Download PDF
Rofo 2004; 176(7): 944-952
DOI: 10.1055/s-2004-813258
Übersicht

© Georg Thieme Verlag KG Stuttgart · New York

Langfristige zentralvenöse Zugänge und deren Komplikationsmanagement

Long-term Central Venous Lines and Their ComplicationsU. K. M Teichgräber1 , B. Gebauer1 , T. Benter2 , J. Wagner3
  • 1Klinik für Strahlenheilkunde, Charité Campus Virchow-Klinikum, Berlin
  • 2Charité Campus Buch im Helios Klinikum Berlin, Robert-Rössle-Klinik, Berlin
  • 3Medizinisches Zentrum für Radiologie, Klinikum der Philipps-Universität Marburg
Further Information

Publication History

Publication Date:
06 July 2004 (online)

Also available at
    Permissions and Reprints

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

Literatur

  • 1 Schillinger F, Schillinger D, Montagnac R. et al . Post catheterisation vein stenosis in haemodialysis: comparative angiographic study of 50 subclavian and 50 internal jugular accesses.  Nephrol Dial Transplant. 1991;  6 (10) 722-724
    CrossrefPubMedGoogle Scholar
  • 2 Benter T, Teichgräber U K, Kluhs L. et al . Anatomical variations in the internal jugular veins of cancer patients affecting central venous access. Anatomical variation of the internal jugular vein.  Ultraschall Med. 2001;  22 (1) 23-26
    Article in Thieme ConnectPubMedGoogle Scholar
  • 3 Smith J R, Friedell M L, Cheatham M L. et al . Peripherally inserted central catheters revisited.  Am J Surg. 1998;  176 (2) 208-211
    CrossrefPubMedGoogle Scholar
  • 4 Walshe L J, Malak S F, Eagan J. et al . Complication rates among cancer patients with peripherally inserted central catheters.  J Clin Oncol. 2002;  20 (15) 3276-3281
    CrossrefPubMedGoogle Scholar
  • 5 Collignon P, Soni N, Pearson I. et al . Sepsis associated with central vein catheters in critically ill patients.  Intensive Care Med. 1988;  14 (3) 227-231
    CrossrefPubMedGoogle Scholar
  • 6 Andrews J C. Percutaneous placement of a Hickman catheter with use of an intercostal vein for access.  J Vasc Interv Radiol. 1994;  5 (6) 859-861
    PubMedGoogle Scholar
  • 7 Forauer A R, Brenner B, Haddad L F. et al . Placement of hemodialysis catheters through dilated external jugular and collateral veins in patients with internal jugular vein occlusions.  AJR Am J Roentgenol. 2000;  174 (2) 361-362
    PubMedGoogle Scholar
  • 8 Kaufman J A, Greenfield A J, Fitzpatrick G F. Transhepatic cannulation of the inferior vena cava.  J Vasc Interv Radiol. 1991;  2 (3) 331-334
    CrossrefPubMedGoogle Scholar
  • 9 Kenney P R, Dorfman G S, Denny D F Jr. Percutaneous inferior vena cava cannulation for long-term parenteral nutrition.  Surgery. 1985;  97 (5) 602-605
    PubMedGoogle Scholar
  • 10 Teichgräber U K, Benter T, Gebel M. et al . A sonographically guided technique for central venous access.  AJR Am J Roentgenol. 1997;  169 (3) 731-733
    PubMedGoogle Scholar
  • 11 Teichgräber U K, Benter T, Schultz H J. et al . Ultraschallgesteuerte Punktionstechnik von zentral-venösen Gefäßen in Ein-Personen-Technik.  Ultraschall Med. 2000;  21 (3) 132-136
    PubMedGoogle Scholar
  • 12 Lorch H, Zwaan M, Kagel C. et al . Central venous access ports placed by interventional radiologists: experience with 125 consecutive patients.  Cardiovasc Intervent Radiol. 2001;  24 (3) 180-184
    CrossrefPubMedGoogle Scholar
