Central venous catheter (CVC) placement in patients with bleeding disorders (BD)

Introduction

Previous series showed that CVC placement under standardized techniques could be safe in patients with BD without its correction. Moreover, BD correction with hemoderivates might be risky and expensive.

Objectives

To study prospectively the incidence of complications and the financial impact derived from CVC placement in patients with BD without its previous correction.

Methods

A total of 203 CVC in 121 patients were placed during a 32-month period. BD were defined as a prothrombin time (PT) of less than 50%, and/or an activated partial thromboplastin time (aPTT) of 50 s or more (range 35–45 s), and/or a platelet count (PC) < 100,000/mm³. External or internal bleeding were considered CVC placement-related complications. The internal jugular vein, subclavian vein and femoral vein were the chosen insertion sites. Procedure-related transfusion requirements, surgical corrections or lengthening of hospital stay were defined as major complications. Fresh frozen plasma (FFP) and platelet units (PTL) required for correction of BD were estimated by standard formulas.

Results

The mean age was 47.7 years (14–74 years) with a male/female ratio of 1.7. The internal jugular vein was the insertion site in 80.3% of patients. The APACHE II score was 16.5 ± 7.8 (2–40). Three operators performed 91.6% of the procedures. There were no mortality or major complications associated with CVC placement, with 10 patients showing local hematomas. Results for PT (%) were 50 ± 24.8 (1–114), for aPTT (s) 53.6 ± 29.9 (16–180) and for PC (/mm³) 115,571 ± 89,516 (5000–475,000) (mean ± SD). The average PC in patients with thrombocytopenia was 56,133/mm³.

FFP and PTL units saved, and local and US saved charges according to published payment rates are depicted in Table 1.

Table 1 Table

Conclusions

The need for coagulopathy correction and the levels of coagulation tests to be considered safe for CVC placement are still a matter of debate. In our study population no previous correction was shown to impose an increased risk.