Katheterthrombosen im Kindesalter und ihre Prävention

Zusammenfassung

Die häufigste Ursache von Thromboembolien im Neugeborenenalter ist das Vorhandensein von Gefäßkathetern. Eine genetische Prädisposition mit den bekannten Mutationen ist zusätzlich oft nachweisbar. Für das Verstehen der Pathologie ist die bei Neugeborenen andere hämostaseologische Balance zu berücksichtigen. Bei der Indikation für Gefäßkatheter ist stets die besondere Situation des unter Umständen sehr kleinen Kindes berücksichtigen. Bei Frühgeborenen besteht in den ersten Lebenstagen eine stark erhöhte Hirnblutungsgefahr. Die differenzierte Abwägung von Indikation und Kontraindikationen ist deshalb unbedingt erforderlich. Zur Vermeidung der Katheterthrombose bewährten sich verschiedene Schemata zur Prophylaxe, insbesondere wurde die Gabe von Heparin in Low-Dose-Dosierung (ggf. als kontinuierliche Infusion) für unterschiedliche Gefäßzugänge empfohlen. Im Neugeborenenalter sind spezifische lokalisationsbezogene Komplikationen der Nabelgefäßkatheterisierung zu berücksichtigen. Das frühzeitige Erkennen einer Katheterthrombose ist wichtig, deshalb sind die Frühzeichen dieser Komplikation unbedingt zu beachten. Eine Thrombolysetherapie sollte in jedem Fall erwogen werden. Allerdings sind dabei der Zustand des Patienten und die Dynamik des Thrombuswachstums in die Überlegungen einzubeziehen.

Summary

Vascular catheters are the most important cause of thromboembolism in neonates. Additionally, a concomittant genetic predisposition with the well-known mutations is often present. In order to understand the pathology, knowledge about the specific condition of the newborn is important, especially concerning the altered hemostatic balance. For indications the specific situation of the very small infant is to be considered, e. g. the increased risk of cerebral bleeding in the first days of life of prematures. Therefore, careful consideration of indication and contraindications is mandatory. To avoid catheter-related thrombosis different schedules of prophylaxis are well-tried, especially low dose heparinization (sometimes as continuous infusion) is recommended for different types of vascular access. In neonates specific organ-related complications of umbilical catheters are to be considered. For the early diagnosis of catheter-related thrombosis, attention should be given to its first signs. Thrombolytic therapy is worth to be considered. However, the state of the patient and the dynamic of thrombus growth must be taken into account.

Schlüsselwörter

Katheterthrombose - Embolie - Heparin

Keywords

Thrombosis - embolism - heparin

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