CN110960298A

Movatterモバイル変換

Info

Publication number: CN110960298A
Application number: CN201911253957.6A
Authority: CN
Inventors: 胡桂菊
Original assignee: Individual
Current assignee: Individual
Priority date: 2019-12-10
Filing date: 2019-12-10
Publication date: 2020-04-07
Anticipated expiration: 2039-12-10
Also published as: CN110960298B

Abstract

Translated fromChinese

本发明公开了隧道式PICC置管术中皮下隧道建立用具及其使用方法，主要涉及皮下隧道建立技术领域。包括隧道针和针内推杆；所述针管靠近针头的一侧设有柱形腔和弹簧腔，所述柱形腔和弹簧腔之间设有限位凸环；所述针头后端设有球面部、第一柱体部、第二柱体部和限位凸缘；所述限位凸缘与限位凸环之间的腔室为弹簧腔，所述弹簧腔内设有复位弹簧；所述球面部外端与针管末端之间设有可弯曲折叠的密封套垫；所述针内推杆滑动连接设置在针管内，所述针内推杆内端与限位凸缘接触，所述针内推杆外端穿出针管设有按座。本发明的有益效果在于：它在皮下隧道建立、PICC导管穿过皮下隧道过程中避免皮下组织或者血管受到损伤；实现PICC导管更加快速的穿过皮下隧道。

The invention discloses a subcutaneous tunnel establishment appliance in a tunnel-type PICC cannulation operation and a use method thereof, and mainly relates to the technical field of subcutaneous tunnel establishment. It includes a tunnel needle and a push rod in the needle; the side of the needle tube close to the needle is provided with a cylindrical cavity and a spring cavity, and a limiting convex ring is arranged between the cylindrical cavity and the spring cavity; the rear end of the needle is provided with a spherical surface part, the first cylinder part, the second cylinder part and the limit flange; the cavity between the limit flange and the limit convex ring is a spring cavity, and a return spring is arranged in the spring cavity; A bendable and foldable sealing sleeve is arranged between the outer end of the spherical surface and the end of the needle tube; the inner needle push rod is slidably connected and arranged in the needle tube, the inner end of the needle inner push rod is in contact with the limiting flange, the The outer end of the inner push rod of the needle passes through the needle tube and is provided with a press seat. The beneficial effect of the present invention is that it avoids damage to subcutaneous tissue or blood vessels during the establishment of the subcutaneous tunnel and the passage of the PICC catheter through the subcutaneous tunnel, and enables the PICC catheter to pass through the subcutaneous tunnel more quickly.

Description

Subcutaneous tunnel establishment tool in tunnel type PICC (peripherally inserted central catheter) catheterization and use method thereof

Technical Field

The invention relates to the technical field of subcutaneous tunnel establishment, in particular to a subcutaneous tunnel establishment tool in a tunnel type PICC (peripherally inserted central catheter) catheterization and a using method thereof.

Background

The peripheral intravenous placement of a central venous catheter (PICC) is used as a safe and convenient venous access, is widely applied in clinic, particularly for patients needing chemotherapy or transfusion of hypertonic and irritant liquid, the PICC is the preferred mode, but due to certain limiting conditions, such as small preset tube vein diameter, poor blood vessel anatomical position, extreme skin looseness and the like, a lot of patients cannot smoothly place the PICC or have too high risk of catheter-related complications after placement, and the application of the tunnel type PICC placement technology well solves the problem.

As shown in figure 7 of the accompanying drawings, the tunneled PICC is a new technology for inserting a central venous catheter through a peripheral vein, and is different from the conventional PICC in that: the use of tunneled PICC placement techniques generally reduces the risk of thrombosis by creating a subcutaneous tunnel that places the vascular puncture site a distance from the catheter exit port and transfers the catheter exit port to a more suitable and advantageous location.

As shown in fig. 6, the conventional subcutaneous tunnel establishment method is analyzed according to the operation sequence in the operation of fig. a → B → C.

FIG. A: firstly, clamping a skin layer at a position a in a graph A by using an operation clamp, and cutting a small opening on the skin at the position a by using an operation knife; then clamping the skin layer at b in the graph A by using an operation clamp, and cutting a small opening on the skin at b by using an operation knife; and a → b, a subcutaneous tunnel is established.

