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Zentralvenöse Katheter als Zugang für die Akut- und Dauerdialyse

Central venous catheters as access for acute and long-term dialysis

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Zusammenfassung

Zentralvenöse Dialysekatheter sind für Akutdialysen als schnelle großlumige Zugänge zum Blutkompartiment unverzichtbar. Sollte ein solcher zentraler Venenkatheter mehr als 2 bis 3 Wochen notwendig sein, wäre schon initial oder sonst im Verlauf die Implantation eines getunnelten Dialysekatheters mit Cuff indiziert. Solche getunnelten Katheter können über viele Wochen oder auch über Jahre genutzt werden. Ihre Komplikationsrate ist niedriger als die Komplikationsrate der nichtgetunnelten Akutkatheter.

Der Anteil der Dialysepatienten, die über solche getunnelten Katheter mit Cuff auf Dauer dialysiert werden, ist in den letzten Jahren rapide angestiegen und beträgt derzeit in Deutschland ca. 20%. Diese Katheter weisen aber sicher mehr infektiöse Komplikationen und mehr Thrombosen als native arteriovenöse (AV-)Fisteln oder Prothesenshunts auf. Die Mortalität der Patienten mit Dauerdialysekathetern ist ebenfalls höher als die mit AV-Shunts. Aus diesem Grund können zentralvenöse Katheter immer nur als Dialysezugangsweg der 3. Wahl angesehen werden, wenn AV-Fisteln nicht möglich sind.

Katheter werden in verschiedensten Designs angeboten deren Vorteile im Einzelnen unklar bleiben. Zur Vermeidung von Kurz- und Langzeitkomplikationen sind verschiedene Maßnahmen bei der Implantation und bei der Verwendung im Rahmen der Dialysebehandlung entwickelt worden, die die Anwendung sicherer machen.

Abstract

Central venous dialysis catheters are indispensible as a rapid large lumen access to the blood compartment. If such a central venous catheter is necessary for longer than 2–3 weeks it is better to implant a tunnelled cuffed catheter initially or to switch early from the non-tunnelled acute catheter to a tunnelled cuffed catheter. Tunnelled cuffed catheters can be used for many weeks or even years and the complication rate is less than that of non-tunnelled acute catheters.

The proportion of dialysis patients with long-term dialysis using tunnelled cuffed catheters has increased rapidly in recent years and now stands at approximately 20 % in Germany. These catheters are, however, prone to more infectious complications and more thromboses than native arteriovenous fistulas or prosthetic shunts. The mortality of patients with long-term dialysis catheters is also higher than those with arteriovenous shunts. For these reasons central venous catheters will always be regarded as the third choice dialysis access when arteriovenous fistulas are not possible.

Catheters are available in a wide variety of designs but the individual advantages are still unclear. In order to avoid short-term and long-term complications a variety of measures for implantation and use during dialysis treatment have been developed which make the use safer.

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Authors and Affiliations

  1. Innere Medizin II – Nephrologie, Rheumatologie, Intensivmedizin , Knappschaftskrankenhaus Bottrop, Osterfelderstr. 155a, 46242, Bottrop, Deutschland

    M. Hollenbeck

  2. Abteilung für Radiologie und Nuklearmedizin, Knappschaftskrankenhaus Bottrop, Bottrop, Deutschland

    A. Niehuus & S. Hennigs

  3. Klinik für Gefäßchirurgie, Knappschaftskrankenhaus Bottrop, Bottrop, Deutschland

    G. Wozniak

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  1. M. Hollenbeck
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  2. A. Niehuus
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  3. G. Wozniak
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  4. S. Hennigs
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Correspondence to M. Hollenbeck.

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Hollenbeck, M., Niehuus, A., Wozniak, G. et al. Zentralvenöse Katheter als Zugang für die Akut- und Dauerdialyse. Chirurg 83, 801–808 (2012). https://doi.org/10.1007/s00104-012-2306-x

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