WO1983002064A1

WO1983002064A1 - Catheter for central veins

Info

Publication number: WO1983002064A1
Application number: PCT/EP1982/000270
Authority: WO
Inventors: Gesellschaft Für Medizinischen Bedarf ... Sterimed
Original assignee: Kramann, Bernhard; Rust, Meinhard
Priority date: 1981-12-17
Filing date: 1982-12-17
Publication date: 1983-06-23
Also published as: DK164988B; DK375083D0; DE3150052C2; EP0082504A1; DE3271594D1; FI832781A; US4509945A; DK164988C; DK375083A; FI832781A0; FI71491B; ATE20190T1; EP0082504B1; FI71491C; DE3150052A1

Abstract

The catheter comprises a guiding wire (3) of which the end (4) is bent as the grip of a walking-stick. Such arrangement allows a safe and fast catheterization of the central veins through a peripheral access.

Description

Central vein catheter

Technical field

The invention relates to a catheter for catheterizing central veins via peripheral venous access.

State of the art

Central vein catheters (vena cava) play an important role in shock treatment, in determining central venous blood pressure or monitoring it during surgical interventions and in parenteral nutrition. Depending on the point of entry of the catheter into the human body, a distinction is made between the central access routes and the peripheral access routes. In the first case, access is via the jugular vein, anonymous vein, or subclavian vein, while in the second case, access is through leg or arm veins. The catheterization via a central access path has the advantage that the catheter is in a relatively large lumen; Vessel that has no venous valves, can be placed and the path to the vena cava is short. A disadvantage of the central access routes, however, is that it is difficult to find the veins that are suitable for a function and. due to the close proximity of. large arteries require special caution. The puncture cannula only reaches the anonymous vena at a depth of approximately 5 cm. To puncture the jugular vein, the puncture cannula must be guided through the sternocleidomastoid muscle at a certain angle to the skin surface in order to hit the vein at a depth of 3 to 4 cm, which runs immediately next to the carotid artery. The catheterization of central veins via a central access can therefore only be carried out largely safely by particularly experienced and experienced doctors, such as anesthetists in particular. For less experienced or unfavorable external circumstances, such as the care of accident victims at the scene of an accident or in the rescue vehicle or plane, access to the central veins is via a peripheral vein, i.e. a leg vein or an artery. vein, preferable because these veins are usually well visible through the skin, or can be made easy to find by briefly tying the leg or upper arm. However, advancing the catheter is more difficult when accessing via a peripheral vein, on the one hand because the path to the vena cava is significantly longer, and on the other hand because the peripheral veins have a smaller inner diameter and venous valves also have to be overcome.

Therefore, with a considerable percentage of catheterizations via peripheral access, difficulties arise when advancing the catheter tube: for example, the tube tip can take a wrong path (via falsa), get caught on venous valves or vascular branches, and life-threatening complications such as embolism or bleeding in the thorax. There is therefore a need to improve the previously practiced methods of central vein catheterization via a peripheral access and to provide a corresponding catheter. The object of the invention was to provide a new catheter for the catheterization of central veins via a peripheral access, which allows central venous catheterization, "especially also in emergency situations under the often unfavorable environmental conditions of an accident site or in an ambulance. and aircraft, safely and quickly.

Description of the invention

It has now been found that the catheterization of the superior vena cava via a peripheral venous access can be carried out significantly better and without complications with a catheter which is equipped with a guide wire, the front elastic end of which is curved like a walking stick. This finding is very surprising, since it was previously assumed that such curly-like styled mandrins were not suitable for advancement in veins because they would cause injuries there, for example to the venous claps.

OMPI The invention therefore relates to a catheter for catheterizing central veins via peripheral venous accesses, comprising a catheter tube with an inner diameter of 0.5 to 2 mm, an outer diameter of 0.7 to 2.4 mm and a length of 400 to 800 mm, with guidewire d is curved like a walking stick at its distal end over a distance of 15 to 30 mm. Peripheral venous access means in particular the access via the veins in the area of the elbow and the back of the hand. In order to simplify the insertion of the catheter tube into the venous cannula, a new displacement device is proposed according to the invention, which is characterized in that the mutual displacement ¬ availability of catheter and guide wire is limited by abutment devices. The mutual displacement path preferably corresponds approximately, but at least to the length of the curved distal end of the guide wire. In the front stop position, the curved end of the guide wire protrudes from the distal end of the catheter tube. In the rear stop position, the curved end of the guide wire is withdrawn in the distal end of the catheter tube.

1 and 5 show ready-to-use venous catheters.

Fig. 2 shows a catheter with the guidewire withdrawn.

3 and 4 show shifting devices.

