HK1132893B - Endoscope system for gastrostomy catheter placement - Google Patents

Description

Endoscopic system for placement of gastrostomy catheter

Technical Field

The present invention relates to an apparatus for confirming the position of an indwelling gastrostomy catheter and a method of confirming the indwelling position, which is utilized when the gastrostomy catheter is indwelling in a patient so as to supply fluids (such as nutrients and food in the form of fluid) to the stomach of the patient.

Background

Gastrostomy catheters have traditionally been used to provide fluids (e.g., nutrients and food in fluid form) to persons who have a reduced ability to ingest food through their mouths due to aging or illness (hereinafter referred to as "patients"). This gastrostomy catheter is provided with: an intragastric fixation component disposed on an interior portion of the stomach wall in a hole for ingestion (gastrostomy hole) provided in the abdomen of a patient; and a tubular member having a tip end coupled to the intragastric fixation member and a base end passing through the hole and extending outside the patient's body. When the gastrostomy catheter is attached at the hole formed in the patient's body, it is then necessary to confirm whether the intragastric fixing part of the gastrostomy catheter is left in the correct state inside the stomach.

One method of confirming the indwelling position of the gastrostomy catheter in this case is a method in which an endoscope is inserted into the digestive tract from the oral cavity or the nose, and observation is performed using the endoscope. There is also a method in which a gastrostomy catheter is left in a hole in a patient, then a fluid or the like in the body is sucked out from the gastrostomy catheter by a syringe, and the left-over position of the gastrostomy catheter is confirmed according to the characteristics of the sucked-out fluid. With these methods, there is a problem in that suction is performed using a syringe after the gastrostomy catheter has been indwelling, unless there is a significant difference in the characteristics of the aspirated fluid or the like, it is difficult to make judgment, which results in poor reliability. Therefore, it is preferable to adopt an endoscopic method in order to confirm the indwelling position more reliably. However, the method using the endoscope has various problems such as high cost for cleaning the endoscope after use and discomfort to the patient.

In view of these problems, by attaching a disposable cover to the endoscope, the cost of cleaning the endoscope after use can be significantly reduced (see, for example, Japanese unexamined patent application publication H3-292925). The endoscopic probe cover (protective cover) includes a tube and a linear body which cover the endoscopic probe very tightly, and has a structure in which the tube can be torn off after use by pulling the linear body. Therefore, the endoscope probe is not in direct contact with the fluid or the like in various parts of the body and is not contaminated, which makes the sterilization and cleaning operations largely unnecessary, and thus the cost due to the sterilization and cleaning can be reduced.

However, with the above-described endoscope probe cover, there is a risk that, when the thread-like body is pulled and the tube is torn off, dirt adhering to the surface of the tube will adhere to the endoscope probe. Also, in this case, there is still a problem in that if the endoscopic probe is inserted into the esophagus from the mouth or nose, it causes discomfort to the patient when the endoscopic probe is inserted.

Disclosure of Invention

One aspect of the present invention is an apparatus for confirming the position of an indwelling gastrostomy catheter, the catheter comprising: a tubular member for extending through an aperture formed between a skin surface of a patient and an inner surface of a stomach wall and extending from outside the patient to the inner surface of the stomach wall; and an intragastric fixation component that is couplable to a tip of the tubular component and is disposed at an inner surface of the stomach wall, the intragastric fixation component having a through hole adapted to receive the tubular component therethrough, the apparatus for confirming a position of an indwelling gastrostomy catheter comprising: a fiberscope with which the inner surface of the stomach wall can be observed, the fiberscope being adapted to extend through the interior of the tubular member such that a tip of the fiberscope protrudes from the through-hole of the intragastric fixation member; and a protective cover adapted to pass through the gastrostomy catheter together with the fiberscope in a state in which the fiberscope is covered, the protective cover including an optically transparent window member at a distal end thereof, the optically transparent window member allowing observation of an inner surface of the stomach wall by means of the fiberscope.

