Zusammenfassung
Der Wechsel zentralvenöser Katheter (ZVK) bei Intensivpatienten erfolgt bei Katheterdysfunktion, katheterassoziierter Sepsis, oder wenn ein anderer Kathetertyp erforderlich wird. Dieser kann durch Neupunktion oder durch Wechsel über einen Führungsdraht erfolgen. Bei mechanischen Katheterdefekten oder bei Wechseln des Kathetertyps wird der Wechsel über Draht empfohlen. Zu den Kontraindikationen gehören der Katheterinfekt und die infizierte Kathetereinstichstelle. In der Literatur finden sich nur wenige Hinweise auf das exakte aseptische Vorgehen bei einem derartigen ZVK-Wechsel, das wegen der unmittelbaren Nähe von kontaminiertem und sterilem Material problematisch ist. Wir beschreiben das in unserer Abteilung etablierte Verfahren, mit dem der ZVK-Wechsel mit Führungsdraht mit minimiertem Risiko einer Kreuzkontamination durch das entfernte Kathetermaterial erfolgen kann.
Abstract
Central venous catheters are exchanged in cases of malfunction, suspected infections, or when another catheter type is required. It can be replaced by new venipuncture or using a guide wire. The guide wire technique should be used with a defective catheter or when the catheter type is to be changed. It is contraindicated at exit site infections or proven or suspected catheter infections. Due to possible cross contamination of new by old catheter material meticulous aseptic technique is required. A detailed description of the process of catheter exchange using a guide wire with special regard to the aseptic technique is given.
Schlüsselwörter
Zentraler Venenkatheter - Katheterwechsel - Führungsdraht - Kreuzkontamination - Asepsis
Key words
Central venous catheter - catheter exchange - guide wire - cross contamination - asepsis
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Dr. Michael Przemeck
Abteilung Anästhesiologie I, Medizinische Hochschule Hannover
Carl-Neuberg-Straße 1
30625 Hannover
Email: przemeck.michael@mh-hannover.de
