Association of Thrombocytopenia With Bleeding Risk During Central Venous Catheter Placement in Pediatric Patients With Cancer

Stokes, Sarah C.; Yamashiro, Kaeli J.; Brown, Erin G.

doi:10.1001/jamasurg.2021.2080

Cited by 4 publications

(9 citation statements)

References 8 publications

(5 reference statements)

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“…These results are also in line with previous studies in thrombocytopenic patients undergoing CVC placement in which major bleeding complications are rare 7 . Meanwhile, minor bleeding events (like oozing and local bleeding resolved by manual compression) occurred at rates similar to those previously reported 7,46,47 …”

Section: Discussionsupporting

confidence: 91%

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Prophylactic platelet transfusion and risk of bleeding associated with ultrasound‐guided central venous access in patients with severe thrombocytopenia

Zarama

Revelo-Noguera

Quintero

et al. 2023

Academic Emergency Medicine

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Background: Reported risk of bleeding complications after central catheter access in patients with thrombocytopenia is highly variable. Current guidelines recommend routine prophylactic platelet (PLT) transfusion before central venous catheter placement in patients with severe thrombocytopenia. Nevertheless, the strength of such recommendations is weak and supported by observational studies including few patients with very low PLT counts (<20 × 10 9 /L). This study aims to assess the risk of bleeding complications related to using or not using prophylactic PLT transfusion before ultrasound-guided central venous access in patients with very low PLT counts. Methods:This was a retrospective cohort study of patients with very low PLT counts (<20 × 10 9 /L) subjected to ultrasound-guided central venous catheterization between January 2011 and November 2019 in a university hospital. Bleeding complications were graded according to the Common Terminology Criteria for Adverse Events. A multivariate logistic regression was conducted to assess the risk of major and minor bleeding complications comparing patients who did or did not receive prophylactic PLT transfusion for the procedure. Multiple imputation by chained equations was used to handle missing data. A two-tailed p < 0.05 was considered statistically significant.Results: Among 221 patients with very low PLT counts, 72 received prophylactic PLT transfusions while 149 did not. Baseline characteristics were similar between transfused and nontransfused patients. No major bleeding events were identified, while minor bleeding events were recognized in 35.7% of patients. Multivariate logistic regression analysis showed no significant differences in bleeding complications between patients who received prophylactic PLT transfusions and those who did not (odds ratio 0.83, 95% confidence interval 0.45-1.55, p = 0.567). Additional complete case and sensitivity analyses yielded results similar to those of the main analysis. Conclusions:In this single-center retrospective cohort study of ultrasound-guided central venous access in patients with very low PLT counts, no major bleeding was identified, and prophylactic PLT transfusions did not significantly decrease minor bleeding events.

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Section: Discussionsupporting

confidence: 91%

“…7 Meanwhile, minor bleeding events (like oozing and local bleeding resolved by manual compression) occurred at rates similar to those previously reported. 7,46,47 Current guidelines recommend prophylactic PLT transfusion for central venous access when PLT counts are less than 20 × 10 9…”

Section: Discussionmentioning

confidence: 99%

Prophylactic platelet transfusion and risk of bleeding associated with ultrasound‐guided central venous access in patients with severe thrombocytopenia

Zarama

Revelo-Noguera

Quintero

et al. 2023

Academic Emergency Medicine

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“…We also suggest a larger strategy of prevention of nosocomial infection in all pediatrics units of our hospital 9. The high rate of catheter-related bleeding and hematoma can be explained by including patients with cancer with aplastic anemia suffering from severe thrombocytopenia,10 11 although platelet transfusion was performed prior to catheter placement 12 13. For children with cancer, we suggest the use of PICCs, which is a less invasive technique compared with SVCs or totally implantable venous-access ports (TIVAPs), which is the gold standard for chemotherapy in children with malignancies 14 15.…”

Section: Discussionmentioning

confidence: 99%

Complications and its risk factors of percutaneous subclavian vein catheters in pediatric patients: enhancing the outcomes of a university hospital in a low-income and middle-income country

