DE102013100991A1 - Catheter with positioning system - Google Patents

Abstract

The invention relates to a catheter (2) with an upper (3) and a lower (4) end and with at least one first channel (5) connecting both ends, and with a positioning system for positioning the lower end (4) in a cavity system ( 1) a human body. The positioning system comprises a guide wire (6) which can be inserted and removed in the first channel (5) so as to be translationally and rotatably movable, and which is at least so long that a first partial area (7) of the guide wire (6) extends from the lower end (4) The first channel (5) can be pushed out, while a second partial area (8) at least partially always protrudes from the catheter (2) at the upper end (3) and a manipulation device (11) for translational and rotary movement of the guide wire (6) in the first channel (5) relative to the catheter (2). The invention is preferably applicable to so-called bronchus blockers (2, 19, 20) with an inflatable balloon (19), in particular in the form of a full torus which concentrically surrounds the catheter, in the region of its lower end (4), the positioning system for positioning the lower end End (4) in the airways of a patient, especially in the area of the bronchi. The guide wire (6) is in particular designed to be torsionally rigid and its first partial area (7) is at least partially flexible and pre-bent, preferably with a pre-bent tip area (9) in the form of approximately a quarter circle. The manipulation device (11) can be designed similar to a small medical syringe, the guide wire (6) being connected to the plunger of the syringe and being movable with it.

Description

The present invention relates to a catheter, in particular a so-called bronchus blocker, which can be positioned for treatment and / or diagnosis at specific locations in a cavity system of a body.

A known approach in the positioning of a catheter is to use as an aid an endoscope (eg a flexible fiber optic), the front end of which, when advancing in a cavity system, at least partially illuminates and images it, and possibly relatively well through a movable front segment a desired position can be advanced. A catheter carried by the endoscope or a catheter introduced via or through the endoscope can thus be brought into a desired position. However, in branched cavity systems, for example the bronchi of a lung, only a certain area can be achieved with such relatively thick instruments. Also, the overview is easily lost if the tip of the endoscope is possibly misdirected at a turn.

One of the essential ideas of the present invention is therefore to be able to move a catheter independently of an endoscope and to be able to precisely position its tip, wherein this movement can be monitored and tracked by a distance-guided endoscope. This will be explained below by way of example with reference to specific applications.

Thoracic interventions, for example, and particularly at the lung, often require so-called one-lung ventilation, i. Ventilation of the anaesthetized patient then takes place only via the lungs of the non-operated side. The lung of the site to be operated is then functionally switched off for ventilation. For one-lung ventilation, either a special breathing tube with two ventilation lumens (= double-lumen tube) or a 50 to 80 cm long, special catheter with a tip inflatable balloon (= bronchial blocker) are available.

In contrast to the double-volume tube, in which one respiratory lumen leads to the left and the other to the right lung, a bronchus blocker does not have a ventilation lumen, but at most a small lumen through which air can be sucked out of the switched-off lung.

In both the double-lumen and the bronchial blocker, the lung (s) are closed by means of an inflatable balloon (also called a cuff). In the case of the double-lumen subcuvette, after the cuff has been inflated, it is only possible to ventilate the lungs of this side through the ventilation lumen facing the non-operating side. By inflating the cuff of the bronchial blocker, however, the lung of the operated side is completed; the ventilation of the opposite side then takes place via a conventional respiratory tube, next to or in which the bronchial blocker is located.

Interventions in the thorax and in particular on the lung not only require the elimination of ventilation of the side to be operated, but also the most complete collapse of the lung. Only in this way the necessary space for the surgical intervention is created.

Due to the dimensioning of the ventilation lumens, double-lumen tubes generally allow a faster ventilation and thus a better collapse of the lungs on the side to be operated on. However, double lumen tubes are relatively traumatic and should therefore only be placed as long as necessary. Umintubation of the patient to a conventional breathing tube is always necessary if the patient is already ventilated or must remain ventilated after the procedure. Due to the necessarily small outer diameter of children, double lumen tubes are also not available in pediatric sizes as the two ventilation lumens would simply be too small.