And then, the solid tunnel needle is punctured from a → b subcutaneously, the tunnel needle needs to be carefully inserted slowly and at a constant speed in the puncturing process, the tissue damage caused by puncturing the intradermal tissue by the needle head of the tunnel needle is avoided, the postoperative infection is avoided, and the blood loss caused by puncturing the subcutaneous blood vessel is avoided as much as possible. However, in the whole process, on the premise of ensuring slow and uniform needle insertion, the penetration direction of the needle head is ensured, so that the needle head is prevented from puncturing intradermal tissues or subcutaneous blood vessels, and the requirement on an operating doctor is high.

And B: after the tunnel needle is pierced from a → b, the end of the PICC catheter is sleeved outside the tunnel needle, and then the PICC catheter is slowly and uniformly inserted from a → b along the guide direction of the tunnel needle, and the end edge of the PICC catheter can cut subcutaneous tissues or blood vessels in the process.

And (C) figure: after the PICC catheter a → b is punctured, the tunneled needle is withdrawn from the subcutaneous tunnel from side b, withdrawing the PICC catheter.

Subsequent book operations, not shown in the figures, are described as follows: the intravascular guide wire is pulled out and then inserted into an expansion tube with a tearing sheath; then the PICC catheter is placed into the dilating tube and is also placed into the blood vessel; then, a PICC catheter is further slowly placed into the expansion tube while tearing and stripping the sheath once; after the PICC catheter is completely placed into the dilating tube, the avulsion sheath is just completely detached.

The tunnel type PICC catheterization operation process has the advantages that in the process of establishing a subcutaneous tunnel and in the process of inserting a tunnel needle, on the premise of ensuring slow and uniform needle insertion, the needle insertion direction is ensured, so that the needle is prevented from puncturing intradermal tissues or subcutaneous blood vessels, and the requirement on an operating doctor is high. Also, the PICC catheter is slowly and uniformly advanced from a → b, during which the edge of the distal end of the PICC catheter may cut through the subcutaneous tissue or blood vessels. This is a problem to be solved. My design is a technical improvement on the establishment of a subcutaneous tunnel in the tunnel type PICC catheterization. He can greatly reduce the operation difficulty and avoid the damage of subcutaneous tissues or blood vessels.

Disclosure of Invention

The invention aims to provide a subcutaneous tunnel establishment tool in tunnel type PICC (peripherally inserted central catheter) catheterization, which avoids subcutaneous tissues or blood vessels from being damaged in the process of establishing a subcutaneous tunnel and enabling a PICC catheter to pass through the subcutaneous tunnel; simultaneously, the PICC catheter can be rapidly passed through the subcutaneous tunnel.

In order to achieve the purpose, the invention is realized by the following technical scheme:

the subcutaneous tunnel building tool in the tunnel type PICC catheterization comprises a tunnel needle and a needle inner push rod;

the tunnel needle comprises a needle tube and a needle head, wherein a cylindrical cavity and a spring cavity are arranged on one side of the needle tube close to the needle head, and a limiting convex ring is arranged between the cylindrical cavity and the spring cavity;

the rear end of the needle head is provided with a spherical part, a first cylindrical part, a second cylindrical part and a limiting flange; the cross section of the outer end of the spherical part is larger than the pipe diameter of the needle tube, the inner end of the spherical part is connected to one end of a first column part, the first column part is connected in a column cavity in a sliding mode, one end of a second column part is connected to the first column part, the second column part can penetrate through a limiting convex ring, the limiting flange is connected with the tail end of the second column part, a cavity between the limiting flange and the limiting convex ring is a spring cavity, and a reset spring is arranged in the spring cavity;

a sealing sleeve gasket capable of being bent and folded is arranged between the outer end of the spherical part and the tail end of the needle tube;

the needle inner push rod is arranged in the needle tube in a sliding connection mode, the inner end of the needle inner push rod is in contact with the limiting flange, and the outer end of the needle inner push rod penetrates out of the needle tube to be provided with a pressing seat.

