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Anästhesiol Intensivmed Notfallmed Schmerzther 2017; 52(01): 55-64
DOI: 10.1055/s-0042-104853
Fachwissen
Georg Thieme Verlag KG Stuttgart · New York

Notfälle im Rettungsdienst und in der Klinik: Gefäßzugänge bei Kindern

Vascular access in pediatric patients in emergency situations
Tomohiro Yamamoto
,
Ehrenfried Schindler
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Publication History

Publication Date:
11 January 2017 (online)

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Zusammenfassung

Der i. v. Gefäßzugang ist im Notfall zwingend notwendig, um Medikamente und/oder Flüssigkeiten zuführen zu können. Gerade aber bei kleinen Kindern oder Säuglingen ist die Punktion peripherer Venen mitunter schwierig und in einer zeitkritischen Situation häufig auch sehr stressbelastet. In solchen Situationen muss der Anwender Alternativen zur etablierten Venenpunktion kennen und Hilfsmittel beherrschen können. Im Rettungsdienst sind die intraossären (i. o.) Gefäßzugänge ohne Verzögerung anzuwenden, falls die peripheren Venenpunktion nicht zügig garantiert werden kann. Obwohl inzwischen zahlreiche transportable Ultraschallgeräte auf dem Markt sind, die auch im Rettungsdienst eingesetzt werden können, sind diese zurzeit noch nicht flächendeckend im außerklinischen Alltag verfügbar. Nach Stabilisierung der Vitalfunktionen und Transport ins Krankenhaus kann die Anlage eines periphervenösen (PVK) oder zentralvenösen Katheters (ZVK) erwogen werden, um einen bereits liegenden i. o. Zugang zu ersetzen. In dieser Übersicht sollen die gängigen Gefäßzugänge bei Kindern und Säuglingen besprochen, Alternativen diskutiert und zentrale Punktionstechniken beschrieben werden. Die Anwendung des Ultraschalls zu Gefäßpunktion nimmt einen immer größeren Stellenwert ein. Daher werden auch ultraschallbasierte Techniken vorgestellt. Die Sonografie kann die Anlage von peripheren Verweilkanülen und/oder zentralvenösen Kathetern beim pädiatrischen Patienten in innerklinischen Notfallsituationen oder bei schwierigen Venenverhältnissen erheblich erleichtern.

Abstract

Vascular access is necessary for the administration of medication and for the collection of blood samples in an emergency. Peripheral venous access is occasionally difficult in infants and younger children, particularly during emergencies. However, reliable vascular access and prompt treatment are required in these circumstances to successfully treat the patient. During the rescue service, immediate establishment of the intraosseous vascular access is very important, in case peripheral vascular access cannot be established rapidly. Although numerous transportable ultrasound machines have been developed, which may be utilized during rescue service, relatively difficult access hampers their application during the rescue service. After stabilizing vital functions and transportation to the hospital, peripheral venous access or central venous access can be attempted again in order to replace intraosseous vascular access. In this manuscript, we first discuss intraosseous vascular access as an alternative vascular access technique, which can be attempted during the rescue service. Next, we introduce ultrasound-guided and other techniques for peripheral and central vascular access as potential alternatives for pediatric patients with difficult vascular access or in-hospital emergency situations. Timely decision-making and prompt utilization of alternative procedures to achieve unimpeded vascular access is essential for the treatment and survival of pediatric patients in an emergency.

Kernaussagen

  • In Notfallsituationen wird die periphere Verweilkanüle oder der intraossäre Gefäßzugang empfohlen.

  • Intraossär verabreichte Medikamente erreichen schnell den zentralen Kreislauf.

  • Die aktuelle Leitlinie des European Resuscitation Council empfiehlt einen i. o. Zugang, sollte der i. v. Zugang nicht innerhalb von 2 min erfolgreich sein.

  • Es wird empfohlen, den i. o. Zugang nach Stabilisierung der Vitalfunktionen und Transport ins Krankenhaus durch einen entsprechenden peripheren oder zentralen Venenkatheter zu ersetzen.

  • Die Sonografie kann die Anlage von peripheren Verweilkanülen sowie zentralvenösen Kathetern beim pädiatrischen Patienten erheblich erleichtern und ist gerade in der Pädiatrie inzwischen klinischer Standard.

Schlüsselwörter

zentraler Venenkatheter - peripherer Venenkatheter - intraossärer Zugang - intravenöser Zugang - Ultraschalltechnik - Landmarkentechnik

Key words

central venous catheter - peripheral venous catheter - intraosseous catheter - intravenous catheter - ultrasound - landmarks technique
 

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