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Zentrale Venenkatheter bei Neugeborenen, Säuglingen und Kindern

Central venous catheter for newborns, infants and children

  • Allgemeinanästhesie
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Zusammenfassung

Für Neugeborene, Säuglinge und Kleinkinder sind zentrale Venenkatheter sowohl für den intra- als auch den postoperativen Verlauf bei großen Eingriffen wichtig. Die Vorteile der Ultrasonographie können für die Anlage von Gefäßzugängen der Vv. jugularis interna, subclavia, femoralis und auch peripherer Venen genutzt werden. Die ultraschallgezielte Punktion der inneren Jugularvene erhöht die Erfolgsrate, reduziert die Zeit zur erfolgreichen Punktion und verringert die versehentliche Punktion der A. carotis bei Kindern im Vergleich zur landmarkengestützten Technik. Platzmangel kann die ultraschallgezielte Punktion bei extrem Frühgeborenen erschweren. Jedoch sollten der Verlauf und die Durchgängigkeit der Vene mit Ultraschall immer vor der Kanülierung bestimmt werden. Nach der Kanülierung der V. subclavia wird mit Ultraschall eine Fehllage des Führungsdrahts in der gleichseitigen V. jugularis interna ausgeschlossen. Eine rasche und klare Erkennung der Bewegung der viszeralen gegen die parietale Pleura mithilfe des Ultraschalls bedeutet den Ausschluss eines Pneumothorax nach der Punktion. Falls eine hämodynamische Instabilität besteht, sollte die Ultraschallkontrolle zum Ausschluss einer perikardialen Effusion verwendet werden.

Abstract

In neonates, infants and young children central venous catheters are of vital importance during surgery as well as postoperative care. The benefit of ultrasonography seems to be very important for vascular access of the internal jugular (IJV), subclavian (SCV), femoral and even peripheral veins. Ultrasound-guided cannulation of the IJV increases the success rate, reduces the time to the successful puncture and decreases the inadvertent puncture of the carotid artery in children in comparison to the landmark-guided technique. Due to compression of the vessel by the approaching needle in neonates transfixing the vein and aspirating blood on withdrawal of the needle may be the preferred technique. The lack of space may prevent ultrasound-guided puncture of the SCV in very low birth weight infants. However, the location of the vein and its patency should always be determined via ultrasound prior to cannulation. After catheterization of the SCV the homolateral IJV is screened by the use of ultrasound to detect wrong guide wire migration. A clear and rapid visualization of visceral pleura movement against the parietal pleura during respiration via ultrasound indicates the absence of pneumothorax after cannulation. In the case of haemodynamic instability, ultrasound should be used to exclude pericardial effusion.

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  1. Abt. für Anästhesiologie, Landeskrankenhaus Klagenfurt, St. Veiterstr. 47, 9020, Klagenfurt, Österreich

    C. Breschan, M. Platzer & R. Likar

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  1. C. Breschan
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  2. M. Platzer
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  3. R. Likar
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Correspondence to C. Breschan.

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Breschan, C., Platzer, M. & Likar, R. Zentrale Venenkatheter bei Neugeborenen, Säuglingen und Kindern. Anaesthesist 58, 897–904 (2009). https://doi.org/10.1007/s00101-009-1602-4

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