JP2003180840A - Infection-preventing gastrostomy kit - Google Patents

Abstract

<P>PROBLEM TO BE SOLVED: To provide an infection-preventing gastrostomy kit by which a catheter can be indwelled simply without infecting an wounded part and without a pain of a patient in the case of performing a gastrostomy operation via an endoscope. <P>SOLUTION: This infection-preventing gastrostomy kit has a stopper at one terminal and comprises a catheter fixed to the lumen of the stomach and the outside of the body through the abdominal wall, and an over tube for introducing the catheter into the lumen of the stomach. Hydrophilic treatment is performed to the lumen of the over tube or at least one of the outer walls of the catheter and the stopper. <P>COPYRIGHT: (C)2003,JPO

Description

Description: BACKGROUND OF THE INVENTION 1. Field of the Invention The present invention relates to an anti-infection gastrostomy kit. In particular, the present invention relates to an infection-preventing gastrostomy kit, which is used to prevent infection when performing a gastrostomy procedure via an endoscope and to easily place a catheter. 2. Description of the Related Art As a method of administering nutrition to patients who cannot take nutrition orally, generally, intravenous nutrition,
Nasal gastrointestinal feeding and enteral feeding from a gastrostomy were performed. [0003] Intravenous nutrition is a so-called intravenous drip that replenishes nutrients from the vein, but has the merit of being able to be administered to any patient, but requires strict cleanliness and places a heavy burden on the caregiver. At home, management is very difficult. In addition, the increase in medical expenses further increases the burden on caregivers, and thus it has been difficult to adapt the method to patients who need long-term nutritional management. In nasogastric tube feeding, a catheter is inserted through the nose, and the catheter is placed in the stomach to supply nutrients. Although it has the merit that it can be easily performed, the indwelling catheter comes in contact with the nasal cavity and the pharynx, causing not only pain for the patient but also the catheter being pulled out due to a sense of restraint due to the indwelling catheter.
In the case of a long period of time, an ulcer is formed in a portion in contact with the catheter, so that this method is also difficult to adapt to a patient who needs long-term nutritional management. [0005] Enteral nutrition from a gastrostomy is a technique in which a fistula for supplying nutrients from the abdominal wall to the stomach lumen is constructed by a small operation using an endoscope, and nutrients are supplied from the fistula. is there.
Small surgery is needed, but it is about 10 minutes,
Because the wound is small, the patient recovers quickly. In addition, enteral nutrition from gastrostomy requires less strict cleanliness than the above-mentioned intravenous nutrition, and less discomfort than nasogastric tube nutrition, so there is less extraction and QOL (quality of life) of patients. Is improved. Furthermore, since it can be sufficiently managed even at home and facilities, it is an optimal nutritional administration method for patients and caregivers who require long-term nutritional management, and further spread is expected in the future. [0006] The minor operation indicated for enteral nutrition from a gastrostomy is a percutaneous endoscopic gastrostomy.
In general, there are three methods for percutaneous endoscopic gastrostomy: a pull method, a push method, and an introducer method. [0007] The introducer method is a method in which a catheter is inserted from the lumen of a trocar punctured from the abdominal wall and placed there. It is said that there is little infectious disease because the endoscope is inserted only once and the catheter is inserted from the punctured lumen of the trocar. The catheter cannot be used. In addition, since only a balloon-shaped stopper can be used as a stopper at the tip of the catheter to be placed in the stomach wall, the catheter may deviate due to rupture of the balloon after placement, and caregivers may periodically inflate the balloon. Had to be managed. The push method is a method in which a catheter placed through the mouth is pushed into the stomach along with a guide wire that protrudes from the mouth to the outside of the abdominal wall, and when the catheter comes out of the abdominal wall, the guide wire is pulled out and placed. Compared to the introducer method, a catheter with a large diameter can be indwelled, and the stopper at the tip of the catheter to be indwelled in the stomach wall has a shape that can be firmly held on the stomach wall, so that there is little deviation of the catheter, and a regular shape such as a balloon shape No administration is required. However, at the time of a small operation, it is necessary to insert the endoscope twice in order to confirm the construction of the catheter and the indwelling position of the catheter. Needless to say at the time of construction, confirmation of the indwelling position is indispensable for strong fistula