Another aspect of the invention is a method of the invention for confirming the position of an indwelling gastrostomy catheter comprising: a tubular member for extending through an aperture formed between a skin surface of a patient and an inner surface of a stomach wall and extending from outside the patient to the inner surface of the stomach wall; and an intragastric fixation component couplable to a tip of the tubular component and disposed at an inner surface of the stomach wall, the intragastric fixation component having a through-hole adapted to receive the tubular component therethrough, the method comprising: indwelling the gastrostomy catheter, wherein the gastrostomy catheter is indwelling in the hole; covering the fiberscope, wherein the fiberscope is covered by a protective cover; inserting the fiberscope covered by the protective cover into the tubular member with a distal end portion of the fiberscope protruding from the through hole of the intragastric fixation member; confirming the indwelling position in which the inner surface of the stomach wall observed by means of the fiberscope is inspected; withdrawing the fiberscope, wherein the fiberscope that has been covered by the protective cover is withdrawn from the gastrostomy catheter; and removing the protective cover, wherein the fiberscope is withdrawn from the protective cover.

Drawings

Fig. 1 shows a gastrostomy catheter in which (a) is a plan view, (b) is a front view, and (c) is a bottom view;

FIG. 2 is a front view of the instrument of the present invention for confirming an indwelling position, according to one embodiment;

FIG. 3 is a cut-away, partial cross-sectional view of the instrument for confirming an indwelling position of FIG. 2;

FIG. 4 is an oblique exploded view showing each of the components constituting the instrument for confirming the indwelling position;

FIG. 5 is a cross-sectional view of the fiberscope shaft;

FIG. 6 is a partial sectional view showing a state where an instrument for confirming an indwelling position is located over a gastrostomy catheter indwelling in a patient;

FIG. 7 is a partial sectional view showing a state where an instrument for confirming an indwelling position is inserted into a gastrostomy catheter indwelling in a patient's body; and

fig. 8 is a partial sectional view showing a state of confirming an indwelling position of a gastrostomy catheter using an instrument for confirming an indwelling position.

Description of the reference numerals

10: gastrostomy catheter

12: tubular member

13: intragastric fixing component

18: through hole

20: instrument for confirming indwelling position

23: fiberscope

24: protective cover

24 a: window unit

24 c: metal wire

AW: abdominal wall

SW: stomach wall

Detailed Description

An embodiment of the present invention will be described below with reference to the accompanying drawings. Fig. 1 shows a gastrostomy catheter 10 pertaining to the embodiment mode, and fig. 2 shows an instrument 20 for confirming an indwelling position so as to confirm the indwelling position of the gastrostomy catheter 10. The gastrostomy catheter 10 includes an outer fixing member 11, a tubular member 12 connected to the center of the lower end surface of the outer fixing member 11, and an intragastric fixing member 13 attached to the lower end of the tubular member 12, all of which are made of a soft plastic material such as polyurethane or silicone. In the following description, the external fixing part 11 will be regarded as an upper side, and the stomach-inside fixing part 13 will be regarded as a lower side.

The external fixing member 11 includes: an insertion opening 11a, which is annular and relatively thick; and protruding pieces 11b, 11c having an oval outline and including an insertion opening 11a, the protruding pieces 11b, 11c protruding from lower ends of both side portions of the insertion opening 11a at both sides when viewed as a plane. The function of these projections 11b, 11c is to prevent the gastrostomy catheter 10 from being pulled into the stomach S (see fig. 6 to 8). Then, a valve body 14a formed with a center cutout is disposed vertically passing through an inner peripheral surface of an insertion hole 14, the insertion hole 14 being formed in the center of the insertion opening 11 a. Further, an engagement groove is formed along the circumference at the upper side of the valve body 14a on the inner peripheral surface of the insertion hole 14, although not described. Then, a cover member 15 for closing the insertion hole 14 of the insertion opening 11a is attached to the distal end side of the protruding piece 11 b.