Bronchus blockers have the disadvantage that the venting of the lung takes longer on the side to be operated on and the collapse of the lung only becomes complete through gas absorption, thus typically requiring more time. But you can with a bronchus blocker but more easily adapt to the individual situation. Umintubation of the patient is (almost) always unnecessary as the blocker can be advanced through a recumbent conventional breathing tube and withdrawn after removal of the one-lung resuscitation and removed. This is an important advantage, especially in critically ill patients with markedly reduced lung function or in patients with difficult airway conditions. Bronchial blockers are also available in sizes suitable for (small) children and not only allow (like double-lumen tubes) the one-lung ventilation of the left or right lung, but also in principle a selective blockade of individual lung lobes or peripheral lung sections.

The gold standard for left-right and deep positioning or positional control of both double-lumen tubes and bronchus blockers is flexible fiber (endo) scopy. While a Doppellumentubus typically blind initially advanced and subsequently controlled the position by means of a flexible fiber optic and possibly. Under Vision is corrected, so a bronchus blocker is positioned exclusively under fiber optic control.

Previously used as bronchus blocker alienated embolectomy catheter must ultimately be placed with "try" because the tip is not controllable. In view of the now available, better alternatives, their use is obsolete today.

On the market, there are on the one hand blocker with slightly bent tip (Fuij, Univent) or by means of cable abknickbarer tip (Cohen), on the other hand, a Y-shaped double blocker (EZ-Blocker). The Univent tube has an advanceable bronchus blocker integrated into the tube, the others mentioned can be combined with different tubes. All of these blockers are intended for use in adult patients and possibly larger children, and allow the elimination of the left and right lungs by inflating the cuff placed in the left or right main bronchus. Due to the principle and / or size, however, they are not suitable for eliminating lung lobes or peripheral lung sections.

The Arndt Endobronchial Blocker is a more flexible system in this regard and even allows one-lung ventilation for children under one year old. The Arndt Endobronchial Blocker has a nylon thread in the central channel that protrudes as a loop at the tip. By means of this sling, the blocker at the tip of the flexible fiber optic can be tied to a certain extent. The blocker is then taken along with the advancement of the fiber optics, brought with the fiber optics in the desired position and then deported from the fiber optics. Alternatively, this blocker guided through the sling can also be lowered down to the flexible fiber optic and into the desired position. A special, so-called multi-port adapter attached to the tube offers separate access for the bronchus blocker and the fiber optic and also allows connection of the ventilation system.

But the Arndt system has disadvantages: Due to the principle blocker and fiber optics must be able to be brought together to the desired location in the bronchial system. The forward or deportation of the blocker of the fiber optic happens blind and once deported from the fiber optic blocker is initially no longer controllable. The need for a repositioning of the lying blocker receiving the loop with the flexible fiber optic is often difficult and requires some practice. However, once the loop has become too small due to retraction or the nylon thread has been pulled out of the blocker (which is usually necessary for optimum ventilation of the lung), it is impossible, at least for the smaller sizes of the Arndt Endobronchial Blocker Advance nylon thread again. The blocker is then no longer taxable or feasible.

The drawbacks or limitations of the Arndt system addresses the idea of first pushing an overlong (140 cm) guide wire over the working channel of the fiber optic to the desired position, then removing the fiber optic, then the bronchus blocker (after pulling out the nylon thread) onto the Thread the guidewire, advance it, and then position the blocker under fiber optic control (the fiber optic reinserted over the conventional breathing tube) [ Sebranek JJ et al .: Placement of an Arndt Endobronchial Blocker Using a Seldinger Technique in a Patient with Left Mainstem Bronchial Compression (Abstract), Society for Airway Management 16th Scientific Meeting. Toronto, 21.-23.9.2012 ].