formation. But this was painful for the patient. In addition, there is a problem that bacteria in the oral cavity adhere to the indwelling catheter, thereby infecting the punctured wound. Therefore, the oral cavity is disinfected before surgery. However, while disinfection is troublesome, it was difficult to prevent infectious diseases by itself. With the pull method, a catheter to be placed is tied to the tip of the guide wire protruding from the mouth with respect to the guide wire protruding from the mouth to the outside of the abdominal wall, and the catheter is drawn from the mouth to the stomach by pulling the guide wire protruding out of the abdominal wall. It is a method of indwelling and is the most frequently used technique because of the certainty of the technique. This method, compared to the push method,
There was only the difference between pushing and pulling, and had the same advantages and disadvantages as a method of placing a catheter from the mouth to the stomach. SUMMARY OF THE INVENTION It is an object of the present invention to provide a catheter for performing a gastrostomy procedure through an endoscope without infecting a wound and without causing pain to a patient. The object of the present invention is to provide an infective gastrostomy kit that can be placed in the infection. [0012] That is, the present invention provides a catheter having a stopper at one end, which is fixed through the abdominal wall between the lumen of the stomach and the exterior of the stomach, and the catheter connected to the lumen of the stomach. An anti-infection gastrostoma construction kit, comprising an overtube for introducing into the blood vessel, wherein at least one of the lumen of the overtube or the outer wall of the catheter and the stopper is subjected to a hydrophilic treatment. The present invention will be described below in detail with reference to the drawings. FIG. 1 shows the entire overtube used in one embodiment of the present invention, and FIG. 2 shows the entire catheter having a stopper at the end used in one embodiment of the present invention. FIG. 3 is a sectional view of a human body when a catheter is constructed using an overtube by a pull method according to an embodiment of the present invention. Further FIG.
FIG. 1 is a cross-sectional view of a human body when an indwelling position is confirmed by an endoscope after constructing a catheter according to one embodiment of the present invention. (Overtube) The overtube (1) in FIG. 1 is composed of a mouthpiece (2) and a tube (3), and a mouthpiece (2) is attached to the proximal end of the tube (3). , Flanges at both ends (4)
Is provided. This is provided so that the patient can hold the mouthpiece (2) in a stable state and that the patient has rigidity so that the mouthpiece (2) is not damaged when bitten. The material is preferably a styrene-based hard resin, but the material is not limited as long as the material does not cause discomfort when added and has rigidity. Overtube inserted from mouth (1)
Must pass through the bent part (7) near the pharynx, so that a flexible material is preferable, and a polyvinyl chloride resin, a polyurethane resin, or a rubber resin is more preferable. However, because of the flexible material, the lumen of the tube (3) may be crushed at the bent portion (7) shown in FIG. 3, and in order to prevent this, metal or hard resin previously processed into a coil shape is used. Preferably it is embedded in the wall of the tube (3). The metal is preferably stainless steel, and the hard resin is preferably a styrene resin.
However, the present invention is not limited to this as long as it can be embedded in a wall and can maintain rigidity without being deformed at a bent portion. The indwelled overtube (1) preferably has a length such that it passes through the esophagus and its tip is located near the cardia of the stomach. If the overtube is longer than this position, the operability of the indwelling catheter will deteriorate,
The length of the overtube (1) is preferably selected according to the patient's physique. Also over tube (1)
The inner and outer diameters of can be adjusted to the outer diameter of the endoscope used.
Further, it is preferable to select an inner and outer diameter that can minimize the burden on the patient during insertion. Next, when the overtube (1) is inserted, the insertability is improved and a medical instrument such as an endoscope inserted into the lumen of the overtube is prevented from being caught at the tip of the overtube. Preferably, the distal end of the overtube is angled with respect to the longitudinal direction. If the angle is too large, the insertability deteriorates. If the angle is too small, the tip becomes sharp and damages the tissue. Therefore, the angle formed by the surface formed at an angle with the longitudinal direction of the overtube (1) is 30. It is preferable that the angle be in the range of 70 to 70 degrees.