The cover member 15 includes: an elongated strip-shaped coupling member 15a coupled to an end of the projection 11 b; and a wide member 15b which is shorter and wider than the band-shaped coupling member 15a and is formed at the tip of the band-shaped coupling member 15 a. Then, a plug member 16 having a columnar shape and short in the axial direction is provided on the wide member 15 b. The band-shaped coupling member 15a is flexible, and it can be flexed so as to rotate vertically or bend at an acute angle while the coupling member to the protruding piece 11b is at the center. The plug member 16 is provided on the strip-shaped coupling member 15a on the side of the wide member 15b such that the plug member 16 faces the insertion hole 14 when the strip-shaped coupling member 15a is bent to position the wide member 15 over the insertion opening 11 a.

The plug member 16 is formed with a columnar shape fittable into the insertion hole 14 and is provided on an outer peripheral surface of the plug member 16 with an annular projection 16a extending along a periphery thereof, which is detachably engageable with an engagement groove formed on an inner peripheral surface of the insertion hole 14. Therefore, the engagement groove can be engaged with the annular projection 16a by bending the band-shaped coupling member 15a to invert it upward and pushing the plug member 16 into the insertion hole 14, and this makes it possible to close the insertion hole 14 of the insertion opening 11a in an air-tight manner. The insertion hole 14 of the insertion opening 11a can also be opened by widening the part 15b to release the fit between the plug part 16 and the insertion hole 14.

The tubular member 12 is formed in a cylindrical shape, and a supply passage (not shown) for allowing a fluid (such as a nutrient and food in a fluid form) to pass is formed inside the tubular member 12; the upper end of the supply passage is communicatively coupled with the insertion hole 14 of the external fixing member 11. The intragastric fixing component 13 is connected to the tubular component 12 via a connecting component 17 fixed to the lower end of the tubular component 12. The connecting member 17 is formed into a cylinder for covering the outer circumferential surface of the tubular member 12, and is formed integrally with the stomach-interior fixing member 13. Then, the connecting member 17 is attached to the lower end of the tubular member 12 in such a manner that the connecting member 17 is in a state of being not removable from the tubular member 12.

The stomach interior fixing member 13 includes: four band-shaped coupling members 13a coupled to the edge of the lower end opening of the connection member 17 and extending in four directions; four coupling membrane parts 13b, which four coupling membrane parts 13b are arranged between the upper parts of each coupling part 13a and together with the four coupling parts 13a form a generally dome-shaped stomach wall contacting part; and a converging part 13c at which the tips of all the coupling parts 13a converge. The four coupling members 13a comprise band-shaped members bent substantially in a semicircular shape, which are separated into 4 directions from the lower end of the connecting member 17, respectively extend downward from the horizontal plane, after which they are converged and coupled below the central axis of the tubular member 12 to form the converging member 13 c. That is, the converging part 13c allows each of the coupling parts 13a to be coupled by coupling the lower ends of all the coupling parts 13a together, and the converging part 13c is also positioned by all the coupling parts 13a below the central axis of the tubular part 12.

Further, the stomach-interior fixing member 13 including the coupling member 13a, the coupling membrane member 13b, and the converging member 13c is integrally formed with the connecting member 17. Furthermore, all the coupling parts 13a and the coupling membrane parts 13b are made of a soft, flexible, elastic material, and the overall substantially hemispherical shape is normally maintained by this elastic force, as shown in fig. 1, but by pulling the converging part 13c downwards, the shape can be extended so that it straightens or elongates. Further, the space formed between the lower portions of each coupling member 13a forms a passage for fluid (such as nutrients and food in fluid form) sent from the supply passage of the tubular member 12 to enter the stomach S. A through hole 18 is additionally formed at the center of the converging part 13 c. The intragastric fixation component 13 configured in this way is positioned on the inner surface of the patient's stomach wall SW (see fig. 6 to 8), and functions to prevent the gastrostomy catheter 10 from being removed from the patient's body.

As shown in fig. 2 to 4, the instrument 20 for confirming the indwelling position includes: a fiberscope 23 having a configuration in which a lens 21 is attached to the end of a fiberscope shaft 23a, and a connecting member 22 is attached to the trailing end thereof; a protective cover 24; and a connector fitting 25. As shown in fig. 5, the fiberscope shaft 23a is flexible, and is configured by a bundle of fibers including a plurality of light guides 23b for irradiating light onto the stomach wall SW, and an image guide 21a for transmitting an image via the lens 21. The connection member 22 is connected to a wiring 22a for connecting the image guide 21a to an image display (not shown) and a wiring 22b for connecting the light guide 23b to a light source device (not shown).

