JP2017018218A - Medical tubular body - Google Patents

Abstract

PROBLEM TO BE SOLVED: To provide a medical tubular body capable of improving dialysis efficiency.SOLUTION: A medical tubular body 100, which is a medical tubular body detained in the penetration state through a blood vessel wall W, includes a first lumen 3 extending toward one of the upstream side and the downstream side of a blood vessel, and a second lumen 4 insertable by a catheter forming a passage of blood. The second lumen is formed so that a tip 4a of the catheter is projected toward the other of the upstream side and the downstream side of the blood vessel.SELECTED DRAWING: Figure 2

Description

  The present invention relates to a medical tubular body that is indwelled while being pierced through a blood vessel wall, and in particular, intends to improve dialysis efficiency.

  Conventionally, medical tubular bodies have been used for hemodialysis against living bodies such as human bodies. In dialysis, in order to circulate blood outside the body, a channel for removing blood from the body (blood removal route) and a channel for returning blood to the body (blood return route) are required. These channels are generally installed by placing two puncture needles in a blood vessel. Since the waste blood and water are removed by dialysis treatment, the blood that is returned to blood returns to the blood removal route again (recirculation). It is said that it is better to install the tip of the road at a distance of 5 cm or more.

  The medical staff is also careful to separate the tips of the two flow paths, but this distance is not always maintained. Further, in the puncture needle described above, since two puncture needles must be punctured in order to install the two flow paths, there is a burden of pain due to puncture and damage to the blood vessel wall.

  As other medical tubular bodies, indwelling catheters are used. The indwelling catheter has two or more lumens (lumens), and is mainly used by being inserted into a central vein (for example, see Patent Documents 1 to 4).

JP 2004-167253 A JP-T-2005-516693 Special table 2007-533365 gazette Japanese translation of PCT publication No. 2004-526481

  However, the conventional indwelling catheter as described above generally has a relatively close tip opening position for blood removal / return, and there is a concern about the problem of recirculation. In addition, even in an indwelling catheter in which the interval between the tip openings for blood removal / return is sufficient, the tip openings for blood removal / return are all directed in the same direction, either upstream or downstream of the blood vessel. Will be placed. For this reason, the tip opening of one of blood removal and blood return is arranged in the opposite direction to the blood flow. In this way, when the tip opening is disposed in the opposite direction to the blood flow, stress on the blood is generated at the tip opening, which increases the possibility of hemolysis, turbulence, and thrombus, resulting in dialysis efficiency. There is a concern that it will decrease.

  This invention was developed in order to solve such a subject, and it aims at providing the medical tubular body which can improve a dialysis efficiency.

  The medical tubular body of the present invention is a medical tubular body placed in a state where the blood vessel wall is pierced, a first lumen extending toward one of the upstream side and the downstream side of the blood vessel, and a blood flow A second lumen into which a catheter forming a channel can be inserted, and the second lumen is formed to project the distal end of the catheter toward the other of the upstream side and the downstream side of the blood vessel. It is characterized by.

  Here, it is preferable that the medical tubular body of the present invention is formed so that the second lumen is spirally wound around the first lumen.

  In the medical tubular body of the present invention, it is preferable that at least a distal end side portion of the second lumen is folded, and the distal end side portion is expandable when the catheter is inserted.

  In addition, the medical tubular body of the present invention includes a cylindrical wall that forms the first lumen on the inner peripheral side, and the second lumen is formed inside the cylindrical wall, for example, the first lumen. It is preferably formed so as to be wound spirally around the periphery. In addition, it is preferable that the outer peripheral surface of the said cylindrical wall makes a cylindrical shape.

In addition, it is preferable that the catheter changes the direction of the tip while curving along the shape of the second lumen and protrudes toward the other of the upstream side and the downstream side of the blood vessel.
In the case where at least the distal end portion of the second lumen is not folded, it is desirable to provide a check valve at the proximal end opening of the second lumen. Alternatively, instead of the check valve, the intermediate portion in the longitudinal direction of the second lumen may be formed of a material having flexibility so that the blood flow can be blocked by being sandwiched by a knife.