The angled outer periphery is preferably chamfered to prevent tissue damage during insertion. (Catheter) The catheter (5) shown in FIG. 2 is provided with a stopper (6) for fixing to the stomach wall at the base end side, and is of a type used by a pull method. The stopper (6) is preferably made of a material that is soft and has good biocompatibility in order to fix the stopper to the stomach wall for a long time, and is more preferably silicone or polyurethane. The shape is preferably a conical shape or a dome shape that deforms when the catheter is pulled with a constant force. The outer diameter of the catheter (5) depends on the size of the punctured wound, but is preferably in the range of 5 to 11 mm. In addition, since nutrients and drugs are poured into the stomach through the lumen of the catheter, clogging may occur. It is preferable to have no internal diameter. The catheter (5) is provided with a stopper (6).
It is preferable to use the same material because it is processed by bonding or insert molding because it is integrated with the stopper (6). In some cases, the position of the stopper (6) is confirmed by X-ray contrast after construction. ) Itself preferably has a contrast property, and more preferably a barium-based or bismuth-based contrast agent is used. Further, when the catheter (5) is replaced, it is necessary to measure the thickness of the abdominal wall. Therefore, a scale is printed on the outer periphery of the catheter (5) at regular intervals from the stopper (6). Is preferred. This catheter (5) is provided with a loop (10) at one end of the catheter for use in the pull method, and is connected to the loop (9) at one end of the guide wire when the catheter (5) is inserted from the mouth. A flexible material is preferable. (Usage Method) FIG. 3 shows an example of use of an embodiment of the present invention, in which an overtube (1) is used to construct a catheter (5) by a pull method. I have. The overtube (1) is inserted and retained in the mouth, and the catheter (5) passes through the lumen of the overtube (1), so that bacteria do not adhere to the catheter from the mouth. In operation, the loop (9) at one end of the guide wire protruding from the mouth is connected to the loop (1) at one end of the catheter.
0) and pull the catheter (5) from the mouthpiece (2) into the lumen of the overtube (1) by slowly pulling the guide wire (8) protruding from the abdominal wall. Must also be drawn into the lumen of the overtube (1). As described above, a soft material is used as the material of the stopper (6), and when the size of the stopper (6) is larger than the inner diameter of the overtube (1), the drawn over Tube (1)
The stopper (6) is stuck to the inner cavity of the tube, making it difficult to pass through the overtube. Therefore, when hydrophilic treatment is performed on the lumen of the overtube (1), sterile distilled water or the like is poured into the lumen of the overtube. In addition, when hydrophilic treatment is applied to the outer walls of the catheter (5) and the stopper (6), if the outer wall is lubricated with sterile distilled water or the like and inserted into the outer wall, it can be smoothly placed. Patients can be administered without pain and the catheter can be placed without infecting the wound. This hydrophilic treatment is preferably performed with a hydrogel, and more preferably with hyaluronic acid, polyvinylpyrrolidone, polyvinyl alcohol, polyacrylamide, gelatin, or collagen. After the construction, as shown in FIG. 4, the endoscope is used as it is by using the overtube (1) used for the construction to confirm the indwelling position of the stopper (6) of the catheter (5). Although (11) is inserted, since the endoscope can be inserted smoothly through the overtube, the pain to the patient is greatly reduced. According to the present invention, the kit for preventing gastrostoma infectious disease according to the present invention can be used to carry out gastrostoma surgery through an endoscope without infecting the wound and without causing pain to the patient. Detention is possible.

BRIEF DESCRIPTION OF THE DRAWINGS FIG. 1 is a view showing an entire overtube according to an embodiment of the present invention. FIG. 2 is a view showing an entire catheter having a stopper at a distal end according to an embodiment of the present invention. FIG. 3 is a sectional view of a human body when a catheter is constructed using an overtube by a pull method according to an embodiment of the present invention. FIG. 4 is a cross-sectional view of a human body when an indwelling position is confirmed by an endoscope after constructing a catheter according to one embodiment of the present invention. [Description of Signs] 1 Overtube 2 Mouthpiece 3 Tube 4 Flange 5 Catheter 6 Stopper 7 Bend 8 Guide wire 9 Ring at one end of guide wire 10 Ring at one end of catheter 11 Endoscope

Claims (1)

Claims: 1. A catheter having a stopper at one end, the catheter being fixed through the abdominal wall between the lumen of the stomach and the outside of the body,
An anti-infection gastrostomy kit, comprising an overtube for introducing a catheter into the lumen of the stomach, wherein at least one of the lumen of the overtube or the outer wall of the catheter and the stopper is subjected to hydrophilic treatment.