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Management eines massiven zervikalen Hämatoms nach Anlage eines zentralen Venenkatheters unter Tirofiban

Management of a massive cervical hematoma after insertion of a central venous catheter under tirofiban

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Zusammenfassung

Eine 81-jährige Patientin wurde im infarktbedingten kardiogenen Schock zur Herzkatheteruntersuchung übernommen. In der Koronarangiographie zeigte sich ein Verschluss des Ramus interventricularis anterior. Bei unvollständigem Fluss nach perkutaner Koronarintervention mit Implantation von 3 Koronarstents und erhöhter Thrombogenität erfolgte die Gabe von Tirofiban. Im Rahmen der anschließenden Anlage eines zentralvenösen Venenkatheters (ZVK) via V. jugularis interna kam es zu einer arteriellen Fehlpunktion der A. carotis communis mit der Folge von akuter Dyspnoe und eines hämorrhagischen Schocks bedingt durch ein massives zervikales Hämatom. Obwohl die ZVK-Anlage eine häufig angewandte Intervention in der Intensivmedizin darstellt, birgt der Eingriff dennoch ein gewisses Risiko iatrogener Verletzungen. Die Kenntnis über das Notfallmanagement von ZVK-assoziierten Komplikationen ist daher unabdingbar.

Abstract

An 81-year-old woman with infarct-related cardiogenic shock was admitted to the cardiac catheterization laboratory. Coronary angiography revealed an occlusion of the ramus interventricularis anterior. Due to incomplete flow after the percutaneous coronary intervention with implantation of three coronary stents and high thrombus burden, tirofiban was given as a bail out therapy. A central venous catheter (CVC) aimed at the internal jugular vein was incidentally inserted in the common carotid artery, resulting in acute dyspnea and a hemorrhagic shock due to a massive cervical hematoma. Although the CVC is a frequently used intervention in critical care, the procedure still carries some risks of iatrogenic injury. Knowledge about the emergency management of CVC-associated complications is therefore essential.

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  1. Klinik III für Innere Medizin, Herzzentrum, Universität zu Köln, Kerpener Str. 62, 50937, Köln, Deutschland

    R. Pfister &  G. Michels

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  1. R. Pfister
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  2. G. Michels
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Correspondence to G. Michels.

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R. Pfister und G. Michels geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren. Alle Patienten, die über Bildmaterial oder anderweitige Angaben innerhalb des Manuskripts zu identifizieren sind, haben hierzu ihre schriftliche Einwilligung gegeben.

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Pfister, R., Michels, G. Management eines massiven zervikalen Hämatoms nach Anlage eines zentralen Venenkatheters unter Tirofiban. Med Klin Intensivmed Notfmed 113, 676–680 (2018). https://doi.org/10.1007/s00063-018-0422-1

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  • DOI: https://doi.org/10.1007/s00063-018-0422-1

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