In the medical tubular body of the present invention, it is promoted that the distal end of the catheter projects toward the other of the upstream side and the downstream side of the blood vessel at the distal end side opening of the second lumen. It is preferable to provide a guide part.
The guide portion is recessed in an outer peripheral surface of a cylindrical wall that forms the first lumen on the inner peripheral side, and is curved toward the other of the upstream side and the downstream side of the blood vessel. A curved groove is preferable.
The guide portion may be provided on the inner surface of the second lumen. In this case, the guide portion has, for example, a rough surface formed on the other surface of the upstream side and the downstream side of the blood vessel (higher friction than a surface on one side of the upstream side and the downstream side of the blood vessel. It may be configured as a surface).

  The medical tubular body of the present invention may use the second lumen as it is as a blood flow path without inserting a catheter into the second lumen.

  In the medical tubular body of the present invention, it is preferable that the first lumen is a blood flow path.

In the medical tubular body of the present invention, it is preferable that the first lumen is formed by a hollow needle.
Although the first lumen may also serve as the lumen of the hollow needle in this way, at least the tip of the hollow needle may be made of a soft material such as a cannula in consideration of indwelling. desirable.
Instead of such a configuration, in the medical tubular body of the present invention, the first lumen may be capable of inserting an inner needle for puncture.

  Furthermore, in the medical tubular body of the present invention, it is preferable that the first lumen can be inserted with another catheter forming a blood flow path.

  A check valve may be provided on the proximal end side of the first lumen. Alternatively, the intermediate portion in the longitudinal direction of the first lumen may be formed of a material having flexibility so that the blood flow can be blocked by being sandwiched by a knife.

  According to the medical tubular body of the present invention, by inserting a catheter into the second lumen, the first lumen extending toward one of the upstream side and the downstream side of the blood vessel, and the second lumen A blood removal / return route can be secured using a catheter that is inserted and has a tip protruding toward the other of the upstream side and the downstream side of the blood vessel. At this time, since the distal end of the catheter protrudes in a direction away from the distal end of the first lumen, the distal opening positions for blood removal / returning blood can be easily moved away from each other, and recirculation can be easily suppressed. In addition, when the second lumen is used as it is as a blood flow path without inserting a catheter into the second lumen, the position where the tip of the second lumen is sufficiently separated from the tip of the first lumen By providing them at the front end positions of the blood removal and blood return are sufficiently separated from each other, it is easy to suppress recirculation.

  Further, according to the medical tubular body of the present invention, when the catheter is inserted into the second lumen, the distal end of the first lumen and the distal end of the catheter are opposite to each other (the upstream side and the downstream side of the blood vessel). Can be directed to. Therefore, when the first lumen is directed to the upstream side of the blood vessel and the tip of the catheter is directed to the downstream side of the blood vessel, the first lumen is used for blood removal, and the catheter is used for blood return. Stress on blood can be reduced. On the contrary, when the tip of the first lumen is directed to the downstream side of the blood vessel and the tip of the catheter is directed to the upstream side of the blood vessel, the first lumen is used for blood return and the catheter is used for blood removal. By using it, stress on blood can be reduced. In addition, when the second lumen is used as it is as a blood flow path without inserting a catheter into the second lumen, the tip of the first lumen and the tip of the second lumen are opposite to each other ( Therefore, stress on blood can be reduced.

  Therefore, according to this invention, the medical tubular body which can improve a dialysis efficiency can be provided.

