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Krankenhaushygiene up2date 2017; 12(01): 43-56
DOI: 10.1055/s-0042-123726
Präventionsmaßnahmen
© Georg Thieme Verlag KG Stuttgart · New York

Kinderonkologie: Erhaltungspflege von Broviac- und Port-Kathetern

Max Scheler
,
Arne Simon
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Publication Date:
24 March 2017 (online)

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Die meisten Kinder mit Krebs erhalten zu Beginn der Chemotherapie einen zentralen Venenkatheter. Die Prävention von Blutstrominfektionen, die von solchen Gefäßkathetern ausgehen, ist ein wichtiges Merkmal guter klinischer Praxis. Dieser Beitrag diskutiert verschiedene Aspekte von Präventionsbündeln in diesem speziellen klinischen Kontext.
Kernaussagen

  • Nur ein Teil der CA-BSI geht tatsächlich vom Gefäßkatheter aus und lässt sich durch gezielte Präventionsmaßnahmen verhindern [37] [86].

  • BSI und deren Therapie die Chemotherapie relevant verzögern, was sich möglicherweise ungünstig auf die Gesamtprognose auswirkt.

  • Bei jedem Verbandswechsel ist eine antiseptische Behandlung der Eintrittsstelle des Broviac-Katheters nötig. Denn sie ist eine wichtige Quelle für Infektionen, von der eine sekundäre Bakteriämie oder eine Weichteilinfektion ausgehen kann.

  • Bestimmte Zytostatika (v. a. hoch dosiertes Methotrexat und Anthrazykline) können lokale Hautreaktionen am Broviac-Eintritt auslösen, die bei granulozytopenischen Patienten (kein Eiter!) klinisch schwer von Lokalinfektionen zu unterscheiden sind.

  • Die Kontamination von Hubs und Dreiwegehähnen ist eine wichtige Quelle von CR-BSI [65]. Der Umgang mit einem NFC erfordert daher ein gut geschultes Behandlungsteam und die vor jedem Zugriff sorgfältige Desinfektion der NFC-Membran [89].

  • Kontaminierte Infusionslösungen bzw. i. v. Medikamente können eine BSI verursachen [10] [102]. In der Praxis ist die nicht sachgerechte (unzulässige) Teilentnahme aus der gleichen Ampulle für mehrere Patienten ein ernstes Problem [9].

  • Zum Blocken von CVAD soll ausschließlich patientenbezogenes Heparin aus Fertigampullen zum Einsatz kommen.

  • Durch intermittierendes Blocken des Katheters mit Taurolidin lassen sich CR-BSI vermeiden.

  • Eine von PVKs ausgehende Bakteriämie kann zu einer hämatogenen Besiedlung des CVAD führen. Auch für die Anlage und Erhaltungspflege von PVKs sollte es einen eigenen infektionspräventiven Standard geben.

  • Ein einheitliches KISS-Erfassungsmodul für Blutstrominfektionen (mit oder ohne Bezug zum CVAD) bei kinderonkologischen Patienten ist wünschenswert.

 

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