fastening tube 3 is pushed toward the open end of the cylindrical bag body 1. As a result, the loop formed by the closing thread 2 is reduced, the open end 1a of the cylindrical bag 1 is tightened by the closing thread 2 and one end of the tightening tube 3, and the opening is closed (hereinafter closed). The open end of the cylindrical bag body 1 is called a closed end). A closing thread 2 passes through the closed end. Thereafter, the loosening stopper 5 is moved along the closing thread 2 to the position of the other end of the fastening tube 3. Due to the elasticity of the loosening stopper 5 and the frictional force between the loosening stopper 5 and the closing thread 2, the open end is kept closed even when the hand is released from the fastening tube 3 and the closing thread 2.

  FIGS. 19A to 19C show other examples of locking prevention. As shown in FIG. 19 (A), by inserting the closing thread 2 into a notch (break) formed in the locking stopper 5A or as shown in FIGS. 19 (B) and 19 (C), the clips 5B and 5C The closing thread 2 may be prevented from loosening by sandwiching the closing thread 2.

  Next, the end portion of the guide wire 11 that passes through the outer tube 22 and is outside the patient's body is pulled from the outside. As a result, the PEG catheter 12 connected to the guide wire 11 is drawn into the stomach through the oral cavity, larynx, pharynx, and esophagus while being covered with the cylindrical bag 1 (FIG. 8).

  The PEG catheter 12 is drawn into the stomach and the endoscope 24 is inserted again from the oral cavity into the stomach. By inserting the endoscope 24 along the PEG catheter 12, the endoscope 24 can be smoothly guided into the stomach of the patient.

  When the guide wire 11 is pulled, the closed end of the cylindrical bag body 1 hits the tip of the outer cylinder 22 (FIG. 9). It may be confirmed through the endoscope 24 that the closed end of the cylindrical bag body 1 has hit the tip of the outer cylinder 22. In this state, the other ends of the PEG catheter 12 and the cylindrical bag 1 are still outside the patient's mouth (see FIG. 8). It may be confirmed by hand feeling that the closed end of the cylindrical bag body 1 has hit the tip of the outer cylinder 22. Thereafter, the endoscope 24 may be inserted into the stomach. The insertion of the second endoscope can be omitted.

  The loosening stopper 5 is moved away from the other end of the tightening tube 3, that is, toward the end of the closing thread 2, and the tightening tube 3 is moved away from the closed end. Then, the closing thread 2 is loosened, and the open end of the cylindrical bag 1 is opened or can be opened (FIG. 10).

  It is preferable to make a crease or a crease in the opening direction 1a of the cylindrical bag body 1 in advance. When the closing thread 2 is loosened, the opening of the tubular bag 1 is surely opened.

  The guide wire 11 is further pulled out while removing the outer tube 22 from the stomach wall and abdominal wall. The tapered portion 16 and the PEG tube 14 are pulled out of the body through the holes in the stomach wall and the abdominal wall (FIG. 11).

  While the PEG catheter 12 is being pulled out of the patient's body, the endoscopist grasps the other end 1b of the cylindrical bag body 1 protruding from the patient's mouth by hand and is not pulled into the patient's body. To do.

  Finally, the dome 13 appears in the stomach from the open end of the cylindrical bag 1 and hits the stomach wall (FIG. 12). If necessary, the endoscope 24 confirms that the dome 13 is in contact with the stomach wall. The cylindrical bag 1 is pulled out of the patient's mouth.

  The PEG tube 14 drawn out of the patient's body is cut at an appropriate length, and an adapter (not shown) for injecting nutrients is connected to the cut portion. Further, the PEG tube 14 is fixed to the patient's body with an appropriate fixing tool, and the PEG method is finished.

  The guide wire 11 that has passed through the larynx, pharynx, and oral cavity and the outer surface of the tubular bag 1 are contaminated by bacteria attached to the oral cavity, pharynx, and larynx. However, since the guide wire 11 is drawn out of the patient's body through the outer tube 22, the wound portion (hole) of the stomach wall and the abdominal wall is hardly contaminated with bacteria by the guide wire 11. Further, the taper portion 16, the PEG tube 14 and the dome 13 are all covered with the cylindrical bag body 1 and passed through the oral cavity, pharynx and larynx and sent into the stomach. Pulled out. Even if the taper portion 16 and the PEG tube 14 are brought out of the body and come into contact with the wound, there is little possibility that the wound is contaminated with bacteria. The cylindrical bag body 1 whose outer surface is contaminated with bacteria is taken out from the patient's mouth. The wound is not contaminated by the contamination prevention cover 10. Thereby, wound infection can be prevented beforehand.