Jarraya

Kammoun

Chtourou

et al. 2023

World Jnl Ped Surgery

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ObjectiveAssessing central venous catheter-related complications with regular feedback and investigating risk factors are mandatory to enhance outcomes. The aim of this study is to assess our experience in the management of pediatric subclavian vein catheters (SVCs) and to investigate the main risk factors for complications.MethodsIn this prospective observational study, we included children aged 3 months to 14 years who underwent infraclavicular subclavian vein catheterization consecutively using the anatomic landmark technique. Patients were divided into two groups: group 1 included complicated catheters and group 2 included non-complicated catheters. The management protocol was standardized for all patients. After comparing the two groups, univariate and multivariate logistic regression were used to investigate the risk factors for complications.ResultsIn this study, we included 134 pediatric patients. The rate of complications was 32.8%. The main complications were central line-associated bloodstream infection (63.6%), bleeding and/or hematoma (22.7%), mechanical complications (13.6%), and vein thrombosis (13.6%). After adjustment for confounding factors, predictors of catheter-related complications were difficult insertion procedure (adjusted odds ratio (aOR)=9.4; 95% confidential interval (CI): 2.32 to 38.4), thrombocytopenia (aOR=4.43; 95% CI: 1.16 to 16.86), comorbidities (aOR=2.93; 95% CI: 0.58 to 14.7), and neutropenia (aOR=5.45; 95% CI: 2.29 to 13.0).ConclusionsHigh rates of complications were associated with difficult catheter placement and patients with comorbidities and severe thrombocytopenia. To reduce catheter-related morbidity, we suggest an ultrasound-guided approach, a multidisciplinary teaching program to improve nursing skills, and the use of less invasive devices for patients with cancer.

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“…44 In studies involving tunneled catheter placement, platelet transfusions were given in the majority of patients with platelet count <50 x 10 9 /L without major bleeding complications, 45,46 although platelet count <50 x 10 9 /L was associated with an increased risk of minor bleeding events. 46 A systematic review (N = 13 256 catheter insertions) revealed that no studies had demonstrated benefits of prophylactic platelet transfusion for prevention of bleeding complications prior to a central line insertion, and safe values of platelet count at which a central line insertion can be performed remained unclear given the paucity of data. 47 The need for empiric platelet transfusion prior to central line insertion in patients with cancer and thrombocytopenia is the focus of the ongoing PACER trial.…”

Section: Manag Ement Surrounding Thromboc Y Topeniamentioning

confidence: 99%

“…43 Other studies showed that ultrasound-guided catheter insertion could be safe without platelet transfusion, regardless of platelet count prior to procedure. 44 In studies involving tunneled catheter placement, platelet transfusions were given in the majority of patients with platelet count <50 x 10 9 /L without major bleeding complications, 45,46 although platelet count <50 x 10 9 /L was associated with an increased risk of minor bleeding events. 46 A systematic review (N = 13 256 catheter insertions) revealed that no studies had demonstrated benefits of prophylactic platelet transfusion for prevention of bleeding complications prior to a central line insertion, and safe values of platelet count at which a central line insertion can be performed remained unclear given the paucity of data.…”

Section: Manag Ement Surrounding Thromboc Y Topeniamentioning

confidence: 99%

Peri‐procedure management of antithrombotic agents and thrombocytopenia for common procedures in oncology: Guidance from the SSC of the ISTH

Wang

Sanfilippo

Douketis

et al. 2022

Journal of Thrombosis and Haemostasis

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Patients with cancer have an increased risk of thrombosis requiring anticoagulants and/or antiplatelet agents, and they can also encounter thrombocytopenia due to cancer itself or cancer therapies. They often undergo many procedures such as tissue or bone marrow biopsies, placement of central access lines, diagnostic or therapeutic draining procedures, lumbar puncture, and more. Management of antithrombotic agents or thrombocytopenia around the time of these procedures is highly variable.In this document, the Hemostasis and Malignancy Subcommittee of the International Society on Thrombosis and Haemostasis aims to provide useful practice guidance in the management of antithrombotic agents and thrombocytopenia around the time of common procedures in patients with cancer.

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Association of Thrombocytopenia With Bleeding Risk During Central Venous Catheter Placement in Pediatric Patients With Cancer

Abstract: Role of the Funder/Sponsor: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Cited by 4 publications

References 8 publications

Prophylactic platelet transfusion and risk of bleeding associated with ultrasound‐guided central venous access in patients with severe thrombocytopenia

Prophylactic platelet transfusion and risk of bleeding associated with ultrasound‐guided central venous access in patients with severe thrombocytopenia

Complications and its risk factors of percutaneous subclavian vein catheters in pediatric patients: enhancing the outcomes of a university hospital in a low-income and middle-income country

Peri‐procedure management of antithrombotic agents and thrombocytopenia for common procedures in oncology: Guidance from the SSC of the ISTH

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