Kanser Tedavisinde Venöz Erişim ve Komplikasyonların Yönetimi
Özet
Güvenilir venöz erişim, kanser hastalarının tedavisinde kemoterapi, sıvı desteği ve kan transfüzyonları için hayati önem taşır; günümüzde düşük komplikasyon oranları nedeniyle implante edilebilir deri altı portları sıklıkla tercih edilmektedir. Santral venöz kateterler (SVK) tünelsiz, tünelli, port ve kaplamalı gibi türlere ayrılır ve yerleşim yeri olarak juguler, subklavyen veya femoral bölgeler kullanılır. Girişimsel işlemler sırasında pnömotoraks, nadir fakat ölümcül hava embolisi, yanlışlıkla arter delinmesi sonucu vasküler yaralanmalar ve sağ kalbe tel yerleştirilmesine bağlı aritmiler gibi ciddi mekanik komplikasyonlar gelişebilir. İlerleyen süreçte ise lokal enfeksiyonlar veya ampirik antibiyotik ve kateterin çıkarılmasını gerektiren sepsis gibi sistemik enfeksiyonlar (bakteriyemi) görülebilir. Ayrıca, tekrarlayan kanülasyonlar fibrotik stenoz yaratarak santral ven obstrüksiyonuna, Vena Cava Superior Sendromuna ve üst ekstremitelerde derin ven trombozuna yol açabilir. Bu komplikasyonları önlemek adına ultrason rehberliği kullanılması, deneme sayısının üç ile sınırlandırılması, tel uzunluğuna dikkat edilmesi ve operatör deneyimi büyük önem arz eder. Enfeksiyon kontrolü için ise el hijyeni, klorheksidin ile cilt antisepsisi, maksimal bariyer önlemleri alınmalı ve gereksiz kateterler hızla çekilmelidir.
Reliable venous access is vital in the treatment of cancer patients for chemotherapy, fluid support, and blood transfusions; currently, implantable subcutaneous ports are frequently preferred due to their low complication rates. Central venous catheters (CVC) are divided into types such as non-tunneled, tunneled, port, and coated, and jugular, subclavian, or femoral regions are used as insertion sites. During interventional procedures, serious mechanical complications may develop, such as pneumothorax, rare but fatal air embolism, vascular injuries due to accidental arterial puncture, and arrhythmias associated with placing a wire into the right heart. In the following period, local infections or systemic infections (bacteremia) such as sepsis, which require empirical antibiotics and catheter removal, can be seen. In addition, repeated cannulations can cause central vein obstruction by creating fibrotic stenosis, Superior Vena Cava Syndrome, and deep vein thrombosis in the upper extremities. To prevent these complications, utilizing ultrasound guidance, limiting the number of attempts to three, paying attention to the wire length, and operator experience are of great importance. For infection control, hand hygiene, skin antisepsis with chlorhexidine, and maximum barrier precautions must be taken, and unnecessary catheters must be removed promptly.
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