Der Vena Cava-Katheter
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Die verbreitete Verwendung des Vena Cava-Katheters zur Kreislauf- überwachung und zur hochkalorischen intravenösen Ernährung macht es wünschenswert, die dem Verfahren innewohnenden Möglichkeiten und Gefahren besser zu kennen. Es ist deshalb verdienstvoll, da sich über die Landesgrenzen hinaus eine Arbeitsgruppe gebildet hat, die in einer prospek- tiven Studie über 3000 Patienten mit Vena Cava-Kathetern beobachtet hat und nun ihre Ergebnisse vorlegt. Der Bericht erstreckt sich aber nicht nur auf die Erfahrungen mit diesem Patientengut, sondern erfa t auch diejenigen weiterer 11000 Fälle aus der Literatur, soweit diese genügend dokumentiert waren. Als wichtigste Ergebnisse dürfen festgehalten werden: - Eine Infektionsprophylaxe mittels sorgfältiger Asepsis und zusätzlicher lokaler Antibiotikaprophylaxe ist sinnvoll. - Drei Hauptzugänge zum Cavasystem sind empfehlenswert: Vena basilica, Jugularis, Subclavia. - Die Gefährlichkeit des Vena Saphena-Katheters ist statistisch belegt. - Kathetereinschwemmumgen - obwohl selten - haben sich in der v- liegenden Studie sowie in den in der Literatur beschriebenen Fällen als sehr gefährlich erwiesen. Daraus ergeben sich zwei Forderungen: Einer- seits die Konstruktion eines Kathetersystems, das die Gefahr der Ein- schwemmung weitgehend ausschaltet und andererseits ein aktives chir- urgisches Vorgehen (bis und mit Entfernung der Katheterteile aus dem Herzen), wenn das Ereignis eingetreten ist.
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