The pipe holding clamp is characterized by further comprising a pipe holding clamp, a finger ring is arranged at the top of the pipe holding clamp, and a clamping ring seat is arranged at the bottom of the pipe holding clamp.

The tunnel needle rear end is equipped with the ring channel, the ring channel cooperatees with the clamping ring seat and adapts to.

A use method of a subcutaneous tunnel establishment tool in a tunnel type PICC (peripherally inserted Central catheter) catheterization comprises the following steps:

s1, assisting a doctor in an operation to pull back the skin of a patient on two sides of the subcutaneous tunnel to be built by hands so as to ensure that the skin on the subcutaneous tunnel to be built is compact and not loose;

s2, clamping a skin layer by using an operation clamp, cutting a small opening on the skin on two sides of the subcutaneous tunnel to be built by using an operation knife, and building the subcutaneous tunnel between the two small openings;

s3, the rear end of the needle tube of the tunnel needle is held by hand, the needle head is aligned to the incision on one side, the tunnel needle is pre-punctured by about 1cm, and the puncturing position is between the epidermis and the intradermal tissue;

s4, clamping the clamping ring seat in the annular groove to enable the tube holding forceps to clamp the tunnel needle, enabling the index finger and the middle finger of the doctor to penetrate through the ring to apply force to enable the tube holding forceps to stably clamp the tunnel needle, and pressing the pressing seat at the outer end of the push rod in the needle by the thumb;

s5, after the pressing seat is pressed, the push rod in the needle moves towards the needle tube, so that the combination of the limit flange, the second column part, the first column part, the spherical part and the needle head is pushed to probe towards one side far away from the needle tube, the probing stroke of the needle head is equal to the formation that the push rod in the needle moves towards the needle tube after the pressing seat is pressed, the epidermis and the intradermal tissue are separated in the stroke after the probing,

s6, then the pressing base is loosened, the combination of the limiting flange, the second column part, the first column part, the spherical part and the needle head is in a recovery state under the condition of paralysis resetting, the first column part at the inner end is in contact with the limiting convex ring for limiting, and the spherical part is in contact with the tail end of the needle tube for limiting;

s7, then pushing the tunnel needle inwards to move the tunnel needle for the travel distance of the step S5;

s8, repeating the steps S4-S5-S6-S7, and ensuring that the tunnel needle can move a certain distance after repeating the steps each time until the needle head of the tunnel needle extends out of the incision on the other side;

s9, after the needle head extends out of the incision on the other side, the tunnel needle is continuously pushed inwards until the end, close to the needle head, of the needle tube on one side extends out of the incision on the other side by 2-3 cm;

s10, taking out the push rod from the needle tube;

s11, inserting one end of the PICC catheter into the needle tube; until the tip of the PICC catheter can not be inserted deeply into the needle tube;

and S12, pulling out the whole tunnel needle from the incision on the other side, and exposing the tube head of the PICC catheter after the tunnel needle is pulled out from the incision on the other side, so that the PICC catheter can smoothly pass through the subcutaneous tunnel.

Compared with the prior art, the invention has the beneficial effects that:

according to the device and the using method in the technical scheme, the tunnel needle can move for a certain distance every time the pressing seat is pressed, and the distance is certain, so that uniform needle insertion is guaranteed. The subcutaneous tunnel is built by repeatedly pressing the pressing seat for many times. Thus, the attention of the doctor is only focused on the probing direction of the needle, so that the needle is better prevented from puncturing the intradermal tissue or the subcutaneous blood vessel. Moreover, unlike the prior art, the PICC catheter in the present technique is passed through the inside of the needle cannula of the tunneled needle, rather than being sheathed outside the tunneled needle, thus avoiding the possibility of the end edge of the PICC catheter scratching the subcutaneous tissue or the blood vessel, and enabling the PICC catheter to pass through the subcutaneous tunnel more rapidly.

In conclusion, by using the device, the subcutaneous tissue or the blood vessel can be better prevented from being damaged in the process of establishing the subcutaneous tunnel and passing the PICC catheter through the subcutaneous tunnel; simultaneously, the PICC catheter can be rapidly passed through the subcutaneous tunnel.