The main drawback of this approach is the (sterile) handling of a (necessarily) overlong guidewire to hold it blind in correct position while the flexible fiber optic retracts over the guidewire, reinserted through the tube, and then the bronchus blocker is threaded onto the guidewire and is advanced.

All listed bronchus blocking systems and techniques have specific disadvantages or limitations. Desirable is a system that allows an optimal view of the work area, at the same time allows a sensitive and targeted control or a quick and precise (re-) positioning of the bronchial blocker and also ensures the best possible ventilation of the lung.

The present invention is therefore based on the object to provide a catheter which can be very accurately guided and positioned in a cavity system of a human body, wherein a positioning in relatively narrow cavities and in very small patients, especially children, should be possible.

• – einen in den ersten Kanal translatorisch, also axial, und rotatorisch bewegbar einführbaren und entfernbaren Führungsdraht, der mindestens so lang ist, dass ein erster Teilbereich des Führungsdrahtes am unteren Ende aus dem ersten Kanal herausschiebbar ist, während ein zweiter Teilbereich zumindest teilweise immer am oberen Ende aus dem Katheter herausragt,
• – eine Manipulationsvorrichtung zum translatorischen und rotatorischen Bewegen des Führungsdrahtes in dem ersten Kanal relativ zu dem Katheter.

To achieve this object, a catheter is used having upper and lower ends and at least one first channel connecting both ends, and a positioning system for positioning the lower end in a cavity system of a human body. According to the invention, the positioning system comprises the following elements:

• - A in the first channel translationally, so axially, and rotatably movable insertable and removable guide wire which is at least so long that a first portion of the guide wire at the lower end of the first channel can be pushed out, while a second Partial area protrudes at least partially always at the upper end of the catheter,
• A manipulation device for translationally and rotationally moving the guide wire in the first channel relative to the catheter.

In this way, generally under the supervision of an endoscope (eg, a flexible fiber optic) guided behind the catheter, the catheter can be moved independently of the endoscope, and in particular can advance along the guide wire as soon as it has found the desired path.

A particular field of application of the invention is the use in a bronchus blocker having in the region of its lower end an inflatable balloon, in particular in the form of a concentric surrounding the thorax, the positioning system for positioning the lower end of the catheter in the respiratory tract of a patient, especially in the area of the bronchi.

While the catheter is inserted and has not yet reached its final position, the balloon is not or at least not fully inflated and thus requires little more space than the catheter itself. Once the desired position of the bronchial obturator is achieved, the balloon can be inflated, thereby then typically a certain part of the lung is shut off and can be ventilated, for example, through the first channel of the catheter or even completely or partially evacuated.

It is particularly advantageous if the guide wire is torsionally rigid and its first portion is at least partially flexible and pre-bent, preferably with a pre-bent tip portion in the form of about a quarter circle, also referred to in the art as "half J" (depending on the application also can have a longer top again running).

Upon complete retraction of the guidewire into the lower end of the catheter, the pre-bent tip portion is bent almost straight, but must be resilient enough to resume its pre-bent shape when pushed out of the lower end. By fully or partially pushing out the pre-bent tip portion and rotating the guide wire in the catheter, the tip of the guide portion can be placed in any desired direction, even against gravity, allowing the catheter to follow the guide wire in any desired direction, and thus in branches Any desired branch of the bronchi can be pushed and positioned there.

This precise guidance of the guide wire can be carried out most easily by means of a manipulation device, this manipulation device comprising a piston guided in a hollow cylinder with a, preferably rotatably supported in the piston, piston guide rod, which preferably ends in a manipulation end, wherein the piston in the hollow cylinder displaceable and the guide wire in both, ie in the piston and / or in the hollow cylinder, rotatably supported with enough friction that a set by manipulation of the manipulation device position is maintained until a next manipulation and wherein the guide wire with the piston guide rod for the transmission of translational and rotational movements can be connected, preferably by means of a locking device.