  • 13 Adamus R, Beyer-Enke S, Otte P. et al . Sonographisch gesteuerte Punktion der Vena subclavia vor radiologischer Portimplantation.  Fortschr Röntgenstr. 2002;  174 (11) 1450-1453
    PubMedGoogle Scholar
  • 14 Lenhart M, Chegini M, Gmeinwieser J. et al . Radiologische Implantation zentralvenöser Portsysteme am Unterarm.  Fortschr Röntgenstr. 1998;  169 (2) 189-194
    PubMedGoogle Scholar
  • 15 Kluge A, Stroh H, Wagner D. et al . Durchleuchtungsgesteuerte Implantation subkutaner Venenports: Komplikationen und Langzeitergebnisse.  Fortschr Röntgenstr. 1998;  169 (1) 63-67
    PubMedGoogle Scholar
  • 16 Mansfield P F, Hohn D C, Fornage B D. et al . Complications and failures of subclavian-vein catheterization.  N Engl J Med. 1994;  331 (26) 1735-1738
    CrossrefPubMedGoogle Scholar
  • 17 Sznajder J I, Zveibil F R, Bitterman H. et al . Central vein catheterization. Failure and complication rates by three percutaneous approaches.  Arch Intern Med. 1986;  146 (2) 259-261
    CrossrefPubMedGoogle Scholar
  • 18 Denys B G, Uretsky B F, Reddy P S. et al . An ultrasound method for safe and rapid central venous access.  N Engl J Med. 1991;  324 (8) 566
    PubMedGoogle Scholar
  • 19 Randolph A G, Cook D J, Gonzales C A. et al . Ultrasound guidance for placement of central venous catheters: a meta- analysis of the literature.  Crit Care Med. 1996;  24 (12) 2053-2058
    CrossrefPubMedGoogle Scholar
  • 20 Benter T, Teichgräber U K, Kluhs L. et al . Percutaneous central venous catheterization with a lethal complication.  Intensive Care Med. 1999;  25 (10) 1180-1182
    CrossrefPubMedGoogle Scholar
  • 21 Spannagl M, Frey L. Neue Thrombozytenhemmstoffe.  Anaesthesist. 2001;  50 (3) 142-149
    CrossrefPubMedGoogle Scholar
  • 22 Hagley M T, Martin B, Gast P. et al . Infectious and mechanical complications of central venous catheters placed by percutaneous venipuncture and over guidewires.  Crit Care Med. 1992;  20 (10) 1426-1430
    PubMedGoogle Scholar
  • 23 Kincaid E H, Davis P W, Chang M C. et al . „Blind” placement of long-term central venous access devices: report of 589 consecutive procedures.  Am Surg. 1999;  65 (6) 520-523
    PubMedGoogle Scholar
  • 24 Lucey B, Varghese J C, Haslam P. et al . Routine chest radiographs after central line insertion: mandatory postprocedural evaluation or unnecessary waste of resources?.  Cardiovasc Intervent Radiol. 1999;  22 (5) 381-384
    CrossrefPubMedGoogle Scholar
  • 25 Ruesch S, Walder B, Tramer M R. Complications of central venous catheters: internal jugular versus subclavian access - a systematic review.  Crit Care Med. 2002;  30 (2) 454-460
    CrossrefPubMedGoogle Scholar
  • 26 Harvey J E. Comparision of simple aspiration with intercostal drainage in the management of spontaneous pneumothorax.  Thorax. 1993;  48 430-431
    PubMedGoogle Scholar
  • 27 Polderman K H, Girbes A J. Central venous catheter usePart 1: Mechanical complications.  Intensive Care Med. 2002;  28 (1) 1-17
    CrossrefPubMedGoogle Scholar
  • 28 O’Grady N P, Alexander M, Dellinger E P. Guidelines for the prevention of Intravascular catheter related infections.Centrers of Disease Control and Prevention.  MMWR Recommendations Reports. 2002;  51 1-29
    PubMedGoogle Scholar