The lens 21 transmits an image obtained by irradiation of the light guide 23b to the image display via the image guide 21a and the wiring 22 a. In other words, the light guide 23b irradiates the inner surface of the stomach wall SW with the light sent from the light source device to enable observation, and the image guide 21a sends the light reflected from the inner surface of the stomach wall SW and focused through the lens 21 to the image display. Then, the image display enlarges the transmitted images and displays the images on an image display section provided in the image display.

Further, the protective cover 24 is flexible and its end is closed by a light-transmissive window member 24a, and its base end 24b on the opening side is configured by a tube having a diameter slightly larger than other positions. The protective cover 24 is formed to cover and fix the thickness of the fiberscope shaft 23a, and prevents the protective cover 24 from being removed from the fiberscope shaft 23a by inserting the distal end diameter narrowing part 22c of the connecting member 22 into the proximal end 24 b. In this state, the instrument is configured such that the lens 21 is brought into contact with the inner surface of the window member 24 a.

Further, the tip of the wire 24c serving as a linear member pertaining to the present invention is fixed to the edge of the window member 24a on the outer peripheral surface of the protective cover 24. A wire lumen (not shown) for passing the wire 24c through the lower end region of the base end 24b is formed by a portion of a certain length (a length required to bend the boot 24) above the tip on the outer peripheral surface of the boot 24. The wire 24c extends upwardly and beyond the end of the boot 24, after which it passes within the wire lumen and extends outwardly.

A connecting fitting 25 is attached to the gastrostomy catheter 10 to more smoothly insert the protective cover 24 and the like into the gastrostomy catheter 10, and is configured by a connecting member 26, an insertion opening 27 and a gas supply opening 28. The connecting member 26 is configured by a substantially cylindrical engaging member 26b formed in the center of the lower surface of the annular connecting member body 26a, and an insertion hole for allowing insertion of the protective cover 24 is formed therein. Further, the coupling member main body 26a is formed in an annular shape which is substantially the same size as the insertion opening 11a of the gastrostomy catheter 10, and the engaging member 26b is formed in a cylindrical shape having 4 different steps.

The engaging member 26b includes: an uppermost stage in which the outer circumferential surface has an inclined surface having a larger diameter at an upper portion thereof than at a lower portion thereof; a second stage having the same diameter as the lower portion of the uppermost stage; a third stage having substantially the same diameter as the upper portion of the uppermost stage; and a lowest stage in which the outer circumferential surface has an inclined surface having substantially the same diameter as the second stage at an upper portion thereof and a smaller diameter than the upper portion thereof at a lower portion thereof. The third stage of the engaging member 26b is provided with an annular projection 26c which is detachably engageable with an engaging groove formed in the insertion hole 14 of the gastrostomy catheter 10, and when the annular projection 26c is engaged with the engaging groove, an airtight state is achieved between the engaging member 26b and the outer peripheral surface of the insertion hole 14.

The insertion opening 27 is formed with a cylindrical shape, and an insertion hole allowing insertion of the protection cover 24 is formed therein, and an annular reinforcing rib 27a is formed on an edge of the opening at an upper end. Further, the insertion hole formed in the insertion opening 27 and the insertion hole formed in the connection member 26 have the same diameter, and are also coaxially coupled when communicating. The air supply opening 28 is formed in a cylindrical shape extending obliquely upward from the lower end of the insertion opening 27 in a state of being inclined at about 45 ° with respect to the insertion opening 27, and is narrower in diameter than the insertion opening 27. An annular reinforcing rib 28a is also formed on the edge of the air supply opening 28 at the upper end thereof.

An air supply device (not shown) is attached to the annular reinforcing rib 28a of the air supply opening 28, and air supplied from the air supply device passes through the air supply opening 28 and is sent to the lower end in the insertion opening 27. Further, an air flow passage (not shown) for allowing air to pass is formed between the lower end in the insertion opening 27 and the lower end in the connection member 26; the air sent to the lower end inside the insertion opening 27 is released to the outside from the lower end of the connection member 26.