It is a side view of the medical tubular body concerning a 1st embodiment of the present invention. It is a partial cross section side view which shows the use condition of the medical tubular body of FIG. 1, and shows with a catheter. It is a side view which shows the modification of the medical tubular body of FIG. 1, and shows the state by which the front end side part of the 2nd lumen was folded. FIG. 4 is an AA end view of FIG. 3. It is a partial cross section side view which shows the other modification of the medical tubular body of FIG. 1 in use condition, and shows with a catheter. It is a partial cross section side view which shows the use condition of the medical tubular body which concerns on 2nd Embodiment of this invention, and shows with an inner needle and a catheter. It is a partial cross section side view which shows the modification of the medical tubular body of FIG. 6 in a use condition, and shows with an inner needle and a catheter. It is a partial cross section side view which shows the use condition of the medical tubular body which concerns on 3rd Embodiment of this invention, and shows with a catheter.

Hereinafter, with reference to drawings, the medical tubular body concerning one embodiment of the present invention is illustrated and explained in detail.
In this specification, the proximal end side means the side (upper right in FIG. 1) located on the body surface side when the medical tubular body is placed, and the distal end side is the opposite side (see FIG. 1 means the lower left).
First, with reference to FIGS. 1-5, the medical tubular body which concerns on 1st Embodiment of this invention is illustrated and demonstrated.

  As shown in FIGS. 1 to 2, the medical tubular body 100 includes, for example, a synthetic resin or metal hollow needle 1 and a synthetic resin covering member 2 that covers a part of the hollow needle 1. It is configured. The hollow needle 1 is preferably made of a soft material such as a cannula at least at the tip in consideration of indwelling. The medical tubular body 100 includes a first lumen 3 including a hollow portion of the hollow needle 1 and a second lumen 4 formed by the covering member 2. In the present embodiment, the first lumen 3 is formed so as to form a straight line, and the second lumen 4 is formed so as to be spirally wound around the first lumen 3. The second lumen 4 is configured such that a catheter C that forms a blood flow path can be inserted. The first lumen 3 and the second lumen 4 are preferably configured to be completely separated from each other. However, as long as the catheter C is guided along the longitudinal direction of the second lumen 4, the first lumen 3 and the second lumen 4 may be at least partially in communication with each other. Further, a check valve can be provided at the proximal end opening of the second lumen 4 so as to prevent leakage of blood while allowing insertion of the catheter C. Alternatively, the middle portion in the longitudinal direction of the second lumen 4 may be formed of a material having flexibility so that the blood flow can be blocked by being sandwiched by a knife.

  And the medical tubular body 100 can make the 1st lumen | rumen 3 into a blood flow path by inserting the front-end | tip of the hollow needle 1 from the skin S of living bodies, such as a patient, and puncturing the blood vessel wall W. . Further, when the medical tubular body 100 is placed in a state where it pierces the blood vessel wall W in this way, as shown in FIG. 2, the first lumen 3 is one of the upstream side and the downstream side of the blood vessel. It will extend toward. When the medical tubular body 100 is indwelled in this way, the second lumen 4 moves the distal end C1 of the catheter C inserted into the second lumen 4 to the other of the upstream side and the downstream side of the blood vessel. It is formed so as to protrude. In addition, it is desirable that the catheter C bend along the shape of the second lumen 4, change the direction of the distal end, and protrude toward the other of the upstream side and the downstream side of the blood vessel.

  In order to project the distal end C1 of the catheter C in this way, the central axis O2 of the second lumen 4 at the distal end 4a of the second lumen 4 and the first lumen 3 at the puncture portion of the blood vessel wall W are provided. The angle θ (see FIG. 1) formed by the axis O1 parallel to the central axis is preferably 60 ° or more, more preferably 80 ° or more, and further preferably 90 ° or more.

  Thus, the medical tubular body 100 according to the present embodiment extends toward one of the upstream side and the downstream side of the blood vessel in the medical tubular body 100 placed in a state where the blood vessel wall W is pierced. A first lumen 3 and a second lumen 4 into which a catheter C that forms a blood flow path can be inserted are provided. The second lumen 4 moves the distal end C1 of the catheter C upstream and downstream of the blood vessel. It is the structure of being formed so that it may protrude toward the other of these.