Typically, a catheter according to the invention may have more than one channel, also called lumen. The invention is applicable to various known catheters, in particular to bronchus blockers, in which there is at least one second channel, separate from the first channel, which serves in particular for inflating and venting a balloon.

In particular, for applications in the human lung, it is advantageous that the catheter is dimensioned and designed so that it can be inserted in a trachea of a patient in addition to a flexible fiber optic through a breathing tube, especially a pediatric size. It should be noted that it is a great advantage in particularly cramped conditions that, for example, a catheter with a balloon at its lower end can be guided with a flexible fiber optic through a breathing tube so that the balloon is always in front of the tip of the fiber optic so that they do not have to fit through the breathing tube simultaneously with the thickened portion of the catheter to which the balloon is attached.

Advantageous for the use of a correctly positioned catheter is the inventive ability to make the guide wire pulled out of the first channel of the catheter by being pulled out of the manipulation device or removable with the manipulation device from the catheter.

After removal of the guidewire and manipulation device, the catheter may continue to be used in a conventional manner. It is particularly advantageous if the guide wire is protected by a protective cover and thus kept hygienically clean. For this purpose, a protective cover can be provided, which remains pushed together with mounted manipulation device on this and when pulling out the wire over this can be pushed back that the wire is completely wrapped by the protective cover.

Typically, the catheter of the present invention is provided with suitable ports for connecting the manipulation device to the catheter and / or connecting all the channels of the catheter to other devices.

A method for positioning a catheter in a luminal system of a human body is also provided. The catheter has an upper end and a lower end and at least one first channel connecting both ends, into which a guide wire which is translationally, ie axially and rotationally movable, is inserted, which is at least so long that a first at least partially flexible and pre-bent part region of the Guidewire at the lower end of the first channel can be pushed out, while a second portion at least partially always protrudes from the catheter at the upper end, and wherein a manipulation device with the upper end of the catheter and the guide wire is connected so that the guide wire by means of the manipulation device translationally and rotationally displaceable in the first channel and wherein the guide wire is guided by means of the manipulation device in the cavity system to a desired position and thereafter the catheter is pushed together with the guide wire or via this to a desired position.

This method is preferably used for positioning a bronchus observer with an inflatable balloon in the region of its lower end, wherein the cavity system is formed by the trachea and the bronchi of a human lung and wherein the positioning is carried out under observation by a flexible fiber optic, in particular a bronchoscope.

In this application, the advantages of the present invention are particularly evident for days, especially in very small patients.

In the following, the invention will be described with reference to the embodiment and a prototype of a bronchial obturator which can be controlled by means of a manipulation device and a (axially) torsionally rigid guide wire with (preferably) pre-bent, flexible (semi-rigid) tip. The guide wire lies in the lumen of the bronchial obturator and can be advanced and retracted by the attached manipulation device and rotated (independent of the axial movement). The preferred shape of the tip portion of the guidewire corresponds to a half "J" (with a radius of "J" of about 2 cm). For special tasks, however, other tip geometries are imaginable (for example straight or slightly bent, half "J" with an optionally longer straight point, full "J", different radii of the "J").

A prototype of the manipulation device was realized on the basis of a 1 ml syringe. In the following, the function of this prototype in combination with a pediatric Arndt Endobronchial Blocker, from which the nylon thread was pulled out, will be explained. This combination creates a new bronchus blocker system because the Arndt Endobronchial Blocker without nylon thread or loop is equivalent to a single-channel catheter with an inflatable balloon at the tip.

By the construction of the 1 ml syringe (hollow cylinder and piston with rotatable sealing plug), the axial advancing or retraction of the guide wire by advancing or retracting the piston and the rotation of the guide wire and thus orientation of its tip is separated by rotation of the piston in the hollow cylinder , The torsion-resistant guidewire is passed through the rotatable sealing plug and firmly braided through holes in the piston. The prototype manipulation device inserted in the Luer-Lock connector of the Arndt Endobronchial Blocker allows a displacement of the guidewire of approx. 5 cm.

