Ultraschall und Lagekontrolle bei der Anlage zentraler Venenkatheter

ArticleinDer Anaesthesist 58(7):677-685 · July 2009with30 Reads
Impact Factor: 0.76 · DOI: 10.1007/s00101-009-1569-1

    Abstract

    Objectives and methods
    In 2007 a survey on the development of the current practice of using ultrasound to assist central venous catheter (CVC) placement was carried out in 802 departments of anesthesiology and intensive care medicine in hospitals with more than 200 beds in Germany. These data were compared to data from a survey in 2003. Additionally, data regarding control of CVC positioning were collected.
    Results
    The response rate was 58%. In these 468 departments approximately 340,000 CVCs are placed annually and 317 departments have access to an ultrasound machine. Ultrasound guidance is used by 188 (40%) departments for central venous cannulation. Of these only 24 (12.7%) use ultrasound routinely and 114 (60.6%) use it when faced with a difficult cannulation. Approximately one-third of the users perform continuous ultrasound guidance for CVC placement. Equipement was not at disposal in 115 (41.1%) departments not using ultrasound for CVC placement did not possess the equipment and 93 (33.2%) did not consider ultrasound necessary. Positioning of CVCs was controlled either by electrocardiogram (ECG) guidance and/or chest radiograph in 92%.
    Conclusion
    In Germany placement of central venous catheters is still usually based on anatomical landmarks. However, compared to 2003, ultrasound guidance for CVC placement is gradually being introduced (40% compared to 19%).
    Given the well-documented advantages of ultrasound guidance compared to landmark based approaches for central venous cannulation, acquisition of this technology should belong to the training programme of an anesthesiologist.