  Therefore, by inserting the catheter C into the second lumen 4, the first lumen 3 extending toward one of the upstream side and the downstream side of the blood vessel and the second lumen 4 are inserted into the second lumen 4. A blood removal / blood return route can be secured using the catheter C with the distal end C1 protruding toward the other of the upstream side and the downstream side. At that time, since the distal end of the catheter C protrudes away from the distal end of the first lumen 3, it is easy to move the distal opening positions for blood removal and return, and recirculation is easily suppressed. Dialysis efficiency can be improved. Further, when the second lumen 4 is used as it is as a blood flow path without inserting the catheter C into the second lumen 4, the tip 4 a of the second lumen 4 is used as the tip of the first lumen 3. By providing it at a position sufficiently away from 3a, the tip opening positions for blood removal / returning are sufficiently separated from each other, so that recirculation can be easily suppressed.

  Further, according to the medical tubular body 100, when the catheter C is inserted into the second lumen 4, the distal end 3a of the first lumen 3 and the distal end C1 of the catheter C are opposite to each other (on the upstream side of the blood vessel). (Downstream). Therefore, when the distal end 3a of the first lumen 3 is directed to the upstream side of the blood vessel and the distal end C1 of the catheter C is directed to the downstream side of the blood vessel, the first lumen 3 is used for blood removal, and the catheter C is returned. By using it for blood, it is possible to reduce stress on blood and thus improve dialysis efficiency. Conversely, when the distal end 3a of the first lumen 3 is directed downstream of the blood vessel and the distal end C1 of the catheter C is directed upstream of the blood vessel, the first lumen 3 is used for blood return, By using the catheter C for blood removal, the stress on the blood can be reduced, and also in this case, the dialysis efficiency can be improved. Even when the second lumen 4 is used as it is as a blood flow path without inserting the catheter C into the second lumen 4, the tip 3a of the first lumen 3 and the tip of the second lumen 4 are also used. 4a can be directed to the opposite sides (upstream side and downstream side of the blood vessel), so that stress on blood can be reduced.

  In addition, the medical tubular body 100 according to the present embodiment is formed such that the second lumen 4 is spirally wound around the first lumen 3. Therefore, since the protrusion width of the second lumen 4 in the radial direction of the first lumen 3 can be made relatively small and the outer diameter of the entire medical tubular body 100 can be reduced, the puncture of the blood vessel wall W can be facilitated, In addition, it is possible to reduce the load on the living tissue accompanying puncture.

  In the medical tubular body 100 according to this embodiment, the first lumen 3 is a blood flow path. Therefore, since the blood flow path can be directly formed by the first lumen 3, it is not necessary to use a separate catheter for forming the blood flow path. Therefore, the procedure for securing the blood removal / return route can be simplified and the number of necessary medical devices can be reduced.

  Furthermore, in the medical tubular body 100 according to the present embodiment, the first lumen 3 is formed by the hollow needle 1. Therefore, only by puncturing the blood vessel wall W with the hollow needle 1, one of the blood removal and blood return routes can be secured.

Next, a modified example of the medical tubular body 100 described above will be described with reference to FIGS.
The medical tubular body 101 according to this modification has the same configuration as that of the medical tubular body 100 described above except that the configuration of the second lumen 4 is different.

That is, as shown in FIGS. 3 to 4, in the present modification, at least the distal end side portion 4 b of the second lumen 4 is folded, and the distal end side portion 4 b is configured to be expandable when the catheter C is inserted. Has been. More specifically, in this modification, at least the distal end side portion 4b of the second lumen 4 is folded, and the distal end side portion 4b is configured to be able to be restored from the folded state when the catheter C is inserted. .
With such a configuration, the blood vessel wall W can be punctured with the second lumen 4 folded, so that puncture can be facilitated and the burden on the living tissue associated with the puncture can be reduced. In addition, by adopting a configuration in which the second lumen 4 is folded in this way, it is possible to eliminate the need to provide a check valve or the like for preventing blood from leaking from the proximal end opening of the second lumen 4. .