A substantially triangular, sheet-like reinforcing grip member 29 for reinforcing the area between the insertion opening 27 and the air supply opening 28 and also for facilitating the holding of the connector fitting 25 with the hand is formed between the insertion opening 27 and the air supply opening 28. The instrument 20 for confirming the indwelling position shown in fig. 2 is assembled by covering the fiberscope shaft 23a with the protective cover 24, and inserting the protective cover 24 and the like in this state together with the wire 24c through the insertion hole formed in the insertion opening 27 and the connecting member 26 of the connecting fitting 25.

A description will be given below of a method of confirming an indwelling position of a gastrostomy catheter 10 using the apparatus for confirming an indwelling position 20 configured in the above-described manner, with reference to fig. 6 to 8. Fig. 6 shows a state in which the gastrostomy catheter 10 is being detained in the hole provided in the abdominal wall AW and the stomach wall SW of the patient, in which the gastrostomy catheter 10 is detained in the hole using a specific instrument for fitting the gastrostomy catheter 10. A description of the method and structure for performing the indwelling of the assembling apparatus will be omitted here. In the state shown in fig. 6, the plug member 16 of the gastrostomy catheter 10 is removed from the insertion hole 14 to open the upper end of the insertion hole 14. Further, the instrument 20 for confirming the indwelling position is positioned above the gastrostomy catheter 10, and the instrument 20 for confirming the indwelling position in this state is moved downward in the direction of the arrow in the drawing, so that the protective cover 24 protruding from the lower end of the connecting fitting 25 is inserted into the insertion hole 14 of the gastrostomy catheter 10 together with the fiberscope 23.

At this time, the operator holds both sides of the insertion opening 11a on the gastrostomy catheter 10 with one hand, and holds the reinforcement grip member 29 of the coupling fitting 25 with the other hand, and pushes the coupling fitting 25 into the gastrostomy catheter 10. This makes it possible to engage the connection fitting 25 with the gastrostomy catheter 10, as shown in fig. 7. The engagement in this case is achieved by the engagement of the annular projection 26c of the connecting fitting 25 with the engagement groove of the gastrostomy catheter 10, and the airtight state between the connecting fitting 25 and the gastrostomy catheter 10 is achieved. The protective cover 24 is then also inserted toward the lower side of the gastrostomy catheter 10 together with the fiberscope 23, and the lower portion of the protective cover 24 protrudes downward from the through hole 18 formed at the lower end of the gastrostomy catheter 10. It is noted that the protective cover 24 and the fiberscope 23 may be passed through the inside of the coupling fitting 25 after the coupling fitting 25 has been coupled to the gastrostomy catheter 10.

Next, air is supplied from the air supply apparatus into the air supply opening 28, and the air is sent from the connecting part 26 to the stomach S via the tubular part 12 of the gastrostomy catheter 10. This allows the stomach S to expand, as shown in fig. 8. In this state, light is generated by means of the light source device so that the light passes through the wiring 22b and the light guide 23b of the fiberscope shaft 23a and is irradiated to the stomach wall SW, as shown in fig. 8. Further, in this case, as needed, the tip portion of the protective cover 24 may be flexed together with the fiberscope shaft 23a so that the irradiation position of the stomach wall SW may be changed by the light guide 23b, and this is achieved by pushing the wire 24 c.

The range indicated by the two-dot chain line in fig. 8 shows the range of light irradiation of the light guide 23 b. The light irradiated by means of the light guide 23b and reflected by the stomach wall SW is focused by the lens 21, and thereafter, is sent to the image display via the image guide 21a and the wiring 22a of the fiberscope shaft 23 a. The image transmitted to the image display is enlarged in the image display part of the image display, and therefore, from the image displayed in the image display part, it can be confirmed whether the stomach interior fixing part 13 of the gastrostomy catheter 10 is positioned in the correct state within the stomach S. If it can be confirmed that the gastrostomy catheter 10 is left in the correct state, an operation may be performed in which the instrument 20 for confirming the left position is removed from the gastrostomy catheter 10 and the protective cover 24 is also removed from the fiberscope shaft 23 a.

