CN211132392U - Percutaneous left heart drainage tube - Google Patents

Abstract

The utility model discloses a percutaneous left heart drainage tube, which comprises a drainage tube and an infusion tube, wherein the drainage tube comprises a ventricle section positioned in a left ventricle and an artery section positioned in a main artery outside the left ventricle, and an included angle is formed between the ventricle section and the artery section; the ventricular segment consists of an inhalation segment and a non-inhalation segment, the inhalation segment is positioned at the tail end, and a plurality of inhalation side holes are formed in the wall of the inhalation segment; the arterial segment end has a first connector; the perfusion tube is positioned outside the drainage tube, and the tail end of the perfusion tube is provided with a second connector at the first connector; the head end of the perfusion tube is provided with a perfusion tube opening, and the perfusion tube opening is positioned at the artery section above the ventricle section; the non-suction section, the artery section and the perfusion tube of the drainage tube are sleeved with plastic spring rings; the utility model discloses only need a intubate when using, just can constitute a complete blood circulation pipeline, drainage ventricle blood is beaten in the aorta, reduces the operation risk, reduces patient's pain.

Description

Percutaneous left heart drainage tube

Technical Field

The utility model relates to a percutaneous left heart drainage tube for from the internal drainage of ventricle, to aorta output, drainage ventricle blood gets to the aorta promptly.

Background

Heart failure is a worldwide public health problem, has high incidence rate, poor treatment prognosis and heavy economic burden of diseases. Worldwide incidence of 30-65 years of age: 1.5-2%, the incidence rate of people older than 65 years is 6-10%, and the incidence rate is in continuous rising. Heart failure therapies include drug therapy, cardiac resynchronization therapy, heart transplantation, and mechanical assisted circulation. Although the drug treatment of heart failure is constantly optimized, studies have shown that overall 5-year survival rates do not exceed 50%, with end-stage heart failure survival rates being lower.

The ventricular assist device can reduce the work of the heart and provide circulation support, and since 20 th century 60 is used for clinical treatment, the ventricular assist device is not only used for treating acute heart failure in the perioperative period, but also can be used for transition to heart transplantation treatment (BTT), so that the life quality of a patient is improved, the recovery of the cardiac function is promoted, the survival rate is improved, and the ventricular assist device is applied to a part of patients with reversible heart failure, so that the cardiac function of the patient can be recovered. The ventricle auxiliary device is divided into a pulsating blood flow pump and a continuous blood flow pump according to the driving type of the blood pump, the pulsating blood flow pump is eliminated due to thrombus and equipment stability problems, the continuous blood flow pump is divided into an axial flow pump and a centrifugal pump, the axial flow pump is small in size but high in rotating speed, and the blood damage risk is high; the centrifugal pump has the advantages of low rotating speed and high efficiency. Whether the implant is in vivo or not is classified into an implantation-assisted type and a percutaneous-assisted type.

Implantable left ventricular assist devices require surgery to establish left ventricular access to the aorta under extracorporeal circulation, and not all patients are able to tolerate surgery. In addition, studies have shown that patients with severe cardiogenic shock experience a higher post-operative mortality rate if implanted with a long-term left ventricular assist device. The percutaneous ventricular device can be quickly placed to achieve left ventricular unloading, reduce left ventricular filling pressure and left ventricular volume, increase cardiac output, and restore perfusion to vital organs.

All centrifugal pump driven percutaneous ventricular assist devices all require two cannulas, one drainage tube, one infusion tube, such as the extracorporeal membrane pulmonary oxygenation system (ECMO), which draws venous blood through a venous catheter (15-29Fr) placed in the femoral vein, injects oxygenated blood through an arterial catheter (15-23Fr) in the femoral artery after transpulmonary oxygenation, the disadvantage is that two cannulas are required and this way of intubation causes an increase in left ventricular afterload, resulting in left ventricular blood pooling, which may lead to an increase in left ventricular end diastolic pressure (L VEDP), Pulmonary Capillary Wedge Pressure (PCWP) and a decrease in stroke volume for cardiogenic shock patients, further exacerbating the left ventricular engorgement state and risk of bleeding at the point of intubation, distal limb ischemia risk.