  Also in the push method, bacterial contamination of the wound can be effectively prevented by pushing the PEG catheter 12 into the stomach with the anti-contamination cover 10 covered.

  Further, no special skill is required for either the closing of the open end using the closing thread 2 and the fastening tube 3 or the opening of the closed end. Gastrostomy can be completed in a relatively short time.

  It is not always necessary for the closing thread 2 to be led out through the fastening tube 3 at both ends (two pieces). As shown in FIG. 17, one end of the closing thread 2 may be fixed to the fastening tube 3 by adhesion, welding, or the like, and a portion continuing to the other end may be passed through the fastening tube 3 and led to the outside. As shown in FIG. 18, one end of the closing thread 2 is fixed to the ring 7 having a hole in the center by adhesion, welding, etc., and the portion continuing to the other end is loosely passed through the center hole of the ring 7, It may be led out through the fastening tube 3. In any of the modes shown in FIGS. 17 and 18, the opening end of the cylindrical bag body 1 can be easily tightened and closed by the closing thread 2 and the tightening tube 3 or the closed end can be opened.

  FIG. 14 shows a part of a button-type PEG catheter (gastrostomy tube) called a one-step button. The one-step button 30 is attached to the end of the PEG tube of the PEG catheter, and is detached from the PEG tube when the drawing from the stomach to the outside of the body is completed (corresponding to the state shown in FIG. 12). This one-step button 30 is provided integrally with the shaft 31 and the tip of the shaft 31 and incorporates a check valve, and is formed integrally with the dome 32 and the shaft 31 that remain in the stomach. And a cap 34 that is connected to the locking stopper 33 and closes the mouth of the shaft 31. The above-described anti-contamination cover 10 can be applied to a button-type PEG catheter having such a one-step button 30 as well. It goes without saying that the contamination prevention cover 10 can be used for other forms of PEG catheters.

  FIGS. 15A to 15C and FIGS. 16A to 16C show the state of connection between the PEG catheter and the guide wire in detail.

  A spherical head 11a having a diameter larger than the diameter of the cross section of the guide wire 11 is formed at the tip of the guide wire 11 drawn out from the oral cavity of the patient. On the other hand, the tapered portion 16 of the PEG catheter 12 is hollow (inner space is indicated by reference numeral 16a), and a hole 16e having a diameter enough to pass the head portion 11a formed at the distal end of the guide wire 11 is formed at the distal end. It has been. The guide wire 11 drawn out from the oral cavity is inserted into the inside 16 a of the tapered portion 16 through the hole 16 e at the tip of the tapered portion 16.

  In the vicinity of the boundary between the tapered portion 16 and the PEG tube 14, a plate (locking piece) 16b is provided (fixed) obliquely with respect to the axial direction of the tapered portion 16 inside the tapered portion 16. A wide groove 16c having a size that allows the head portion 11a of the guide wire 11 to pass therethrough is formed in one half of the plate 16b provided obliquely (portion toward the PEG tube 14). In the vicinity of the center of the plate 16b, the width of the groove 16c is narrowed, and in the other half portion (portion toward the hole 16e of the taper portion 16), a narrow groove 16d is formed continuously with the wide groove 16c ( Fig. 15 (A) and Fig. 16 (A)).

  When the guide wire 11 is inserted into the tapered portion 16 through the hole 16e at the tip of the tapered portion 16, the spherical head 11a formed at the tip of the guide wire 11 passes through the wide groove 16c, and the head 11a Advances beyond the position of the plate 16b to the PEG tube 14 side. The guide wire 11 enters the narrow groove 16d (FIGS. 15B and 16B). Even if the guide wire 11 is pulled in this state, the head 11a is caught in the narrow groove 16d of the plate 16b, so that the guide wire 11 does not come out of the tapered portion 16 (FIG. 15C, FIG. 16). (C)). In this way, the PEG catheter 12 and the guide wire 11 are connected to each other.