In this operation, the protective cover 24 is first pulled upward together with the fiberscope 23 in a state where the force of pulling the wire 24c has been released, and then the engagement between the annular protrusion 26c of the coupling fitting 25 and the engagement groove of the gastrostomy catheter 10 is released in a state shown in fig. 7. The protective cover 24 and the fiberscope 23 are then removed from the gastrostomy catheter 10 by pulling the protective cover 24 and the fiberscope 23 upwards together with the connecting fitting 25. Further, the connector fitting 25 is removed from the protective cover 24 and the like, and thereafter, the fiberscope shaft 23a and the like are pulled out from the protective cover 24. The protective cover 24 is then discarded and the fiberscope 23 can be reused the next time.

At this time, the lens 21 and the fiberscope shaft 23a do not come into contact with the body of the patient and the liquid and residues in the stomach S, so they are not soiled, and for the most part, they do not need to be cleaned or sterilized. When the fiberscope 23 is reused, the fiberscope shaft 23a is covered with a new protective cover 24. Further, in the above operation, the engagement between the annular protrusion 26c of the connecting fitting 25 and the engagement groove of the gastrostomy catheter 10 is released, and the protective cover 24 and the fiberscope 23 are removed together with the connecting fitting 25 from the gastrostomy catheter 10, but it is also possible to remove the protective cover 24 and the like from the connecting fitting 25 and then release the engagement between the annular protrusion 26c of the connecting fitting 25 and the engagement groove of the gastrostomy catheter 10.

Further, when the nutrient solution is supplied to the stomach S of the patient, for example, through the gastrostomy catheter 10 left in the body of the patient, a connector for a tube extending from the container containing the nutrient solution is connected to the insertion hole 14 of the gastrostomy catheter. In this state, the nutrient solution is supplied to the patient through the tube and the gastrostomy catheter 10. At this time, the nutrient solution coming out of the tubular member 12 flows from the stomach interior fixing member 13 through each coupling member 13a and enters the stomach S. Further, after use, the tube from the nutrient solution container is removed from the insertion hole 14 of the gastrostomy catheter 10, and the insertion hole 14 is closed with the plug member 16. Then, when the gastrostomy catheter 10 needs to be replaced after a certain period of use, it can be replaced with a new gastrostomy catheter 10. Also in this case, the indwelling position of the gastrostomy catheter 10 can be confirmed using the instrument 20 for confirming the indwelling position, which has been described above.

In this way, the instrument 20 of the present invention for confirming the indwelling position of the gastrostomy catheter is provided with the protective cover 24, and the fiberscope shafts 23a are covered with the protective cover 24, and they pass through the gastrostomy catheter 10. Therefore, there is no discomfort to the patient's body caused by the attachment of the fiberscope 23 and the protective cover 24 to the patient's body. Further, after the indwelling position of the gastrostomy catheter 10 has been confirmed, the fiberscope 23 and the like are pulled out from the gastrostomy catheter 10, and then the fiberscope 23 is pulled out from the protective cover 24, so that the fiberscope shaft 23a is not stained with gastric juice and the like.

As a result, there is virtually no need to clean or disinfect the fiberscope 23, making the cost of disinfection and cleaning largely unnecessary, and also making it possible to extend the useful life of the fiberscope 23. Further, the wire 24c is coupled to the tip of the protective cover 24, and the tip of the protective cover 24 protrudes from the through hole of the stomach interior fixing member 13, and in this state, the tip portion of the protective cover 24 can be flexed together with the fiberscope shaft 23a by pulling the wire 24c, so that the irradiation direction of the light guide 23b and the focusing direction of the lens 21 can be changed. This means that the light irradiation direction and the focusing direction can be changed with a simple operation, and the indwelling position can be confirmed more reliably.