  In addition, the shape at the time of folding of the 2nd lumen 4 is not restricted to what is shown in FIG. 4, It can change suitably. Various configurations can be adopted as a specific configuration for restoring from the folded state. For example, the folded state of the second lumen 4 is maintained by temporary bonding, and the temporary bonding is released by the tensile force acting with the insertion of the catheter C (see FIG. 2 above), and the second lumen 4 is restored. Can be. Alternatively, the second lumen 4 is folded and pressed into a separately provided film-like sheath body so that the folded state is maintained, and the sheath body is removed while being ruptured after puncturing the blood vessel wall W. May be.

  Moreover, it can replace with the structure which folds the 2nd lumen | rumen 4, and can also comprise the 2nd lumen | rumen 4 with a slit. That is, a slit as a folded second lumen 4 is formed in a cylindrical wall having flexibility to form the first lumen 3 on the inner peripheral side, and the catheter C is inserted from the proximal end side of the slit. It is good also as a structure which opens the 2nd lumen | rumen 4 by inserting.

  In this modification, the second lumen 4 is folded in order to facilitate puncture and reduce the burden on the living tissue associated with the puncture, but instead of such a configuration, the first lumen is used. The second lumen 4 is formed so as to be spirally wound around the first lumen 3, for example, around the first lumen 3. Can also be adopted. In this case, it is preferable that the outer peripheral surface of the cylindrical wall has a cylindrical shape. When such a configuration is adopted, the second lumen 4 is accommodated within the smooth outer peripheral surface of the cylindrical wall, so that puncture is facilitated and the burden on the living tissue associated with the puncture is reduced. can do.

Next, another modified example of the medical tubular body 100 described above will be described with reference to FIG.
The medical tubular body 102 according to this modification is the same as that of the medical tubular body 100 described above with reference to FIGS. 1 to 2 except that the guide portion 5 is provided at the distal end side opening of the second lumen 4. It has the same configuration.

  That is, as shown in FIG. 5, in this modification, the distal end C1 of the catheter C faces the above-mentioned “the other of the upstream side and the downstream side of the blood vessel” at the distal end side opening of the second lumen 4. A guide portion 5 that promotes the protrusion is provided. More specifically, in this modified example, the guide portion 5 is recessed on the outer peripheral surface of the cylindrical wall that forms the first lumen 3 on the inner peripheral side, and the above-described “upstream and downstream sides of the blood vessel” It is comprised as a curved groove part which curves toward the other. Thus, by providing the guide portion 5, the distal end C1 of the catheter C that has passed through the second lumen 4 is guided in a direction toward the “other of the upstream side and the downstream side of the blood vessel”. be able to.

The guide portion 5 may be provided on the inner surface of the second lumen 4. In this case, the guide portion 5 is, for example, a rough surface formed on the above-mentioned “other of the upstream side and downstream side of the blood vessel” side surface (“the one of the upstream side and downstream side of the blood vessel” side surface It may be configured as a surface having higher friction than that.
Also in the present modification, the second lumen 4 may be folded as in the case of the medical tubular body 101 described above with reference to FIGS.

Next, with reference to FIGS. 6-7, the medical tubular body which concerns on 2nd Embodiment of this invention is illustrated and demonstrated in detail.
As shown in FIG. 6, the medical tubular body 200 according to the present embodiment does not include the hollow needle 1, and is configured as, for example, a synthetic resin tubular body, using FIGS. 1 to 2. Thus, the configuration is the same as that of the first embodiment described above.