The invention is based on the Fi g. 1 to 5 explained in more detail:

Fi g. 1 shows in simplified form an embodiment of the catheter according to the invention packed in a plastic sleeve 6, the distal end 7 of which may be formed to a point if desired, the tip of the distal being used when the catheter is used End 7 can be cut off or can be pierced by means of the catheter tip 2. The curved end 4 of the guide wire 3 also protrudes from the distal end 2 of the catheter lock 1.

OMPI Fig. 2 shows schematically the catheter with drawn into the catheter tube 1 curved distal end 4 of the guide wire 3. The two sleeves 12, 13 of the displacement device 9 are here in one end position, namely the rear stop position .

3 shows a schematic cross section through an embodiment of the displacement device 9. The inner sleeve 12 with the peripheral edge bead 14 encloses the proximal end 5 of the guide wire 3. The female sleeve 13 with a corresponding inner edge bead 15 on the proximal The paint end 5 is detachably placed on the catheter attachment piece 18 of the catheter tube 1 with its distal end, which is expanded in this embodiment, but which does not necessarily have to be the case. The proximal end 8 of the catheter tube 1 is firmly connected to the catheter attachment piece 18, for example it is glued or molded onto the catheter attachment piece. After the catheter has been introduced via a peripheral venous access and the catheter tip 2 has reached its destination in the central venous system, the method shown in FIGS. 1 indicated plastic sheath 6 together with the displacement device 9 together with the guide wire 3. Proximally separated from the catheter attachment piece 18. On . if desired, the catheter hub 18 can be connected via a conventional intermediate piece. corresponding receptacles, which are preferably conical, then a syringe, an infusion bottle or a pressure measuring device can be connected, for example.

FIG. 4 shows an alternative embodiment of the displacement device 9, the outer envelope having an axial guide slot 16 with two end-position snap-in slots preferably arranged perpendicularly thereto as stop devices. 10, - 11 and the inner sleeve 13 has a stop pin 17.

5 shows, similar to FIG. 1, a venous catheter packaged ready for use in a plastic sheath. In this embodiment, however, the plastic sleeve 6 ends in a sleeve 19. The sleeve 19, which, if desired, is equipped with holding wings 20, is attached to a catheter insertion part 21 known per se. The catheter insertion part 21 consists of two parts 22, 23 which can be separated from one another along the dividing line 31 as soon as the sleeve

19 is withdrawn. The displacement device 9 here consists of a proxi al closed with a cover 25 outer sleeve 33 with an axial guide slot 16 in which a piston 24 is movably arranged. The piston 24 is fixedly connected to the proximal end 5 of the guide wire 3 and carries a shift button 26. It goes without saying that the sleeve 33 diametrically opposite the guide slot 16 can have a second guide slot 16, in which a second shift button 26 of the piston correspondingly 24 is performed. The sliding device 9 is detachably screwed by means of a union nut 27, which is designed as a continuation of the sleeve 33, and has an internal thread with a catheter attachment piece 18. Above the connection cone 30 of the catheter connection piece 18, held in a circumferential groove 28, there is a freely rotatable union nut 29, with the aid of which the connection cone 30 of the catheter attachment piece 18 in the connection part of the venous cannula (not shown) can be secured (for example Luer lock) ).

The guidewire 3 fills the lumen of the catheter tube 1 as far as possible, but only to the extent that it is possible to shift against one another with as little friction as possible. In order to reduce the frictional forces between catheter tube 1 and guide wire 3, small amounts of a medically acceptable lubricant, such as glycerin or preferably silicone oil, can be used. The length of the end 4 of the guide wire curved like a walking stick is approximately 1.5 to 3 cm, preferably approximately 2 cm. The material, dimensions and physical behavior of the catheter ski 1 also correspond to that of conventional catheters for central veins. The inner diameter (lumen) of the catheter tube 1 is between -0.5 and 2.0, preferably 0.8 and 1.6, particularly preferably 1.1. and 1.2 mm. The outer diameter of the catheter tube 1 is between 0.7 and 2.4 mm. Preferred outer diameters are 1.4, 1.7 and 2.1 mm. The length of the catheter tube 1 should be approximately 40 to 80 cm, preferably approximately 60 cm. In order to be able to follow the introduction and position of the catheter tube 1 in the body by X-ray, it is expedient to Catheter tube 1 in the axial direction to provide at least one x-ray contrast strip, preferably at least two x-ray contrast strips distributed over the circumference. In order to enable the examiner to get an image of the position or feed length without X-ray imaging

f OMP to make the catheter tube 1, it is expedient to make markings and / or graduations in anatomically determined and / or at regular intervals. For example, a graduation with intervals of 50 mm is advantageous. The material and physical behavior of the guide wire 3 including the curved distal end 4 correspond to that in conventional catheters for arterial access. The guide wire 3 is, for example, a plastic-coated metal wire, the metal wire preferably ending before the beginning of the curvature of the distal end 4, which is curved like a walking stick, or is completely embodied as a plastic wire. The curvature of the distal end 4 is produced in the usual way, for example by appropriate stretching with heating. To the flexibility of the walking stick. To increase the curved distal end 4., it is expedient to set its diameter to about half to about three quarters of the diameter of the uncurved part of the guide wire 3.