  A step portion 16f is formed at the end of the tapered portion 16, and one end of the PEG tube 14 is fitted and fixed to the step portion 16f.

It is a perspective view of a pollution prevention cover. It is a partially expanded perspective view of the contamination prevention cover. FIG. 9 is a cross-sectional view schematically showing the upper body of a patient, showing a state where an endoscope is inserted in the process of performing PEG. FIG. 5 is a cross-sectional view schematically showing an enlarged portion of a stomach of a patient, showing a state where an endoscope is inserted in the process of performing PEG. FIG. 9 is a cross-sectional view schematically showing a portion of a patient's stomach, showing a state in which a guide wire is inserted into the stomach in the course of performing PEG. It is a perspective view which shows the implementation process of PEG and shows a mode that a guide wire and a connection wire are connected. FIG. 4 is a cross-sectional view schematically showing a pharyngeal portion from a patient's head, showing a process of performing PEG. FIG. 5 is a cross-sectional view schematically showing the upper body of a patient, showing a state in which the PEG catheter covered with the anti-contamination cover is drawn in the process of performing PEG. FIG. 3 is a cross-sectional view schematically showing an enlarged portion of a stomach of a patient, showing a state in which a PEG catheter covered with a contamination prevention cover is drawn in a process of performing PEG. FIG. 3 is a cross-sectional view schematically showing an enlarged portion of a stomach of a patient, showing a state in which an open end of a cylindrical bag body is opened in a process of performing PEG. FIG. 3 is a cross-sectional view schematically showing an enlarged portion of a stomach of a patient, showing a state in which the PEG catheter is pulled out of the body in the course of performing PEG. FIG. 3 is a cross-sectional view schematically showing a stomach portion of a patient, showing a state where a dome at the distal end of the PEG catheter hits the stomach wall in the process of performing PEG. It is a perspective view which shows the state in which the PEG catheter was covered with the contamination prevention cover. FIG. 13 is a cross-sectional view schematically illustrating an enlarged portion of a stomach of a patient, illustrating a process of performing PEG corresponding to FIG. 12 when a one-step button is used. (A) to (C) are partially broken sectional views showing the process of connecting the guide wire and the PEG catheter. (A) is the state before the connection. (B) is the guide wire inside the PEG catheter. The inserted state is shown in (C), where the head of the tip of the guide wire is hanging on the plate. (A) to (C) are partial cross-sectional perspective views showing the process of connecting the guide wire and the PEG catheter. (A) is the state before connection, (B) is the guide wire inside the PEG catheter. The inserted state is shown in (C), where the head of the tip of the guide wire is hanging on the plate. It is a partially expanded perspective view which shows the other example of the thread | yarn for closure sewn on the end of the contamination prevention cover. It is a partially expanded perspective view which shows the other example of the thread | yarn for closure sewn on the end of the contamination prevention cover. (A), (B) and (C) are perspective views showing other examples of locking prevention.

Explanation of symbols

DESCRIPTION OF SYMBOLS 1 Cylindrical bag 2 Closing thread 3 Tightening tube 4 Cover 5, 5A, 5B, 5C Loosening prevention 7 Ring
10 Anti-contamination cover
11 Guide wire
12 PEG catheter
13 Dome
14 PEG tube
16 Taper
16b plate
16c, 16d groove
16e hole

Claims (4)

  In a catheter with a conical tip, the conical tip is hollow, and a hole is drilled in the tip. The hole is sized to pass the retaining head formed at the tip of the guide wire. Yes, the diameter of the hollow inside of the conical tip is larger than the diameter of the hole, and the inside of the hollow is allowed to pass through the head of the guide wire inserted from the hole, and the locking prevents the withdrawal A gastrostomy catheter with a piece.   The locking piece is provided obliquely with respect to the axial direction of the conical tip in the hollow interior of the conical tip, and a guide / guide is provided at the end of the locking piece toward the guide wire insertion direction. A first passage groove having a width wider than that of the head portion of the wire is formed, and a second groove for preventing slipping that is narrower than the head portion is formed in succession to the first groove having a wider width. The catheter for gastrostomy construction according to claim 1.   The catheter for gastrostoma construction according to claim 1 or 2, comprising a connecting body that is continuous with the base of the conical tip and a dome provided at one end of the connecting body.   The catheter for gastrostomy construction according to claim 3, wherein the connector is a tube.

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