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
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PD Dr. Ulf Teichgräber
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