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Ultraschallgestützte zentrale Venenpunktion bei Erwachsenen und Kindern

Verfahren und pathologische Befunde

Ultrasound-guided central venous access in adults and children

Procedure and pathological findings

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Zusammenfassung

Punktionen zentralvenöser Gefäße sind anästhesiologische Routineverfahren in der Intensiv- und perioperativen Medizin. Bei diesen Prozeduren kann es zu erheblichen Komplikationen kommen. Punktionen unter Zuhilfenahme der Ultraschalltechnik ermöglichen im Gegensatz zur Landmarkentechnik eine eindeutige Reduktion von Komplikationen und Fehlpunktionen. Zu den Hochrisikogruppen für eine erschwerte zentralvenöse Punktion gehören u. a. Intensiv- und Notfallpatienten sowie antikoagulierte oder dialysepflichtige Patienten. Auch bei der Kanülierung beatmeter oder im Punktionsgebiet voroperierter Patienten sowie bei Kindern und Säuglingen kommt es aufgrund der anatomischen Verhältnisse im Halsbereich gehäuft zu verfahrensbedingten Komplikationen. In diesem Beitrag werden, ausgehend vom Normalbefund, anhand der sonoanatomischen Situation exemplarisch Punktionstechniken erläutert. Bildmaterial veranschaulicht typische und pathologische Befunde im Zusammenhang mit zentralvenösen Punktionen, um Gefahren und Komplikationen sicher zu identifizieren.

Abstract

Central venous line placement is a standard procedure in critical care and peri-operative medicine. This procedure can be associated with severe complications. In contrast to the landmark technique, ultrasound-guided punctures can significantly reduce the rate of complications. Patients with a high risk for difficult vascular access include critical care and emergency patients as well as patients on anticoagulation medication and dialysis. Placement of central venous catheters can be difficult in ventilated patients and if there has been prior surgery in the puncture area. In children and small infants central venous access can also be challenging due to the anatomical relationship in the head and neck region. Puncture techniques are explained briefly by means of ultrasound anatomy. Typical ultrasonographic images visualize pathological findings in order to identify dangers and complications in central venous catheterization.

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Authors and Affiliations

  1. Klinik für Anaesthesiologie, Klinikum der Ludwig-Maximilians-Universität München, München, Deutschland

    P. Scheiermann

  2. Medizinische Klinik III (Kardiologie), Klinikum der Johann Wolfgang Goethe-Universität Frankfurt am Main, Frankfurt am Main, Deutschland

    F.H. Seeger

  3. Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Klinikum der Johann Wolfgang Goethe-Universität Frankfurt am Main, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Deutschland

    R. Breitkreutz

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Correspondence to R. Breitkreutz.

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Scheiermann, P., Seeger, F. & Breitkreutz, R. Ultraschallgestützte zentrale Venenpunktion bei Erwachsenen und Kindern. Anaesthesist 59, 53–61 (2010). https://doi.org/10.1007/s00101-009-1644-7

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