Drawings

FIG. 1 is a schematic structural diagram of the present invention.

FIG. 2 is a schematic view of the structure of the tunnel needle of the present invention.

FIG. 3 is a schematic view of the pipe holding pliers of the present invention.

FIG. 4 is a schematic illustration of the tunnel needle of the present invention when the needle is not extended.

FIG. 5 is a schematic view of the tunnel needle of the present invention after the needle tip has been extended for penetration.

Fig. 6 is a diagram of the steps of a method for establishing a subcutaneous tunnel in the prior art.

Fig. 7 is a tunnel PICC setup diagram.

Reference numerals shown in the drawings:

1. a tunnel needle; 2. a needle inner push rod; 3. a needle tube; 4. a needle head; 5. a cylindrical cavity; 6. a spring cavity; 7. a limit convex ring; 8. a spherical surface portion; 9. a first cylindrical portion; 10. a second column portion; 11. a limiting flange; 12. a return spring; 13. sealing sleeve gasket; 14. pressing the base; 15. a pipe holding clamp; 16. a ring; 17. a clamping ring seat; 18. an annular groove.

Detailed Description

The invention will be further illustrated with reference to the following specific examples. It should be understood that these examples are for illustrative purposes only and are not intended to limit the scope of the present invention. Further, it should be understood that various changes or modifications of the present invention may be made by those skilled in the art after reading the teaching of the present invention, and these equivalents also fall within the scope of the present application.

The invention relates to a subcutaneous tunnel building tool in tunnel type PICC (peripherally inserted central catheter) catheterization, which mainly comprises a tunnel needle 1 and a needle inner push rod 2; as shown in the attached drawing fig. 4 or the five-fold enlarged view of fig. 5 in the specification, the tunnel needle 1 comprises a needle tube 3 and a needle head 4, a cylindrical cavity 5 and a spring cavity 6 are arranged on one side of the needle tube 3 close to the needle head 4, and a limiting convex ring 7 is arranged between the cylindrical cavity 5 and the spring cavity 6; the rear end of the needle head 4 is provided with a spherical part 8, a first cylindrical part 9, a second cylindrical part 10 and a limiting flange 11; the sectional area of the outer end of the spherical part 8 is larger than the pipe diameter of the needle tube 3, the inner end of the spherical part 8 is connected to one end of a first cylindrical part 9, the first cylindrical part 9 is connected in a cylindrical cavity 5 in a sliding mode, one end of a second cylindrical part 10 is connected to the first cylindrical part 9, the second cylindrical part 10 can penetrate through a limiting convex ring 7, a limiting flange 11 is connected with the tail end of the second cylindrical part 10, a cavity between the limiting flange 11 and the limiting convex ring 7 is a spring cavity 6, and a return spring 12 is arranged in the spring cavity 6; a bendable and foldable sealing sleeve gasket 13 is arranged between the outer end of the spherical part 8 and the tail end of the needle tube 3, and the sealing performance of the whole tunnel needle 1 is guaranteed due to the design of the sealing sleeve gasket 13.

The needleinner push rod 2 is arranged in theneedle tube 3 in a sliding connection mode, the inner end of the needleinner push rod 2 is in contact with the limitingflange 11, and the outer end of the needleinner push rod 2 penetrates out of theneedle tube 3 to be provided with apress seat 14.

The device further comprises apipe holding clamp 15, afinger ring 16 is arranged at the top of thepipe holding clamp 15, and aclamping ring seat 17 is arranged at the bottom of thepipe holding clamp 15. The back end of thetunnel needle 1 is provided with anannular groove 18, and theannular groove 18 is matched and adapted with the clampingring seat 17. The clampingring seat 17 is clamped in theannular groove 18, so that thetunnel needle 1 is clamped by thetube holding forceps 15, the index finger and the middle finger of a doctor pass through thefinger ring 16 to apply force, thetunnel needle 1 is stably clamped by thetube holding forceps 15, and the thumb presses thepressing seat 14 at the outer end of thepush rod 2 in the needle.