  • 29 Maki D G, Ringer M, Alvarado C J. Prospective randomised trial of povidone-iodine, alcohol, and chlorhexidine for prevention of infection associated with central venous and arterial catheters.  Lancet. 1991;  338 (8763) 339-343
    CrossrefPubMedGoogle Scholar
  • 30 Polderman K H, Girbes A R. Central venous catheter use. Part 2: infectious complications.  Intensive Care Med. 2002;  28 (1) 18-28
    CrossrefPubMedGoogle Scholar
  • 31 Siegman-Igra Y, Anglim A M, Shapiro D E. et al . Diagnosis of vascular catheter-related bloodstream infection: a meta- analysis.  J Clin Microbiol. 1997;  35 (4) 928-936
    PubMedGoogle Scholar
  • 32 Mermel L A, Farr B M, Sherertz R J. et al . Guidelines for the management of intravascular catheter-related infections.  J Intraven Nurs. 2001;  24 (3) 180-205
    PubMedGoogle Scholar
  • 33 Bouza E, Burillo A, Munoz P. Catheter-related infections: diagnosis and intravascular treatment.  Clin Microbiol Infect. 2002;  8 (5) 265-274
    CrossrefPubMedGoogle Scholar
  • 34 Chastre J, Cornud F, Bouchama A. et al . Thrombosis as a complication of pulmonary-artery catheterization via the internal jugular vein: prospective evaluation by phlebography.  N Engl J Med. 1982;  306 (5) 278-281
    PubMedGoogle Scholar
  • 35 Timsit J F, Sebille V, Farkas J C. et al . Effect of subcutaneous tunneling on internal jugular catheter-related sepsis in critically ill patients: a prospective randomized multicenter study.  JAMA. 1996;  276 (17) 1416-1420
    CrossrefPubMedGoogle Scholar
  • 36 Polderman H, Girbes J. Central venous catheter use. Part 2: infectious complications.  Intensive Care Med. 2002;  28 (1) 18-28
    CrossrefPubMedGoogle Scholar
  • 37 Randolph A G, Cook D J, Gonzales C A. et al . Tunneling short-term central venous catheters to prevent catheter- related infection: a meta-analysis of randomized, controlled trials.  Crit Care Med. 1998;  26 (8) 1452-1457
    PubMedGoogle Scholar
  • 38 Snydman D R, Murray S A, Kornfeld S J. et al . Total parenteral nutrition-related infections. Prospective epidemiologic study using semiquantitative methods.  Am J Med. 1982;  73 (5) 695-699
    CrossrefPubMedGoogle Scholar
  • 39 Raad I I, Hohn D C, Gilbreath B J. et al . Prevention of central venous catheter-related infections by using maximal sterile barrier precautions during insertion.  Infect Control Hosp Epidemiol. 1994;  15 (4 Pt 1) 231-238
    CrossrefPubMedGoogle Scholar
  • 40 Pittet D, Hugonnet S, Harbarth S. et al . Effectiveness of a hospital-wide programme to improve compliance with hand hygiene. Infection Control Programme.  Lancet. 2000;  356 (9238) 1307-1312
    CrossrefPubMedGoogle Scholar
  • 41 Graninger W, Assadian O, Lagler H. et al . The role of glycopeptides in the treatment of intravascular catheter- related infections.  Clin Microbiol Infect. 2002;  8 (5) 310-315
    CrossrefPubMedGoogle Scholar
  • 42 Harter C, Salwender H J, Bach A. et al . Catheter-related infection and thrombosis of the internal jugular vein in hematologic-oncologic patients undergoing chemotherapy: a prospective comparison of silver-coated and uncoated catheters.  Cancer. 2002;  94 (1) 245-251
    CrossrefPubMedGoogle Scholar
  • 43 Haindl H. Technical complications of port-catheter systems.  Reg Cancer Treat. 1989;  2 238-242
    PubMedGoogle Scholar