As mentioned earlier the centrifugal pump, perhaps a single Impella, is a percutaneously implanted axial flow ventricular assist device that pumps left ventricular blood into the aorta by transfixing a mini-axial flow pump connected to the end of a pigtail catheter through the aortic valve via femoral artery puncture. The disadvantages are as follows: the small axial flow pump needs high rotating speed (33000-.

The intubation mode and intubation type of the percutaneous ventricular assist device largely determine the clinical effect of ventricular assist, the intubation speed, the incidence rate of complications, the applicable environment and the like.

In summary, how to design a proper cannula to realize quick, effective and safe auxiliary circulation establishment, simplify the operation process, and reduce the ventricular load by realizing left cardiac drainage in cooperation with a ventricular assist device becomes a problem to be solved by those skilled in the art. The intubation tube of the existing percutaneous ventricular assist device is basically placed through femoral artery and vein, a centrifugal pump is connected in vitro, the centrifugal pump is connected with another intubation tube inserted into artery, a complete blood circulation path is formed, and the blood of the drainage ventricle is delivered to the aorta. The intubation method needs to perform secondary intubation on a human body, has certain operation risk, and has obvious defects that people also need to suffer from twice pain.

SUMMERY OF THE UTILITY MODEL

The utility model aims to solve the technical problem that a percutaneous left ventricle drainage tube is provided, can realize that an intubate can cooperate the centrifugal pump to carry out the left ventricle supplementary, direct drainage left ventricle blood.

In order to solve the technical problem, the percutaneous left heart drainage tube of the utility model comprises a drainage tube and an infusion tube, wherein the drainage tube comprises a ventricle section positioned in the left ventricle and an artery section positioned in the main artery outside the left ventricle, and an included angle is formed between the ventricle section and the artery section; the ventricular segment consists of an inhalation segment and a non-inhalation segment, the inhalation segment is positioned at the tail end, and a plurality of inhalation side holes are formed in the wall of the inhalation segment; the arterial segment end has a first connector; the perfusion tube is positioned outside the drainage tube, and the tail end of the perfusion tube is provided with a second connector at the first connector; the head end of the perfusion tube has a perfusion orifice located at the arterial segment above the ventricular segment, in particular, at 5.5cm of the arterial segment above the ventricular segment (i.e. at the brachiocephalic rod opening). The brachiocephalic trunk is the first branch of the aorta from the heart, and the opening of the perfusion tube can ensure more branch blood supply if the opening is sent from the ascending aorta or the aortic arch part close to the brachiocephalic trunk, so that the ventricular assist device has the possibility of providing full flow; however, if the perfusion opening is too close to the aortic valve opening, perfusion blood flow may form hedging blood flow with the ejection blood of the ventricle, and the opening of the aortic valve is blocked, so that the perfusion tube opening is positioned at the position of the brachiocephalic rod opening by the pipeline, and the influence of perfusion blood flow on the aortic valve opening is reduced on the premise of ensuring more branch blood supply. The non-suction section, the artery section and the perfusion tube of the drainage tube are sleeved with plastic spring rings.

The drainage tube and the perfusion tube are composed of double-cavity tubes, and films are arranged in the double-cavity tubes and divide the double-cavity tubes into the drainage tube and the perfusion tube.

The drainage tube and the perfusion tube are both provided with gold mark points. The gold mark point can display high echo under ultrasound or X-ray, thereby being convenient for positioning; the drainage tube gold mark point is used for positioning the position of the drainage tube in the ventricle and is generally placed at the aortic valve, and the perfusion tube opening mark point is relatively positioned near the head and arm trunk.

And a perfusion tube core is arranged in the perfusion tube. The tube is thin-walled polyurethane or medical PVC, requiring a tube core support, and the tube core does not extend completely through the tube because the tube is required to bend within the aorta.

And a perfusion tube cap is arranged at the second joint of the perfusion tube. The conduit is inserted into the blood vessel, because the pressure conduit of the femoral artery blood vessel is filled with high-pressure blood, the conduit cap is required to block the blood flow, and the perfusion conduit cap can pass through the needle core.