The following procedure is recommended in practice:
First, the bronchial obturator is prepared with the tamper-evident guide wire with manipulation device that appears appropriate for the intended procedure. It is advisable to rinse the bronchus blocker canal first with a little sterile water or sterile "physiological" saline solution. As a result, the guide wire is much easier to insert and subsequently slides on or in a fluid film with virtually no friction, which allows precise manipulation with the guide wire.

The bronchial blocker is first placed in the trachea with the manipulation device (but not yet inserted) in place and the guidewire is fully inserted in the channel of the blocker. For the sake of simplicity, this happens before the intubation, ie the bronchus blocker is then located after the intubation next to the (or coaxial with) the conventional breathing tube. The bristle of the bronchus blocker is pressed against the tracheal wall by the inflated cuff of the breathing tube and fixed - albeit still displaceable. The flexible fiber optic is now by a conventional bronchoscopic adapter attached to the tube (contra-angle with a closable diaphragm opening on which the Ventilator system is connected) introduced. Special multi-port adapters (with a dead volume that is not unproblematic in pediatric surgery) are thus unnecessary for ventilation during the fiber-optically controlled positioning of the bronchial obstructer.

After fiber optic inspection and left-right orientation in the trachea, after appropriate positioning of the fiber optic above the working area, the guide wire is now pushed out of the bronchial obturator by advancing the plunger of the manipulation device and orienting the (preferably) pre-bent, flexible (semi-rigid) tip, that, with further advancement of the guidewire and / or the bronchus blocker, it passes into the desired (main) bronchus. If the bronchus blocker is advanced further, it will inevitably follow the guide wire in the desired direction.

By appropriately advancing or retracting the (preferably) pre-bent, flexible (semi-rigid) tip of the guidewire into the lumen of the bronchus blocker, the tip may also be partially dehumidified so that it can reach almost any point in the space in front of the bronchial block tip. As a result, the targeted probing and positioning of the bronchus blocker at the desired location in the bronchial system is ultimately possible.

With a suitably shaped tip of the guidewire, it is also possible to position the bronchial blocker against gravity (i.e., insert it into the left main bronchus in a right side patient).

The entire positioning procedure can be easily controlled by fiber optics. Difficult manipulations on or with the flexible fiber optics are unnecessary; The fiber optic is just a camera that just needs to be kept still, but not a tool or positioning tool (like the Arndt system described above), so this new bronchus blocking system is easier and faster to handle.

The space required for the positioning of the bronchus blocker is inherently minimal. This procedure is limited only by the bronchus (inner) diameter, which must be large enough to introduce next to the guide wire if necessary. Also a flexible fiber optics or to advance and position the guide wire and retraction of the fiber optic bronchus blocker and position. Thus, in principle, therefore, positions of the bronchus blocker far into the lung periphery are possible. At the same time one always keeps an overview; The view of lower-lying structures in the bronchial system is lost only by advancing the blocker into the desired position and inflating the cuff.

Desirably, the (cylindrical, spherical or even aspherical) cuff is made of a very thin membrane (e.g., polyurethane) and dimensioned so that the cuff already tightly seals the bronchial block to be blocked before the cuff is maximally inflated. This provides the ability to adjust the pressure in the cuff by measuring so as to avoid (damaging) high pressure on the bronchial mucosa.

After placement of the bronchus blocker, the guidewire is typically completely removed so as to release the lumen of the bronchus blocker for drainage or aspiration of gas from the blocked lung.

A desirable embodiment of the invention is a thin plastic wrapper attached to the manipulation device, which is pushed together as the guidewire advances while being e.g. is pushed onto the manipulation device. Upon retraction of the guidewire, this sheath is pulled apart again, then envelops the guidewire and keeps it sterile. If the bronchus blocker has to be repositioned, the guidewire can be advanced quickly and hygienically (even without sterile gloves).

