Besonderheiten des Gefäßzugangs bei Kindern

Kernaussagen

• Kinder benötigen Venenzugänge aus den gleichen Gründen wie Erwachsene. Aufgrund schwieriger Venenverhältnisse sind aber oft unübliche periphere, gehäuft aber auch zentralvenöse Zugänge erforderlich.

• Im Notfall ist ein intraossärer Zugang eine zügig zu etablierende Alternative zum klassischen Venenzugang. Bei der Neugeborenenreanimation ist ein Nabelvenenkatheter eine weitere Option. Bei beiden Verfahren müssen die Komplikationen des Verfahrens beachtet werden.

• Die Sonografie gewinnt einen immer größeren Stellenwert, insbesondere zum Anlegen von ZVK, aber auch für arterielle und periphervenöse Zugänge. Auch aus Trainingsgründen sollte diese unterstützende Technik möglichst häufig eingesetzt werden.

• Adäquate Lagerung, Transfixationstechnik sowie eine differenzierte Auswahl von Führungsdrähten und Punktionstechniken erhöhen die Erfolgsrate.

• Die wesentlichen mechanischen Komplikationen beim Anlegen von ZVK sind Hämatome und Pneumothorax, die sich beide durch den Einsatz der Sonografie reduzieren lassen.

• Die Hauptkomplikation bei länger liegenden ZVK sind die Infektion und Thrombosen. Beide kann man durch eine Schulung des Personals, steriles Arbeiten und prophylaktische Hygienemaßnahmen deutlich reduzieren.

• Literatur

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