And a drainage tube cap is arranged at the first joint. The tube cap of the drainage tube can only pass through the guide wire, and the guide wire always passes through the whole length of the drainage tube in the tube placing process to be used as the guide for placing the tube.

The perfusion tube is provided with a perfusion tube tee joint. The perfusion tube tee joint can be used for exhausting, measuring pressure and sampling.

The pipe inboard is provided with the reinforcement ring, and the reinforcement ring (like C type) is consolidated, does not block mouth of pipe flow, can consolidate the pipeline simultaneously.

During the use, the intubate will once the utility model discloses insert in the aorta, centrifugal pump's import, export are connected respectively to first joint, the second joint outside the aorta, and the centrifugal pump passes through the drainage tube and goes out ventricular blood drainage, pumps through filling the pipe, and the mouth of pipe that fills of filling the pipe is located aorta department, realizes squeezing into the aorta with the blood in the filling tube.

The utility model discloses only need a intubate when using, just can constitute a complete blood circulation pipeline, drainage ventricle blood is beaten in the aorta, reduces the operation risk, reduces patient's pain.

Drawings

The present invention will be described in further detail with reference to the accompanying drawings and specific embodiments.

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

Fig. 2 is a sectional view of the present invention.

Fig. 3 is a schematic view of the front end of the infusion tube.

FIG. 4 is a schematic view of a dual lumen tube.

Detailed Description

As shown in fig. 1, 2, 3 and 4, the percutaneous left heart drainage tube comprises a drainage tube 1 and an infusion tube 2, for example, the drainage tube 1 and the infusion tube 2 are formed by a double-lumen tube (in this case, a connection tube is required to be connected outside the two lumens), and as shown in fig. 4, a film 9 (polyurethane film) is arranged in the double-lumen tube, and the film 9 divides the double-lumen tube into the drainage tube 1 and the infusion tube 2.

The drainage tube 1 comprises a ventricle section positioned in the left ventricle and an artery section 5 positioned in the main artery outside the left ventricle, and an included angle is formed between the ventricle section and the artery section 5. The ventricular segment consists of an inhalation segment 3 and a non-inhalation segment 4, the inhalation segment 3 is positioned at the tail end (the tail end is connected with a pigtail tube 7), and a plurality of inhalation side holes are arranged on the tube wall of the inhalation segment 3; the arterial segment 5 ends with a first connector for connection to a centrifugal pump inlet.

The perfusion tube 2 is positioned outside the drainage tube 1, and the tail end of the perfusion tube 2 is provided with a second connector at the first connector for connecting the outlet of the centrifugal pump. The head end of the perfusion tube 2 has a perfusion tube opening 8, the perfusion tube opening 8 is located at the artery section 5 above the ventricle section, specifically, the perfusion tube opening 8 is located at 5.5cm of the artery section 5 above the ventricle section (i.e. the head arm rod opening). The downstream of the perfusion tube opening 8 is closed, so that a wedge-shaped platform is formed at the reducing positions of the perfusion tube 2 and the drainage tube 1, wherein the angle between the wedge-shaped platform and the pipeline (the drainage tube 1) is 30 degrees, the reducing tube can be conveniently and smoothly inserted at a lower platform angle, the surface of the wedge-shaped platform is smooth and hardened, and the wedge-shaped platform needs to cut the blood vessel when passing through, so that the pipeline is prevented from being cut while the blood vessel is cut.

In order to play a role of supporting and fixing, the non-suction section 4, the artery section 5 and the perfusion tube 2 of the drainage tube 1 are externally sleeved with a plastic spring ring 6.

The drainage tube 1 and the perfusion tube 2 are composed of double-cavity tubes, films 9 are arranged in the double-cavity tubes, and the double-cavity tubes are divided into the drainage tube 1 and the perfusion tube 2 by the films 9.

The drainage tube 1 and the perfusion tube 2 are both provided with gold mark points. The gold mark point can display high echo under ultrasound or X-ray, thereby being convenient for positioning; the drainage tube gold mark point is used for positioning the position of the drainage tube 1 in a ventricle and is placed at the aortic valve, and the perfusion tube orifice mark point is relatively positioned near the head and arm trunk.