This measure is a further subject of the invention. The radius of curvature of the distal end 4 is approximately between 1 and 10 mm.

The catheter according to the invention is expediently designed in such a way that it can be used directly under sterile cautery without the aid of further agents. In a particular embodiment, the catheter therefore comprises a puncture set that allows the vein to be punctured and the catheter to be inserted. A puncture set is advantageous here, which enables the procedure known to the person skilled in the art to be used: a flexible plastic cannula is pushed over a steel cannula, the ground tip of the steel cannula remaining free. After the puncture, the steel cannula is pulled out of the plastic cannula, while the plastic cannula remains in the vein. The catheter tube is then pushed through the plastic cannula into the vein. As soon as the distal end of the catheter has reached the desired target position, the plastic anula can also be withdrawn from the vein.

OM The catheter tube 1 with the guidewire 3 lying in it is expediently made available in a sterile manner in a transparent plastic protective cover 6, closed on both sides, for syringes or infusion tubes, together with the attachment 18 attached to the proximal end 8. The curved distal end 4 of the guide wire 3 protrudes from the distal end 2 of the catheter tube 1 during the storage of the catheter. By this measure that the guide wire 3 is impressed ^¬ adversely during Lager¬ time, the curvature of the curved end 4 is avoided.

Around the catheter tube 1 when in use in the vein. To be able to introduce le, the protruding in the plastic protective cover 6 from the catheter tube 1 distal e curved end 4 of the guide wire 3 into the catheter tube 1 by pulling on the proximal end 5 of the guide wire 3. Then, in the embodiment according to FIG. 1, the plastic protective sheath 6 is opened at its distal end 7 and the distal end 2 of the catheter tube 1 (catheter tip) is inserted into the cannula sitting in the vein. After the catheter tip is ben 2 vorgescho- by the Kunststoffkanü e to eini ge centimeters into the vein, wi the curved end 4 around the guide wire 3 back as far pushed out ^'from the catheter tip 2 so that it can assume its curved shape.

In the exemplary embodiment according to FIG. 5, the catheter guide guide part 21 is connected to the connection part of the plastic venous cannula via a connecting cone 32) and the curved distal end 4 of the guide wire 3 is moved into the rear stop position by moving the push button 26 Catheter tip 2 withdrawn. Then the catheter tip 2 is pushed through the catheter guide part 21 into the plastic venous cannula. The bore of the catheter insertion part 21 tapers in the direction of the venous cannula in a funnel-like manner to an inner diameter which corresponds approximately to the inner diameter of the venous cannula. This design makes it easier to thread the catheter tip 2 into the venous cannula. After the catheter tip 2 has penetrated a few centimeters in the vein from the distal end of the venous cannula, the curved end 4 of the guide wire 3 has been moved distally by shifting the shift button 26

OMP pushed out of the catheter tip 2 into the front stop position. The catheter tube 1 can now be advanced into the vein until the catheter tip has reached the desired location in the vena cava. Now the sleeve 19 of the plastic sheath 6 is withdrawn from the catheter insertion part 21. The two parts 22, 23 of the catheter guide 21 can now be separated from one another and the catheter introduction part 21 can thus be removed. The displacement device 9 is separated from the catheter hub 18. The plastic cover 6 and the displacement device 9 together with the guide wire 3 are then pulled off proximally. The connection cone 30 of the catheter attachment piece 18 can then be inserted into the connection receptacle of the venous cannula and secured by means of the union nut 29. The embodiment according to FIG. 5 enables the catheter according to the invention to be introduced with particularly little contamination.

The limited displaceability according to the invention, which preferably corresponds approximately to the length of the curved distal end 4 of the guide wire 3, can be achieved by various measures having the same effect. For example, catheter tube 1 and guide wire 3 are each concentric with one of two. mutually displaceable sleeves 12, 13 connected, the displaceability of which is determined by stops. The inside! i.egende of the two sleeves 12, 13 has spielsweise at the distal end a Umfangsrandwulst 14 and the outer ones of said two sleeves 12, 13 as Gegena nschlag ^'at the proximal end a Innenrandwulst 15. In another embodiment of the invention, the outer of the two sleeves 12, 13 has an axial guide slot 16 with two terminal snap-in slots 10, 11 perpendicular thereto, in which a stop pin 17 of the inner of the two sleeves 12, 13 runs, with which one bayonet-type mutual fixation of the two sleeves 12, 13 is achieved in the two end positions. As. the effect of the mutual limited displacement of the two sleeves 12, 13 by means of one or more threads is also considered to have the same effect.