Just as quickly as the standard guidewire can be pushed into the bronchial obturator and withdrawn, it is also possible to change it to another guidewire (with a manipulation device) that may be more suitable in the specific case.

Of course, the guidewire can of course also remain in the bronchus blocker or be pushed back into it with sufficient lung collapse, in order to additionally stabilize the blocker and thus better to hold it in position. For this purpose, the bronchus blocker, which is already fixed by the inflated cuff of the breathing tube something, if necessary, also be secured with an adhesive strip or Velcro on the tube.

The manipulation device described is also useful in combination with any other guidewire or catheter (with or without a balloon), as well as the probing or catheterization of other cavities in the human body, e.g. for radiography or interventional procedures under fluoroscopy (X-rays).

The use of the manipulation device described in a long-term probing requires only a modification in which the guide wire is then passed through the rotatable sealing plug, along the piston and through a hole in the rear piston plate. A small clamping device (unless the friction in the sealing plug is sufficient) makes it possible to secure the guidewire on the piston, if necessary, so that it can not be displaced. So you can also push through a long guide wire simply through the manipulation device and then fix it to the piston of the manipulation device, if you want to sensitive tip, for example, in the vascular system, the tip sensitive back and forth or want to rotate. After successful probing, the clamping device is then released again and the guide wire can be further advanced, for example in a blood vessel.

Embodiments of the invention, to which this is not limited, will be explained in more detail below with reference to the drawing. Show it:

1 FIG. 2 is a schematic longitudinal sectional view of a catheter according to the invention during the positioning process; FIG.

2 a cross-section along the line II-II through 1 .

3 a prototype of the device according to the invention with retracted first section and

4 : A prototype of a catheter according to the invention with extended first section of the guide wire.

1 shows schematically a cavity system 1 in the human body, in the present case a portion of the bronchi in the lungs of a human. An inventive catheter 2 is during the process of positioning in this cavity system 1 shown. The catheter 2 has an upper end 3 and a lower end 4 on, being a first channel 5 connecting these two ends together. Through the first channel 5 runs a guidewire 6 that is so long that a first subarea 7 from the bottom 4 protrudes while a second subarea 8th from the upper end 3 of the catheter 2 protrudes. The first section 7 has a pre-bent tip area 9 on, which has approximately the shape of a quarter circle. This area is so flexible that it retracts into the first channel 5 is forced into an approximately straight shape while pushing slowly out of the lower end 4 slowly gradually resumes the preformed shape. By pushing out and turning the guidewire far enough 6 in the first channel 5 can therefore be achieved that the guidewire 6 in any direction. When re-pushing the catheter must 2 the guidewire 6 Follow, making a precise selection of the desired path, the catheter 2 should take, through the guide wire 6 is possible. At the upper end 3 points the catheter 2 a connection 10 on which a manipulation device 11 can be attached. This consists in the present embodiment of a hollow cylinder 12 in which a piston 13 on a piston guide rod 14 to be led. The guidewire 6 runs in the manipulation device 11 in a passageway 15 and is performing 16 in the pistons 13 or the piston guide rod 14 one. The piston guide rod 14 goes into a tampering end 17 which is shaped for handling by the human hand, as known for example from medical syringes. A locking device 18 serves to the guidewire 6 in any initial position with the piston guide rod 14 so connect that guidewire 6 with the piston guide rod 14 and the piston 13 translational, ie axially, can be moved and simultaneously with the piston guide rod 14 is rotationally movable, ie in the first channel 5 can be turned.

In the area of the lower end 4 of the catheter 2 is an inflatable balloon 19 arranged, preferably the shape of a catheter 2 enclosing Volltorus has. This balloon (cuff), can through a second channel 20 be inflated so that it closes the surrounding vessel, in this case a bronchus, and thus separates the underlying part of the lung from the rest of the lung. A suitable inflator 21 inflates with adequate pressure and maintains this pressure for a desired period of time. The whole process of positioning and inflation is generally accomplished by a flexible fiber optic, in the present case a bronchoscope 22 followed, with the catheter 2 and the flexible fiber optic 22 should be designed so that they simultaneously through a breathing tube 24 in the trachea of a patient, although it is also possible, as described above, the catheter 2 next to a breathing tube 24 relocate.