An infusion tube core 10 is arranged in the infusion tube 2. The tube is thin-walled polyurethane or medical PVC, requiring a tube core support, and the tube core does not extend completely through the tube because the tube is required to bend within the aorta.

A second joint of the perfusion tube 2 is provided with a perfusion tube cap. The conduit is inserted into the blood vessel, because the pressure conduit of the femoral artery blood vessel is filled with high-pressure blood, the conduit cap is required to block the blood flow, and the perfusion conduit cap can pass through the needle core.

A drainage tube cap 12 is arranged at the first joint. The drainage tube cap 12 can only pass through the guide wire, and the guide wire always passes through the whole length of the drainage tube in the tube placing process to be used as the guide for placing the tube.

The perfusion tube 2 is provided with a perfusion tube tee joint 11. The perfusion tube tee joint 11 can be used for exhausting, measuring pressure and sampling.

The 2 inboard reinforcing rings that are provided with of filling pipe, reinforcing ring (like the C type) are consolidated, do not block mouth of pipe flow, can consolidate the pipeline simultaneously.

Pipe arranging process:

1. patient supine position, slightly flexed knee joint, straightened hip joint and slightly abducted outward, femoral artery location: taking 2-3cm below the junction of the anterior superior iliac spine and the middle-inner segment of the connection line of the pubic tubercle at the femoral artery pulsation as a starting point, and making an incision of about 5cm longitudinally.

2. The free femoral artery is exposed by about 5cm, the vascular sheath is cut off, and two circles of rubber bands are sleeved under the femoral artery (the two circles of ligation are noticed to prevent the blood vessel from slipping).

3. The rubber belt is lifted, the distal end of the femoral artery is slightly lifted, and certain blood vessel tension is kept. The needle body and the vessel wall form an angle of 30 degrees, the needle is inserted under negative pressure, the angle is reduced as much as possible, the needle tip is prevented from penetrating through the front wall and the rear wall of the vessel, the needle tip is felt to break through the front wall of the vessel, and blood is pumped back.

4. And (3) pressing down the needle handle, firstly placing the guide wire by about 50cm along the puncture needle, ensuring that the guide wire is unobstructed, then ultrasonically displaying the long axis of the ventricle, continuously conveying the guide wire into the ventricle through the aortic valve under the positioning of the ultrasound, and displaying high echo in the ventricle by the guide wire.

5. The puncture needle is taken out along the guide wire after the guide wire is placed in, the guide wire is prevented from being taken out, a small amount of bleeding possibly occurs at the periphery of the guide wire after the puncture needle is taken out, and the temporary gauze compression can be realized.

6. The tearing sheath with the stylet is placed along the guide wire, the front end of the stylet is placed into the blood vessel in a rotating mode until the stylet and the tearing sheath are difficult to insert, the blood vessel can be cut a little along the blood vessel direction by a sharp knife, the tearing sheath body is placed into the blood vessel, and the tearing sheath stylet is pulled out.

7. The percutaneous left heart drainage tube is sent into a blood vessel along a guide wire through a tearing sheath (note that before the pipeline is placed, physiological saline is completely soaked and washed to prevent the generation of wall-attached bubbles in the intubation process; the pigtail catheter needs to face the inner side of an intubation thigh, a perfusion opening needs to face the outer side of the intubation thigh), the ventricular section of the drainage tube can be torn through the tearing sheath, when the distance of the perfusion tube opening is about 3cm from the tearing sheath, the two sides of the tearing sheath are torn and gradually exit from the femoral artery, and meanwhile, the ventricular section of a single double-cavity femoral artery intubation is completely inserted into the blood vessel.

8. The reducing position of the single percutaneous left heart drainage tube is provided with a wedge-shaped step, as shown in figure 3, the wedge-shaped step is positioned at the position of the perfusion tube opening 8 and is formed by closing the perfusion tube 2 at the downstream of the perfusion tube opening 8. This location is a gradual transition (reducing) wedge shape due to the cannula requirements. The cannula can be opened when the cannula reaches the wedge-shaped step, the blood vessel can be cut along the long axis of the blood vessel by a sharp knife, the wedge-shaped part is completely sent into the blood vessel, then the cannula can be opened, the tube core and the tube cap can be taken out when the whole length 1/2 of the tube is immersed into the blood vessel (note that high-pressure blood in the tube can gush out when the tube core tube cap is taken out, so that when the tube core is pulled out, the tube core is immediately closed by using a tube blocking clamp, the tube core is withdrawn firstly, the tube blocking clamp is fastened before the tube core is separated from the tube cap.