  That is, the medical tubular body 200 includes a first lumen 3 and a second lumen 4 so that an inner needle 6 including, for example, a metal hollow needle can be inserted into the first lumen 3. It has become. Therefore, when the blood vessel wall W is punctured with the inner needle 6 inserted into the medical tubular body 200 and the inner needle 6 is removed, one of the blood removal / return routes can be secured by the first lumen 3. . Specifically, the first lumen 3 may be used as it is as a blood flow path, or may be used as an introduction path for inserting another catheter (not shown) that forms the blood flow path. Note that a check valve can be provided on the proximal end side of the first lumen 3 so as to prevent blood leakage while allowing insertion of the inner needle 6 and the other catheter described above. Alternatively, the intermediate portion in the longitudinal direction of the first lumen 3 may be formed of a material having flexibility so that the blood flow can be blocked by being sandwiched between the irons.

  Note that the second lumen 4 is formed so as to be spirally wound around the first lumen 3 in this embodiment as well, but the trajectory of the second lumen 4 can be changed as appropriate. For example, like the medical tubular body 201 which is a modified example shown in FIG. 7, the middle portion in the longitudinal direction of the second lumen 4 extends along the first lumen 3, and the distal end portion of the second lumen 4 May be curved toward the radially outer side of the first lumen 3. Note that the second lumen 4 may have such a configuration as in the case of the first embodiment described above with reference to FIGS.

Next, with reference to FIG. 8, the medical tubular body which concerns on 3rd Embodiment of this invention is illustrated and demonstrated in detail.
As shown in FIG. 8, the medical tubular body 300 according to this embodiment is configured as an indwelling catheter including a second lumen 4 into which a catheter C that forms a blood flow path can be inserted. The configuration is the same as that of the first embodiment described above with reference to FIGS.

  That is, the medical tubular body 300 can be made of, for example, a synthetic resin, and the first lumen 3 serving as a blood flow path and the second lumen 4 into which the catheter C forming the blood flow path can be inserted. And. When placing the medical tubular body 300, for example, after installing a guide wire (not shown) according to the well-known Seldinger method, the medical tubular body 300 is introduced along the first lumen 3 along the guide wire. Then, the guide wire can be removed. Reference numeral 7 denotes a screw portion for fixing the catheter C to the second lumen 4.

  In the present embodiment, as in the above-described embodiment, for example, the second lumen 4 is folded (see FIGS. 3 to 4), or the guide portion 5 (see FIG. 5) is provided. The trajectory of the second lumen 4 can be changed (see FIG. 7), and various changes can be made.

  The above description shows only one embodiment of the present invention, and it goes without saying that various modifications may be made within the scope of the claims.

100 to 102, 200 to 201,300 Medical tubular body 1 Hollow needle 2 Cover member 3 First lumen 3a First lumen tip 4 Second lumen 4a Second lumen tip 4b Second lumen tip Side portion 5 Guide projection 6 Inner needle 7 Threaded portion C Catheter C1 End of catheter S Skin W Blood vessel wall O1, O2 Axis θ angle

Claims (7)

In a medical tubular body placed in a state where the blood vessel wall is pierced,
A first lumen extending toward one of the upstream side and the downstream side of the blood vessel;
A second lumen into which a catheter forming a blood flow path can be inserted;
The said 2nd lumen is formed so that the front-end | tip of the said catheter may protrude toward the other of the upstream and downstream of the said blood vessel, The medical tubular body characterized by the above-mentioned.   The medical tubular body according to claim 1, wherein the second lumen is formed so as to be spirally wound around the first lumen.   The medical tubular body according to claim 1 or 2, wherein at least a distal end portion of the second lumen is folded, and the distal end portion is expandable upon insertion of the catheter.   The guide part which accelerates | stimulates that the front-end | tip of the said catheter protrudes toward the other of the upstream and downstream sides of the said blood vessel was provided in the front end side opening part of the said 2nd lumen. The medical tubular body according to any one of claims.   The medical tubular body according to any one of claims 1 to 4, wherein the first lumen is a blood flow path.   The medical tubular body according to claim 5, wherein the first lumen is formed by a hollow needle.   The medical tubular body according to any one of claims 1 to 4, wherein the first lumen is capable of inserting another catheter that forms a blood flow path.

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