Management bei katheterassoziierter Armvenenthrombose

Zusammenfassung

Zentralvenöse Zugangswege werden mit zunehmender Häufigkeit in der Therapie akuter und chronischer Erkrankungen eingesetzt. Katheterassoziierte Thrombosen und thrombotische Katheterokklusionen sind häufige Komplikationen, insbesondere wenn Portkatheter für langfristige Therapien eingesetzt werden. Diese Übersichtsarbeit beschäftigt sich vorzugsweise mit dem optimalen Umgang mit diesen Komplikationen. Risikofaktoren für katheterassoziierte Thrombosen sind eine Fehllage der Katheterspitze, eine maligne Grunderkrankung und eine Hyperkoagulabilität. Thrombosen treten vor allem im Zusammenhang mit Katheterinfektionen auf; Lungenembolien in der Akutphase und ein postthrombotisches Syndrom im Langzeitverlauf kommen ebenfalls vor. Am häufigsten wird heutzutage die farbkodierte Duplexsonografie zur Diagnose katheterassoziierter Thrombosen eingesetzt, die am häufigsten die V. subclavia betreffen. Die Therapie besteht in der Regel in der Einleitung einer volltherapeutischen Antikoagulation, die für eine Dauer von mindestens 3 Monaten beziehungsweise länger durchgeführt wird, wenn der Katheter für die Fortführung einer Therapie belassen wird. Für die Prävention katheterassoziierter Thrombosen ist die korrekte Lage der Katheterspitze in der proximalen V. cava superior von Bedeutung. Regelmäßiges Spülen des Katheters mit Kochsalzlösung oder unfraktioniertem Heparin beugt einer Katheterokklusion vor. Der primärpräventive Einsatz von Antikoagulanzien zur Verhinderung von Thrombosen kann zum jetzigen Zeitpunkt nicht empfohlen werden.

Abstract

Central venous catheters (CVCs) are important tools in the care of patients with acute or chronic diseases, but catheter-related thrombosis and thrombotic occlusions are frequent complications, especially if CVCs are implanted for long-term use. In this review we focus on the management of these complications. Risk factors for catheter-related thrombosis include dislocation of the catheter tip, the presence of malignant disease and hypercoagulability. Catheter-related thrombosis is associated with catheter infection, pulmonary embolism and post-thrombotic syndrome. Catheter-related thromboses which most frequently involve the subclavian vein are usually diagnosed by duplex ultrasound examination and treated with anticoagulation therapy for a minimum of three months or longer if the catheter is left in place. Prevention of catheter-related thrombotic complications includes proper positioning of the CVC with the catheter tip lying in the proximal superior vena cava and regular flushing of the catheter with saline solution or unfractionated heparin. The use of anticoagulants for primary prevention is currently not recommended.

Schlüsselwörter

Armvenenthrombose - Okklusion - zentralvenöser Katheter - Therapie

Key words

upper extremity deep vein thrombosis - occlusion - central venous catheter - treatment

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