Péče o centrální žilní katétr u pacienta se zhoubným nádorem: doporučení ASOCO pro klinickou praxi

Péče o centrální žilní katétr u pacienta se zhoubným nádorem: doporučení American Society of Clinical Oncology pro klinickou praxi

SOUHRN

Cíl

Vypracovat doporučený postup pro péči o centrální žilní katétry (central venous catheter, CVC) založený na důkazech u pacientů se zhoubným nádorem zaměřený na typ katétru, místo zavedení, postup při zavedení a také profylaxi a léčbu infekce i trombózy související s katétrem.

Metody

Pomocí systematické rešerše MEDLINE a Cochranovy databáze (Cochrane Collaboration Library) od r. 1980 až do července 2012 byly nalezeny relevantní články publikované v anglickém jazyce.

Výsledky

Celková kvalita důkazů z randomizovaných kontrolovaných studií byla vyhodnocena jako dobrá. Je také patrná shoda mezi metaanalýzami a doporučenými postupy vypracovanými jinými skupinami.

Doporučení

Není k dispozici dostatek důkazů pro doporučení jednoho typu CVC nebo jednoho místa zavedení; je třeba se vyhýbat femorální katetrizaci. CVC by měli zavádět dobře vyškolení poskytovatelé a doporučuje se použití klinického balíčku péče o CVC. Je doporučeno použití CVC impregnovaných antimikrobiálními léky/antiseptiky a/nebo heparinem ke snížení rizika infekcí souvisejících s katétrem při použití krátkodobých CVC, zejména u vysoce rizikových skupin; je třeba provést další studie. Profylaktické použití systémových antibiotik před zavedením katétru se nedoporučuje. Není k dispozici dostatek údajů pro doporučení nebo nedoporučení rutinního proplachování antibiotikem/uzamčení katétru (lock therapy); je třeba provést další studie. Před zahájením antibiotické terapie by mělo být provedeno kultivační vyšetření. Některé život ohrožující infekce vyžadují okamžité vyjmutí katétru, ale většinu je možno léčit antimikrobiální terapií při ponechání CVC in situ. Doporučuje se rutinní proplachování fyziologickým roztokem. Profylaktické podávání warfarinu nebo nízkomolekulárního heparinu se nedoporučuje, i když je doporučeno použití tkáňového aktivátoru plazminogenu (tissue plasminogen activator, t‑PA) k obnovení průchodnosti okludovaných katétrů. Odstranění CVC se doporučuje, pokud již není potřebný nebo v případě radiologicky potvrzené trombózy, která se zhoršuje navzdory antikoagulační terapii.

J Clin Oncol 31:1357‑1370. © 2013 by American Society of Clinical Oncology

Celý článek naleznete v časopise Journal of Clinical Oncology číslo 2/2013 na straně 113-127

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Zdroj: Journal od Clinical Oncology