Gefäßzugänge bei Kindern: Technik, Komplikationen und Fallstricke beim zentralen Venenkatheter

Zusammenfassung

Kinder mit komplexen Erkrankungen benötigen häufig einen zentralvenösen Katheter für die intraoperative Anwendung, zur parenteralen Ernährung, zur mehrfachen Blutentnahme und zur Verabreichung von Medikamenten. Heute gelten ultraschallbasierte Techniken als Goldstandard. In diesem Artikel werden Standardpositionen wie auch neue Alternativen vorgestellt.

Abstract

Children with complex diseases often need central venous catheter, not only for intraoperative use, but also for parenteral nutrition, multiple blood draw due to lab examination and to administer drugs that cannot be given via peripheral lines. Whereas the landmark driven vascular access was teached for years, nowadays the routine use of ultrasound based techniques can be called the gold standard. This article highlights standard locations for central venous access like cannulation of the internal jugular vein as well as novel alternatives such as the cannulation of the brachiocephalic vein. The correct insertion depth of central lines is essential to avoid serious complications. Several different formulas are available and can be used. Independent of the used formula, you have to make sure that complications due to incorrect depth of central venous line are a topic of the past. Finally, important tips and tricks to avoid failure and serious complications are discussed.

Kernaussagen

• Die sonografische Punktion der V. jugularis interna ist bei Kindern verglichen mit allen anderen Gefäßlokalisationen hinsichtlich Thromboserate und Infektionshäufigkeit der Zugang der ersten Wahl.

• Wir empfehlen für die Punktion der V. jugularis interna ohne Sonografie eine neutrale Position des Kopfes mit nur leichter Überstreckung.

• Die Technik der Punktion der V. brachiocephalica ist einfach zu erlernen, komplikationsarm und auch bei schwierigen Gefäßverhältnissen eine Alternative zu etablierten Lokalisationen.

• Für die Lagetiefe des Katheters in der rechten V. jugularis interna und der linken V. brachiocephalica gilt als Faustformel: 10% der Körperlänge + 1 cm (für Patienten < 100 cm Körpergröße) bzw. – 1 cm (für Patienten > 100 cm Körpergröße).

• Komplikationen bei der ZVK-Anlage, die auf Katheterfehllagen beruhen, sind vermeidbar. Die sonografische Kontrolle hat zum Ausschluss eines Pneumothorax einen wichtigen Stellenwert – noch vor der Röntgenaufnahme des Thorax. Die Lagekontrolle ist allerdings nicht bei allen Patienten mittels Ultraschall möglich.

Schlüsselwörter

zentraler Venenkatheter - Lagetiefe - ultraschallgestützte Punktion - sonografische Punktion - pädiatrischer Venenkatheter

Key words

central venous access - venous cannulation - pediatric venous access - ultrasound-guided cannulation

Publication History

Article published online:
07 January 2021

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