Further, the instrument of the present invention for confirming the indwelling position of the gastrostomy catheter is not limited to the above-described embodiment, and appropriate modifications may be effected within the technical scope of the present invention. For example, in the above-described embodiment, the external fixation member 11 is provided on the gastrostomy catheter 10, but a gastrostomy catheter not provided with the external fixation member 11 may be used. In this case, the connection fitting 25 may be omitted. Other devices having similar functions may be used instead of the image display device and the light source device and the like. Further, in the above-described embodiment, the end portion of the protective cover 24 is flexed together with the fiberscope shaft 23a by pulling the wire 24c, but the wire 24c may be configured of a rigid material, and the end portion of the protective cover 24 may be flexed together with the fiberscope shaft 23a by pushing the wire 24 c.

With the present invention configured in the above-described manner, a fiberscope used as an endoscope can be covered by a protective cover and passed through a gastrostomy catheter inside. In this way, the fiberscope is inserted together with the protective cover from the gastrostomy catheter that has been left in the patient's body, reaching the inner surface of the stomach wall, and therefore without discomfort to the patient caused by the insertion of the fiberscope and the protective cover. Further, the diameter of the endoscope can be reduced by using a fiberscope as the endoscope, and as a result, the endoscope passes through the gastrostomy catheter more easily.

Further, when the indwelling position of the gastrostomy catheter is confirmed, the protective cover and the fiberscope can then be pulled out together from the gastrostomy catheter, and thereafter, the fiberscope is pulled out from the protective cover, so that the fiberscope can be removed from the patient body without the fiberscope being stained with gastric juice. As a result, there is virtually no need to clean or disinfect the fiberscope, making the cost of disinfection and cleaning largely unnecessary, and also making it possible to extend the useful life of the fiberscope. Further, the end of the protective cover facing the end of the fiberscope includes a window member that allows light emission, and therefore, the accuracy of observation of the stomach wall with the fiberscope due to the protective cover is not reduced.

Another aspect of one embodiment of the present invention is that when the linear member is coupled to the outer periphery at the tip end of the protective cover, and the tip end of the protective cover protrudes from the through hole of the stomach interior fixing member, the tip end member of the protective cover can be flexed together with the fiberscope, so that the viewing direction of the fiberscope can be changed by the operation of the tail end portion of the linear member. Thereby, the viewing direction of the lens can be changed with a simple operation, and this makes confirming the indwelling position more reliable. In this case, the direction of the through-hole of the stomach interior fixing member can be confirmed using a fiberscope. Further, the fiberscope is flexed by the protective cover, and thus the fiberscope itself can be manufactured with a simple structure. Thus, the number of components of the fiberscope itself that may fail can be reduced. In this case, the operation of the trailing end portion of the linear member includes the pushing and pulling operation of the linear member.

Claims (2)

1. An apparatus for confirming the position of an indwelling gastrostomy catheter, the catheter comprising: a tubular member for extending through an aperture formed between a skin surface of a patient and an inner surface of a stomach wall and extending from outside the patient to the inner surface of the stomach wall; and an intragastric fixation component that is couplable to a tip of the tubular component and is disposed at an inner surface of the stomach wall, the intragastric fixation component having a through hole adapted to receive the tubular component therethrough, the apparatus for confirming a position of an indwelling gastrostomy catheter comprising: a fiberscope with which the inner surface of the stomach wall can be observed, the fiberscope being adapted to extend through the interior of the tubular member such that a tip of the fiberscope protrudes from the through-hole of the intragastric fixation member; and a protective cover adapted to pass through the gastrostomy catheter together with the fiberscope in a state in which the fiberscope is covered, the protective cover including an optically transparent window member at a distal end thereof, the optically transparent window member allowing observation of an inner surface of the stomach wall by means of the fiberscope.

2. The apparatus for confirming the position of an indwelling gastrostomy catheter according to claim 1, further comprising a linear member adapted to be coupled to the outer periphery of the protective cover at the distal end thereof so that when the distal end of the protective cover is projected from the through hole of the intragastric fixing member, the distal end portion of the protective cover can be flexed together with the fiberscope by the operation of the trailing end portion of the linear member, whereby the observation direction of the fiberscope can be changed.