Particularly advantageous for the positioning and for the reproducibility of operations, it is when the manipulation device 11 with a scale 23 equipped, which shows the respective position of the pre-bent tip portion 9 of the guidewire 6 for an operator. When removing the manipulation device and pulling out the guide wire 6 it is advantageous if at the same time a protective cover when pulling out 25 over the guide wire 6 is pulled. This protective cover 25 may for example consist of a thin plastic film and during the positioning process on the manipulation device 11 kept together.

2 shows a cross section through 1 along the line II-II, that is a cross section through the breathing tube 24 with inserted bronchoscope 22 and parallel catheter 2 , The 2 Figure 1 illustrates, without being true to scale, the conditions in the trachea of a patient. The bronchoscope 22 and the catheter of the invention 2 should be designed and dimensioned so that they are both in the breathing tube 24 Find space, preferably even in confined spaces, as they can occur in very small children. It can be seen that the second channel 20 to inflate the balloon 19 generally requires little space in the cross section of the catheter, possibly also on the outside can run, and that the guide wire 6 not necessarily a large part of the first channel 5 so there are also situations where the first channel 5 can fulfill its actual function while the guidewire 6 remains in it.

3 shows a photo of a prototype of the catheter according to the invention 2 with withdrawn first section 7 of the guidewire 6 ,

4 shows the same prototype but with advanced first section 7 of the guidewire 6 and during a rotary manipulation by rotation at the end of the manipulation 17 the piston guide rod 14 ,

The present invention enables rapid and precise positioning of a catheter at locations where this is slow or difficult with conventional means. In particular, positions against gravity are possible even without rearrangement of a patient.

LIST OF REFERENCE NUMBERS

1

 cavity system

2

 catheter

3

 Upper end of the catheter

4

 Lower end of the catheter

5

 First channel

6

 guidewire

7

 First section

8th

 Second subarea

9

 Pre-bent tip area

10

 connection

11

 manipulation device

12

 hollow cylinder

13

 piston

14

 Piston guide rod

15

 Through channel

16

 execution

17

 manipulation end

18

 Locking device

19

 Balloon (cuff)

20

 Second channel (inflation channel)

21

 inflator

22

 Flexible fiber optics (bronchoscope)

23

 scale

24

 breathing tube

25

 Collapsible protective cover

QUOTES INCLUDE IN THE DESCRIPTION

This list of the documents listed by the applicant has been generated automatically and is included solely for the better information of the reader. The list is not part of the German patent or utility model application. The DPMA assumes no liability for any errors or omissions.

Cited non-patent literature

• Sebranek JJ et al .: Placement of an Arndt Endobronchial Blocker Using a Seldinger Technique in a Patient with Left Mainstem Bronchial Compression (Abstract), Society for Airway Management 16th Scientific Meeting. Toronto, 21.-23.9.2012 [0015]

Claims (10)

