SOP Management von Portinfektionen

Portsysteme garantieren einen sicheren venösen Zugang bei Patienten mit schlechtem Venenstatus und sind grundlegend für die Langzeitapplikation von Medikamenten wie z. B. Chemotherapeutika. Doch sind sie nicht frei von Komplikationen. Eine Portinfektion ist eine lebensgefährliche Situation, die Infektionsrate schwankt in aktuellen Studien zwischen 0,8% und 7,5% und ist bei Krebspatienten noch deutlich höher mit 16–31% [1]. Die vorliegende SOP soll einen Überblick zum Management von Portinfektionen geben.

Schlüsselwörter

Portinfektion - catheter-related bloodstream infection - Chemotherapie - Antibiotika-Lock-Therapie - Hygiene

Publication History

Article published online:
13 February 2024

• Literatur

• 1 Lipitz-Snyderman A, Sepkowitz KA, Elkin EB. et al. Long-term central venous catheter use and risk of infection in older adults with cancer. J Clin Oncol 2014; 32: 2351-2356
• 2 National Nosocomial Infections Surveillance (NNIS) system report, data summary from October 1986-April 1998, issued June 1998. Am J Infect Control [Anonym]. 1998; 26: 522-533
• 3 Mermel LA, Allon M, Bouza E. et al. Clinical practice guidelines for the diagnosis and management of intravascular catheter-related infection: 2009 update by the Infectious Diseases Society of America. Clin Infect Dis 2009; 49: 1-45
• 4 Safdar N, Maki DG. The pathogenesis of catheter-related bloodstream infection with noncuffed short-term central venous catheters. Intensive Care Med 2004; 30: 62-67
• 5 Mermel LA, McCormick RD, Springman SR. et al. The pathogenesis and epidemiology of catheter-related infection with pulmonary artery Swan-Ganz catheters: a prospective study utilizing molecular subtyping. Am J Med 1991; 91: 197S-205S
• 6 Howell PB, Walters PE, Donowitz GR. et al. Risk factors for infection of adult patients with cancer who have tunnelled central venous catheters. Cancer 1995; 75: 1367-1375
• 7 Kochanek M, Schalk E, von Bergwelt-Baildon M. et al. Management of sepsis in neutropenic cancer patients: 2018 guidelines from the Infectious Diseases Working Party (AGIHO) and Intensive Care Working Party (iCHOP) of the German Society of Hematology and Medical Oncology (DGHO). Ann Hematol 2019; 98: 1051-1069
• 8 Meyer E, Beyersmann J, Bertz H. et al. Risk factor analysis of blood stream infection and pneumonia in neutropenic patients after peripheral blood stem-cell transplantation. Bone Marrow Transplant 2007; 39: 173-178
• 9 Raad II, Luna M, Khalil SA. et al. The relationship between the thrombotic and infectious complications of central venous catheters. JAMA 1994; 271: 1014-1016
• 10 Uhrig M. Portkatheter. Accessed October 24, 2023 at: https://www.onkopedia.com/de/onkopedia-p/guidelines/portkatheter
• 11 Camp-Sorrell D, Cope DG, Ezzone SA, Gerber DL, Lamprecht M. Access Device Guidelines: Recommendations for Nursing Practice and Education. Pittsburgh: The Oncology Nursing Society; 2011
• 12 Deutsches Krebsforschungszentrum (dkfz). Port zur Chemotherapie: Wie pflegen, wann entfernen?. Accessed October 24, 2023 at: https://www.krebsinformationsdienst.de/behandlung/chemotherapie/portsysteme.php
• 13 Bouza E, Burillo A, Muñoz P. Catheter-related infections: diagnosis and intravascular treatment. Clin Microbiol Infect 2002; 8: 265-274
• 14 Zingg W, Sax H, Inan C. et al. Hospital-wide surveillance of catheter-related bloodstream infection: from the expected to the unexpected. J Hosp Infect 2009; 73: 41-46
• 15 Böll B, Schalk E, Buchheidt D. et al. Central venous catheter-related infections in hematology and oncology: 2020 updated guidelines on diagnosis, management, and prevention by the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO). Ann Hematol 2021; 100: 239-259
• 16 Rijnders BJ, Verwaest C, Peetermans WE. et al. Difference in time to positivity of hub-blood versus nonhub-blood cultures is not useful for the diagnosis of catheter-related bloodstream infection in critically ill patients. Crit Care Med 2001; 29: 1399-1403
• 17 Mayhall CG. Diagnosis and management of infections of implantable devices used for prolonged venous access. Curr Clin Top Infect Dis 1992; 12: 83-110
• 18 Lee YM, Moon C, Kim YJ. et al. Clinical impact of delayed catheter removal for patients with central-venous-catheter-related Gram-negative bacteraemia. J Hosp Infect 2018; 99: 106-113
• 19 Fares J, Khalil M, Chaftari AM. et al. Impact of catheter management on clinical outcome in adult cancer patients with gram-negative bacteremia. Open Forum Infect Dis 2019; 6: ofz357
• 20 Fernandez-Hidalgo N, Almirante B, Calleja R. et al. Antibiotic-lock therapy for long-term intravascular catheter-related bacteraemia: results of an open, non-comparative study. J Antimicrob Chemother 2006; 57: 1172-1180
• 21 Fortún J, Grill F, Martín-Dávila P. et al. Treatment of long-term intravascular catheter-related bacteraemia with antibiotic-lock therapy. J Antimicrob Chemother 2006; 58: 816-821
• 22 Peterson WJ, Maya ID, Carlton D. et al. Treatment of dialysis catheter-related enterococcus bacteremia with an antibiotic lock: a quality improvement report. Am J Kidney Dis 2009; 53: 107-111
• 23 Ławiński M, Majewska K, Fołtyn I. et al. The efficacy of alcohol-antibiotic lock therapy for treatment of catheter related bloodstream infections in patients receiving home parenteral nutrition. Pol Przegl Chir 2015; 86: 563-568