  • 44 Merrer J, De Jonghe B, Golliot F. et al . Complications of femoral and subclavian venous catheterization in critically ill patients: a randomized controlled trial.  JAMA. 2001;  286 (6) 700-707
    CrossrefPubMedGoogle Scholar
  • 45 Smith J P. Thrombotic complications in intravenous access.  J Intraven Nurs. 1998;  21 (2) 96-100
    PubMedGoogle Scholar
  • 46 Ray C E Jr, Shenoy S S, McCarthy P L. et al . Weekly prophylactic urokinase instillation in tunneled central venous access devices.  J Vasc Interv Radiol. 1999;  10 (10) 1330-1334
    PubMedGoogle Scholar
  • 47 Rabe C, Gramann T, Sons X. et al . Keeping central venous lines open: a prospective comparison of heparin, vitamin C and sodium chloride sealing solutions in medical patients.  Intensive Care Med. 2002;  28 (8) 1172-1176
    CrossrefPubMedGoogle Scholar
  • 48 Schmitz-Rode T, Kilbinger M, Gunther R W. Korrektur zentralvenöser Katheter über einen Führungsdraht mit beweglichem Kern.  Fortschr Röntgenstr. 1999;  170 (2) 222-224
    PubMedGoogle Scholar
  • 49 Kohler T R, Kirkman T R. Central venous catheter failure is induced by injury and can be prevented by stabilizing the catheter tip.  J Vasc Surg. 1998;  28 (1) 59-65
    PubMedGoogle Scholar
  • 50 Gilon D, Schechter D, Rein A J. et al . Right atrial thrombi are related to indwelling central venous catheter position: insights into time course and possible mechanism of formation.  Am Heart J. 1998;  135 (3) 457-462
    CrossrefPubMedGoogle Scholar
  • 51 Aitken D R, Minton J P. The „pinch-off sign”: a warning of impending problems with permanent subclavian catheters.  Am J Surg. 1984;  148 (5) 633-636
    CrossrefPubMedGoogle Scholar
  • 52 Hinke D H, Zandt-Stastny D A, Goodman L R. et al . Pinch-off syndrome: a complication of implantable subclavian venous access devices.  Radiology. 1990;  177 (2) 353-356
    CrossrefPubMedGoogle Scholar
  • 53 Lokich J J, Bothe A Jr, Benotti P. et al . Complications and management of implanted venous access catheters.  J Clin Oncol. 1985;  3 (5) 710-717
    PubMedGoogle Scholar
  • 54 Defalque R J, Campbell C. Cardiac tamponade from central venous catheters.  Anesthesiology. 1979;  50 (3) 249-252
    PubMedGoogle Scholar
  • 55 Murray B H, Cohle S D, Davison P. Pericardial tamponade and death from Hickman catheter perforation.  Am Surg. 1996;  62 (12) 994-997
    PubMedGoogle Scholar
  • 56 van Engelenburg K C, Festen C. Cardiac tamponade: a rare but life-threatening complication of central venous catheters in children.  J Pediatr Surg. 1998;  33 (12) 1822-1824
    CrossrefPubMedGoogle Scholar
  • 57 Collier P E, Ryan J J, Diamond D L. Cardiac tamponade from central venous catheters. Report of a case and review of the English literature.  Angiology. 1984;  35 (9) 595-600
    PubMedGoogle Scholar
  • 58 Collier P E, Blocker S H, Graff D M. et al . Cardiac tamponade from central venous catheters.  Am J Surg. 1998;  176 (2) 212-214
    CrossrefPubMedGoogle Scholar
  • 59 Kowalski C M, Kaufman J A, Rivitz S M. et al . Migration of central venous catheters: implications for initial catheter tip positioning.  J Vasc Interv Radiol. 1997;  8 (3) 443-447
    PubMedGoogle Scholar

PD Dr. Ulf Teichgräber

Klinik für Strahlenheilkunde, Charité Campus Virchow-Klinikum

Augustenburgerplatz 1

13353 Berlin

Phone: ++49/30/45 05-5 72 98

Fax: ++49/30/45 05-5 79 07