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Anästhesiol Intensivmed Notfallmed Schmerzther 2011; 46(3): 202-210
DOI: 10.1055/s-0031-1274932
Fachwissen Anästhesiologie und Intensivmedizin
Topthema: Ultraschall in der Anästhesie und Intensivmedizin
© Georg Thieme Verlag Stuttgart · New York

Ultraschall in der Anästhesie und Intensivmedizin – Ultraschall bei Gefäßpunktionen

Real-time ultrasound guided vascular accessMatthias Georg Boschin
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Publication History

Publication Date:
11 March 2011 (online)

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Zusammenfassung

In der perioperativen Patientenversorgung sind Punktionen venöser und arterieller Gefäße Alltag. Viele Punktionen werden nach anatomischen Landmarken durchgeführt. Mitentscheidend für den Punktionserfolg sind dabei gute anatomische Kenntnisse, die optimale Identifikation der Landmarken und die Erfahrung des durchführenden Arztes. Liegen anatomische Varianten oder pathologische Gefäßveränderungen vor, kann das landmarkengestützte Vorgehen schwierig oder unmöglich sein. Die Ultraschallunterstützung bei arteriellen, zentral- und periphervenösen Gefäßpunktionen kann die Patientensicherheit bei Erwachsenen und Kindern verbessern. Umgebende anatomische Strukturen und die Nadelposition können während des Punktionsvorgangs kontinuierlich dargestellt werden. Komplikationen können reduziert und der Punktions-erfolg erhöht werden. Voraussetzung für den sicheren Einsatz einer ultraschall-gesteuerten Punktionstechnik ist eine entsprechende Ausbildung. Dieser Artikel gibt einen Überblick über die aktuelle Literatur und beschreibt die Praxis ultraschallgesteuerter Gefäßzugänge.

Abstract

Central venous catheterization and arterial catheterization are common procedures performed perioperatively by anesthetists. The traditional technique of locating surface landmarks was used to assist in vascular access. In patients with anatomical variants or pathological vessel changes it could be difficult or impossible to succeed with this traditional approach. Ultrasound-guided vascular access can improve patient safety in adults and children. Surrounding anatomical structures are visualized and the needle is advanced under continuous observation. Complications can be reduced and success improved. It is mandatory to offer an appropriate ultrasound training programs for physicians using this technique. This article summarizes the literature and describes a practical method of ultrasound-guided vascular access.

Schlüsselwörter:

perioperative Versorgung - Ultraschall - intravaskuläre Katheter - Anästhesie

Keywords:

perioperative care - ultrasonography - interventional catheterization - anesthesiology - physician's practice patterns

Kernaussagen

  • Kenntnisse des Ultraschallgeräts, Organisation der Aufstellung und Bedienung sowie Wissen um die relevante Sonoanatomie sind notwendig, bevor eine ultraschallgesteuerte Gefäßpunktion durchgeführt wird.

  • Gefäße sind im Ultraschall gut erkennbar: Blut erscheint als echoarmes Medium im Ultraschallbild schwarz.

  • Anatomische Normvarianten von Gefäßen können in relevanter Anzahl auftreten und eine Punktion schwierig bis unmöglich machen.

  • Die 2D-Ultraschalltechnik bietet aufgrund der Echtzeitdarstellung der individuellen Patientenanatomie eindeutige Vorteile und ist das überlegene Verfahren.

  • Mehrfachpunktionen erhöhen das Risiko für Komplikationen. Eine „Ein-Stich“-Technik ist ideal.

  • Die beste Evidenz existiert im Rahmen der zentralvenösen Zugangswege für die V. jugularis interna bei Erwachsenen.

  • Auch für andere Gefäßpunktionen ist ein Vorteil der sonografisch gesteuerten Technik denkbar, weitere Untersuchungen zur Effektivität und Sicherheit wären aber wünschenswert.

  • Die ultraschallgestützte Punktion ist ein Verfahren mit eigenen Risiken. Sie schließt Komplikationen keinesfalls aus.

Weiteres Material zum Artikel

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Dr. med. Matthias Georg Boschin

Email: Matthias.Boschin@UkMuenster.de

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