9. When the total length 1/3 of the pipeline is immersed in a blood vessel, the heart ultrasonic assistance is needed, the long axis of the ventricle is displayed, the visible strong echo pipeline passes through the aortic arch and the ascending aorta, when the pigtail catheter and the front end of the catheter completely pass through the aortic valve after being sucked into the hole part, the guide wire and the pipe cap can be withdrawn (note that when the pipe cap and the guide wire are pulled out, the drainage pipeline is clamped by the pipeline blocking clamp immediately), and the gold mark point of the pipeline is positioned at the position of the aortic valve.

10. Also note that cardiac ultrasound is used to observe the location of the perfusion orifice, located proximal to the brachiocephalic trunk. After the position of the pipeline is correct, the pipeline fixer is fixed on the leather surface and can be connected with a centrifugal pump in an exhaust way.

During the use, an intubate will the utility model discloses insert in the aorta, centrifugal pump's import, export are connected respectively to first joint, the second joint outside the aorta, and centrifugal pump work passes through the drainage tube with the blood in the left ventricle and pumps, enters into filling tube 2 along the drainage tube, and filling tube 2's the mouth of pipe 8 that fills is located aorta department, realizes squeezing into the aorta with the blood in filling tube 2.

The above-mentioned embodiment does not limit the utility model in any way, and all the technical solutions that adopt the mode of equivalent replacement or equivalent transform to obtain all fall within the protection scope of the utility model.

Claims (9)

1. The percutaneous left cardiac drainage tube is characterized by comprising a drainage tube (1) and an infusion tube (2), wherein the drainage tube (1) comprises a ventricle section positioned in a left ventricle and an artery section (5) positioned in a main artery outside the left ventricle, and an included angle is formed between the ventricle section and the artery section (5); the ventricular segment consists of an inhalation segment (3) and a non-inhalation segment (4), the inhalation segment (3) is positioned at the tail end, and a plurality of inhalation side holes are formed in the tube wall of the inhalation segment (3); the end of the artery segment (5) is provided with a first joint; the perfusion tube (2) is positioned outside the drainage tube (1), and the tail end of the perfusion tube (2) is provided with a second connector at the first connector; the head end of the perfusion tube (2) is provided with a perfusion tube opening (8), and the perfusion tube opening (8) is positioned at the artery section (5) above the ventricle section; the non-suction section (4) of the drainage tube (1), the artery section (5) and the perfusion tube (2) are sleeved with plastic spring rings (6).

2. The percutaneous left cardiac drainage tube of claim 1, wherein: the perfusion orifice (8) is located 5.5cm from the arterial segment (5) above the ventricular segment.

3. The percutaneous left cardiac drainage tube of claim 1, wherein: the drainage tube (1) and the perfusion tube (2) are composed of double-cavity tubes, a film (9) is arranged in each double-cavity tube, and the double-cavity tubes are divided into the drainage tube (1) and the perfusion tube (2) by the film (9).

4. The percutaneous left cardiac drainage tube of claim 1, wherein: the drainage tube (1) and the perfusion tube (2) are both provided with gold mark points.

5. The percutaneous left cardiac drainage tube of claim 1, wherein: a perfusion tube core (10) is arranged in the perfusion tube (2).

6. The percutaneous left cardiac drainage tube of claim 1, wherein: a perfusion tube cap is arranged at the second joint of the perfusion tube (2).

7. The percutaneous left cardiac drainage tube of claim 1, wherein: and a drainage tube cap is arranged at the first joint.

8. The percutaneous left cardiac drainage tube of claim 1, wherein: the perfusion tube (2) is provided with a perfusion tube tee joint (11).

9. The percutaneous left cardiac drainage tube of claim 1, wherein: the inner side of the perfusion tube (2) is provided with a reinforcing ring.

Images