Langfristige zentralvenöse Zugänge und deren Komplikationsmanagement

Zusammenfassung

Langfristige (> 14 Tage) zentralvenöse Zugänge werden in zunehmendem Maße implantiert, wobei die allgemein angestrebte Reduktion der stationären Verweildauer diese Entwicklung akzelerieren wird. Implantiert werden subkutan getunnelte und nichtgetunnelte Katheter sowie Portsysteme. Der interventionellen Radiologie kommt sowohl bei der Katheterimplantation als auch bei der Erkennung und Behandlung von Katheterkomplikationen eine große Bedeutung zu. Es werden die verschiedenen Zugangswege über periphere und zentrale Venen beschrieben und es wird die Implantationstechnik für die verschiedenen Systeme erläutert. Die abschälbare Schleuse (peel-away) ermöglicht es dem Radiologen, mittels Seldinger-Technik auch ohne chirurgische Präparation die Implantation von subkutan getunnelten Zugängen vorzunehmen. Bei den Komplikationen können periprozedurale, Früh- und Spätkomplikationen unterschieden werden. Dem Radiologen kommt bei der Insertion dieser Katheter, der Überwachung der Systeme und dem Management der katheterassoziierten Komplikationen eine wesentliche Bedeutung zu. Erkennung von Komplikationen und deren Behandlungsmöglichkeit sowie präventive Maßnahmen werden erläutert und diskutiert.

Abstract

The implantation of permanent (> 14 days) central venous catheters is constantly increasing, accelerated by a trend toward outpatient therapies. Subcutaneous tunneled and non-tunneled catheters as well as port systems are available. The interventional radiologist plays an important role in the implantation of central venous catheters as well as in detection and treatment of any complications. Various access ways via peripheral and central veins are described and the implantation techniques for the different systems explained. The use of peel-away sheaths allows the radiologist to implant subcutaneous tunneled catheters via the Seldinger technique without surgical preparation. Procedure-related early and late complications may occur, and the radiologist plays an important role in the surveillance and management of catheter-associated complications. This review demonstrates the different catheter systems and implantation techniques.

Key words

Central venous catheter - surveillance - complication - management

Literatur

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