Aktuelle Praxis zur Durchführung ultraschallgesteuerter Punktionen an gastroenterologischen Abteilungen

Zusammenfassung

Ziel: Abdominale ultraschallgesteuerte Punktionen werden in Kliniken täglich vielfach durchgeführt. Bisher existieren wenige Leitlinien oder Empfehlungen für dieses Verfahren. Ziel der Studie war es, die aktuelle Praxis bei ultraschallgesteuerten Punktionen an größeren deutschen gastroenterologischen Fachabteilungen zu erfragen.

Material und Methoden: An 349 deutschen Kliniken mit eigener Gastroenterologie und einer Bettenzahl größer 500 wurden 349 Kliniken mit einem Fragebogen zu Vorbereitung, Vorgehen und postinterventioneller Überwachung bei ultraschallgesteuerter Punktion angeschrieben. Die Rücklaufquote betrug 51 % (n = 177).

Ergebnisse: Insgesamt 51,2 % (88/172) der Kliniken legen vor Punktion grundsätzlich einen venösen Zugang. Eine Analgosedierung führen 19,1 % (33/173) der Kliniken standardmäßig und 60,1 % (104/173) bei Bedarf durch. Eine Lokalanästhesie wird in 84,8 % (145/171) der Kliniken eingesetzt. Zur gezielten Punktion verwenden 40,6 % (81/176) der befragten Kliniken einen Punktionsschallkopf, 29,5 % (52/176) einen ansteckbaren Punktionsaufsatz. Eine Mindestthrombozytenzahl von 50 000/µl vor Punktion fordern 80,6 % (141/175) der Kliniken. In 86,5 % (147/170) der Kliniken wird als Grenzwert für den Quick-Test mindestens 50 % verwendet. Die am häufigsten von den Kliniken angegebenen Grenzwerte für International Normalized Ratio (INR) liegen zwischen 1 und 1,5 und für die partiale Thromboplastinzeit (PTT) zwischen 28 und 50 s. Das Pausieren gerinnungshemmender Medikamente wird sehr heterogen gehandhabt. Die postinterventionelle Überwachungszeit bei ambulanten Punktionen liegt zwischen 2 – 24 h.

Schlussfolgerung: Unsere Ergebnisse zeigen, dass bei der Vorbereitung ultraschallgesteuerter Punktionen, beim Punktionsvorgang und bei der Nachsorge erhebliche Unterschiede in der täglichen Praxis bestehen. Die Erstellung einer Leitlinie zur standardisierten Durchführung ultraschallgesteuerter Punktionen scheint sinnvoll zu sein.

Abstract

Objective: Ultrasonographically guided adominal biopsies are a frequent daily procedure in German hospitals. There are, however, few guidelines or recommendations for these common procedures. The oive of the current study was to assess current practice with respect to ultrasonographically guided biopsy procedures in a survey of hospitals with established departments of gastroenterology or with over 500 beds.

Material and Method: A questionnaire addressing the preparation for, procedure during, and post-interventional monitoring following ultrasonographically guided biopsies was mailed to 349 German hospitals. The response rate was 51 % (n = 177).

Results: Establishment of an intravenous access is standard in 51.2 % (88/172) of the hospitals. Sedation analgesia is standard in 19.1 % (33/173) of the hospitals and is an option in a further 60.1 % (104/173). Local anesthesia is performed in 84.8 % (145/171) of the hospitals. A dedicated transducer for targeted biopsy is used in 40.6 % (81/176) of the hospitals, while 29.5 % (52/176) use a separate biopsy bracket attached to the probe. In 80.6 % (141/175) of the hospitals, a minimum platelet count of 50,000/µL is required. A minimum of 50 % is used as limit for quick in 86.5 % (147/170) of the hospitals. A value of 1 − 1.5 for the international normalized ratio (INR) is most commonly used in the hospitals. A partial thromboplastin time (PTT) between 28 and 50 sec. is used as the upper limit. Interruption of anticoagulants is handled in a very heterogeneous manner. Postinterventional monitoring following biopsy in ambulatory patients ranges from two to 24 hours.

Conclusion: Our survey shows relevant differences in preparation, execution and postinterventional monitoring in ultrasonographically guided biopsy procedures as routinely performed in German hospitals. There seems to be a need for a guideline standardising ultrasonographically guided biopsy procedures.

Schlüsselwörter

Punktionen - Nadelbiopsie - Feinnadelbiopsie - Ultraschall - interventioneller Ultraschall

Key words

punctures - biopsy needle - fine-needle biopsy - ultrasonography - interventional ultrasonography

¹ Both authors contributed equally.

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