Catheter ( 2 ) with an upper ( 3 ) and a lower ( 4 ) End and at least one first channel ( 5 ) and with a positioning system for positioning the lower end ( 4 ) in a cavity system ( 1 ) of a human body, the positioning system comprising: - one in the first channel ( 5 ) translationally and rotationally movable insertable and removable guidewire ( 6 ) which is at least as long that a first subregion ( 7 ) of the guidewire ( 6 ) at the lower end ( 4 ) from the first channel ( 5 ), while a second subregion ( 8th ) at least partially always at the upper end ( 3 ) from the catheter ( 2 protruding, - a manipulation device ( 11 ) for translational and rotational movement of the guide wire ( 6 ) in the first channel ( 5 ) relative to the catheter ( 2 ). Catheter ( 2 ) according to claim 1, wherein the catheter ( 2 ) a bronchial blocker ( 2 . 19 . 20 ) with an inflatable balloon ( 19 ), in particular in the form of a solid torus surrounding the catheter approximately concentrically, in the region of its lower end ( 4 ) and the positioning system for positioning the lower end ( 4 ) in the airways of a patient, especially in the area of the bronchi. Catheter ( 2 ) according to claim 1 or 2, wherein the guidewire ( 6 ) is torsionally rigid and its first part ( 7 ) is at least partially flexible and pre-bent, preferably with a pre-bent tip region ( 9 ) in the form of about a quarter circle. Catheter ( 2 ) according to one of the preceding claims, wherein the manipulation device ( 11 ) one in a hollow cylinder ( 12 ) guided piston ( 13 ) with a piston guide rod (preferably rotatably supported in the piston) ( 14 ), preferably in a manipulation end ( 17 ), wherein the piston ( 13 ) in the hollow cylinder ( 14 ) and the guidewire ( 6 ) with piston ( 13 ) in the hollow cylinder ( 14 ) and / or in the piston guide rod ( 14 ) is rotatably supported, each with sufficient friction that one by a manipulation of the manipulation device ( 11 ) position is maintained until a next manipulation and the guidewire ( 6 ) with the piston guide rod ( 14 ) is connectable to the transmission of translational and rotational movements, preferably by means of a locking device ( 18 ). Catheter ( 2 ) according to one of the preceding claims, wherein the catheter ( 2 ) at least one of the first channel ( 5 ) separate second channel ( 20 ), in particular for inflating and venting a balloon ( 19 ). Catheter ( 2 ) according to one of the preceding claims, wherein the catheter ( 2 ) is dimensioned and designed in such a way that, in addition to a flexible fiber optic ( 22 ) through a breathing tube ( 24 ), in particular also of a pediatric size, can be introduced into a trachea of a patient. Catheter ( 2 ) according to one of the preceding claims, wherein the guide wire ( 6 ) from the first channel ( 5 ) is pulled out of the manipulation device ( 11 ) or with the manipulation device ( 11 ) from the catheter ( 2 ) is removable. Catheter ( 2 ) according to one of the preceding claims, wherein the catheter ( 2 ) at least one connection ( 10 ) for connecting the manipulation device ( 11 ) with the catheter ( 2 ) and / or to connect all channels ( 5 . 20 ) with other devices. Method for positioning a catheter ( 2 ) in a cavity system ( 1 ) of a human body, wherein the catheter ( 2 ) an upper ( 3 ) and a lower one ( 4 ) End and at least one both ends ( 3 . 4 ) connecting the first channel ( 5 ), in which a translationally and rotationally movable guide wire ( 6 ) is inserted, which is at least as long that a first at least partially flexible and pre-bent portion ( 7 ) of the guidewire ( 6 ) at the lower end ( 4 ) from the first channel ( 5 ), while a second subregion ( 8th ) at least partially always at the upper end ( 3 ) from the catheter ( 2 protruding, and wherein a manipulation device ( 11 ) with the upper end ( 3 ) of the catheter ( 2 ) and the guide wire ( 6 ) is connected so that the guide wire ( 6 ) by means of the manipulation device ( 11 ) translationally and rotationally in the first channel ( 5 ) is displaceable and wherein the guide wire ( 6 ) by means of the manipulation device ( 11 ) in the cavity system ( 1 ) is guided to a desired position and then the catheter ( 2 ) together with the guide wire ( 6 ) or pushed over this to a desired position. The method of claim 9, wherein the catheter ( 2 ) a bronchial blocker ( 2 . 19 . 20 ) with an inflatable balloon ( 19 ) in the region of its lower end ( 4 ) and the cavity system ( 1 ) is formed by the trachea and the bronchi of a human lung and wherein the positioning under observation by a flexible fiber optic ( 22 ), in particular a bronchoscope.

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