s3, the rear end of aneedle tube 3 of thetunnel needle 1 is held by hand, aneedle head 4 is aligned to an incision on one side, thetunnel needle 1 is pre-punctured by about 1cm, and the puncturing position is between epidermis and intradermal tissue;

s4, clamping theclamping ring seat 17 in theannular groove 18 to enable thetube holding forceps 15 to clamp thetunnel needle 1, enabling the index finger and the middle finger of the doctor to pass through thefinger ring 16 to apply force to enable thetube holding forceps 15 to stably clamp thetunnel needle 1, and pressing thepressing seat 14 at the outer end of thepush rod 2 in the needle by the thumb;

s5, when thepressing seat 14 is pressed, the needle inner pushingrod 2 moves towards theneedle tube 3, so that the combination of the limitingflange 11, thesecond column part 10, thefirst column part 9, thespherical part 8 and theneedle head 4 is pushed to probe towards the side far away from theneedle tube 3, the probing stroke of theneedle head 4 is equal to the formation that the needle inner pushingrod 2 moves towards theneedle tube 3 after thepressing seat 14 is pressed, the epidermis and the intradermal tissue are separated in the stroke after probing,

s6, then thepressing base 14 is loosened, the combination of the limitingflange 11, thesecond column part 10, thefirst column part 9, thespherical part 8 and theneedle 4 is in a recovery state under the condition of paralysis resetting, thefirst column part 9 at the inner end is in contact with the limitingconvex ring 7 for limiting, and thespherical part 8 is in contact with the tail end of theneedle tube 3 for limiting;

s7, and then pushing thetunneling needle 1 inward to move thetunneling needle 1 by the stroke distance described in step S5;

s8, repeating the steps S4-S5-S6-S7, and ensuring that thetunnel needle 1 can move a certain distance after repeating the steps each time until theneedle head 4 of thetunnel needle 1 extends out of the incision on the other side;

s9, after theneedle head 4 extends out of the notch on the other side, thetunnel needle 1 continues to be pushed inwards until the end, close to theneedle head 4, of theneedle tube 3 extends out of the notch on the other side by 2-3 cm;

s10, taking out theneedle push rod 2 from theneedle tube 3;

s11, inserting one end of the PICC catheter into theneedle tube 3; until the tip of the PICC catheter cannot be inserted further into theneedle cannula 3;

and S12, pulling out thewhole tunnel needle 1 from the incision on the other side, and exposing the head of the PICC catheter after thetunnel needle 1 is pulled out from the incision on the other side, so that the PICC catheter can pass through the subcutaneous tunnel smoothly.

According to the device and the using method in the technical scheme, thetunnel needle 1 can move for a certain distance every time thepressing seat 14 is pressed, and the distance is constant, so that uniform needle insertion is guaranteed. The establishment of the subcutaneous tunnel is performed by repeatedly pressing the pressing base 14 a plurality of times. Thus, the attention of the physician needs to be focused only on the probing direction of theneedle 4, thereby better preventing theneedle 4 from puncturing the intradermal tissue or subcutaneous blood vessel. Moreover, unlike the prior art, the PICC catheter in the prior art is passed through the inside of theneedle tube 3 of thetunnel needle 1 instead of being sleeved outside thetunnel needle 1, so that the possibility that the end edge of the PICC catheter cuts the subcutaneous tissue or the blood vessel is avoided, and the PICC catheter can more quickly pass through the subcutaneous tunnel.

Claims

1. Subcutaneous tunnel establishes apparatus in tunnel type PICC puts a tub art, its characterized in that: comprises a tunnel needle (1) and an inner needle push rod (2);

the tunnel needle (1) comprises a needle tube (3) and a needle head (4), one side, close to the needle head (4), of the needle tube (3) is provided with a cylindrical cavity (5) and a spring cavity (6), and a limiting convex ring (7) is arranged between the cylindrical cavity (5) and the spring cavity (6);