"£ JRE OP The catheter according to the invention is preferably provided sterile together with a vein puncture cannula, in particular a venous cannula whose steel cannula is surrounded by a plastic cannula and whose steel cannula can be removed after the vein has been punctured. A so-called peel pack is preferred as common packaging.

The catheter according to the invention allows the rapid and low-complication catheterization of central veins via a peripheral venous access. Another advantage is that the catheter can be provided in a configuration or packaging that allows its use without the hands of the examiner coming into direct contact with the catheter.

The terms "proximal" and "distal" are seen in the context of the present invention from the perspective of the examiner, i.e. A proximal part of an embodiment according to the invention is closer to the examiner than a distal part during catheterization.

The invention relates to the embodiments described above, their patent law! Equivalent values and the subject matter of the claims.

OMF

Claims

- ιo -patent claims

1. Catheter for catheterizing central veins via peripheral vein accesses comprising a catheter tube (1), in particular a catheter tube (1) with an inside diameter of 0.5 to 2 mm, an outside diameter of 0.7 to 2.4 mm and a length of 400 to 800 mm, with guide wire (3) which is curved like a walking stick at its distal end (4) over a distance of 15 to 30 mm.

2. Catheter according to claim 1, characterized in that the diameter of the curved distal end (4) of the guide wire (3) is less than the diameter of the straight part of the guide wire (3).

3. Catheter according to claim 2, characterized in that the diameter of the curved distal end (4) of the guide wire (3) is about half to about three-quarters of the diameter of the straight part of the. Guide wire (3).

4. Catheter according to one of claims 1 to 3, characterized gekennzeich¬ net that a device (9) is provided, the mutual displacement of catheter tube (1). compared to the guide wire (3) to approximately the length of the curved distal end (4) of the guide wire (3) allowed.

5. Catheter according to claim 4, characterized in that in egg ner Verschiebendstel L ung the curved distele end (4) of the guide wire

(3) also protrudes from the distal end (2) of the catheter lock (1) and, in the other displacement end position, the curved distal end (4) of the guide wire (3) is completely in the distal end (2) of the catheter tube (1) is pulled in hi.

6. Catheter according to one of claims 4 or 5, characterized gekennzeich¬ net that the mutually limited displacement of the catheter tube (1) relative to the guide wire (3) by two concentric sleeves (12, 13), the egg ne is connected to the catheter tube (1) and the other is connected to the guide wire (3),

OI P - Γ-

given is.

7. Catheter according to claim 6, characterized in that the inner one of the two sleeves (12, 13) has a peripheral edge bead (14) as a stop and the outer face of the two sleeves (12, 13) has an inner edge bead (15) as a counter-stop.

8. Catheter according to claim 6, characterized in that the outer lying of the two sleeves (1'2, 13) has an axial guide slot (16) with two perpendicular end locking slots (10, 11) in which a stop pin (17) the inner of the two sleeves (12, 13) runs _. , having.

9. Catheter according to one of claims 4 or 5, characterized in that the mutual limited displaceability of catheter tube (1) relative to the guide wire (3) through a sleeve (33) with one or more axial guide slots (16), in which a piston (24) connected to the guide wire (3) and having one or more sliding knobs (26) running in the guide slots (1'6) runs _. , given is.

10.. Catheter according to claim 6, characterized in that the limited mutual displacement of the two sleeves (12, 13) is accomplished by one or more threads.

11. Catheter according to one of claims 1 to 10, characterized gekennzeich¬ net that it is surrounded by a plastic sheath (6).

12. Catheter according to claim 11, characterized in that the distal end (7) of the plastic sheath (6) tapers.

13. Catheter according to claim 12, characterized in that the dista¬ le end (7) of the plastic sheath (6) by means of the catheter tip (2) is designed to be penetrable.

14. Catheter according to claim 11, characterized in that the plastic sheath (6) is connected at the distal end with a sleeve (19) which can be plugged onto a catheter insertion part (21).

15. Catheter according to one of claims 1 to 14, characterized gekennzeich¬ net that it is provided together with a suitable venipuncture cannula in a package.

16. Catheter according to claim 15, characterized in that it is packaged in a peel pack.