the rear end of the needle head (4) is provided with a spherical part (8), a first column part (9), a second column part (10) and a limiting flange (11); the cross section area of the outer end of the spherical part (8) is larger than the pipe diameter of the needle tube (3), the inner end of the spherical part (8) is connected to one end of a first column part (9), the first column part (9) is connected in a column cavity (5) in a sliding mode, one end of a second column part (10) is connected to the first column part (9), the second column part (10) can penetrate through a limiting convex ring (7), a limiting flange (11) is connected with the tail end of the second column part (10), a cavity between the limiting flange (11) and the limiting convex ring (7) is a spring cavity (6), and a reset spring (12) is arranged in the spring cavity (6);

a sealing sleeve gasket (13) which can be bent and folded is arranged between the outer end of the spherical part (8) and the tail end of the needle tube (3);

the needle inner push rod (2) is arranged in the needle tube (3) in a sliding connection mode, the inner end of the needle inner push rod (2) is in contact with the limiting flange (11), and the outer end of the needle inner push rod (2) penetrates out of the needle tube (3) to be provided with a pressing seat (14).

2. The subcutaneous tunnel establishment tool in tunnel type PICC catheterization of claim 1, characterized in that: the pipe clamping device is characterized by further comprising pipe clamping pliers (15), wherein a finger ring (16) is arranged at the top of the pipe clamping pliers (15), and a clamping ring seat (17) is arranged at the bottom of the pipe clamping pliers (15).

3. The subcutaneous tunnel establishment tool in tunnel type PICC catheterization of claim 1, characterized in that: the tunnel needle (1) is characterized in that an annular groove (18) is formed in the rear end of the tunnel needle, and the annular groove (18) is matched and adapted with the clamping ring seat (17).

4. A method of using the subcutaneous tunnel establishment tool in the tunnel PICC catheterization of claims 1-3, characterized in that:

the method comprises the following steps:

s3, the rear end of a needle tube (3) of the tunnel needle (1) is held by hand, a needle head (4) is aligned to an incision on one side, the tunnel needle (1) is pre-punctured by about 1cm, and the puncturing position is between epidermis and intradermal tissue;

s4, clamping the clamping ring seat (17) in the annular groove (18) to enable the tube holding forceps (15) to clamp the tunnel needle (1), enabling the index finger and the middle finger of a doctor to pass through the ring (16) to apply force to enable the tube holding forceps (15) to stably clamp the tunnel needle (1), and pressing the pressing seat (14) at the outer end of the push rod (2) in the needle by the thumb;

s5, after the pressing seat (14) is pressed, the needle inner push rod (2) moves towards the needle tube (3) to push the combination of the limiting flange (11), the second column part (10), the first column part (9), the spherical part (8) and the needle head (4) to probe towards one side far away from the needle tube (3), the probing stroke of the needle head (4) is equal to the formation that the needle inner push rod (2) moves towards the needle tube (3) after the pressing seat (14) is pressed, and the epidermis and the intradermal tissue are separated in the probing stroke,

s6, then the pressing seat (14) is loosened, the combination of the limiting flange (11), the second column part (10), the first column part (9), the spherical part (8) and the needle head (4) is in a recovery state under the condition of paralysis resetting, the first column part (9) at the inner end is in contact limiting with the limiting convex ring (7), and the spherical part (8) is in contact limiting with the tail end of the needle tube (3);

s7, then pushing the tunnel needle (1) inwards to move the tunnel needle (1) for the stroke distance of the step S5;

s8, repeating the steps S4-S5-S6-S7, and ensuring that the tunnel needle (1) can move a certain distance after repeating the steps each time until the needle head (4) of the tunnel needle (1) extends out of the incision on the other side;

s9, after the needle head (4) extends out of the cut on the other side, the tunnel needle (1) continues to be pushed inwards until the end, close to the needle head (4), of the needle tube (3) on one side extends out of the cut on the other side by 2-3 cm;

s10, then the needle inner push rod (2) is taken out from the needle tube (3);

s11, inserting one end of the PICC catheter into the needle tube (3); until the head of the PICC catheter can not be inserted deeply in the needle tube (3);

and S12, pulling out the whole tunnel needle (1) from the incision on the other side, and exposing the head of the PICC catheter after the tunnel needle (1) is pulled out from the incision on the other side, so that the PICC catheter can smoothly pass through the subcutaneous tunnel.