Bleeding Complications of Central Venous Catheterization in Septic Patients With Abnormal Hemostasis

Vinson, David R.; Hance, Luke G; Mark, Dustin G.; Ballard, Dustin; Hung, Yu-Po; Combs, M.

doi:10.1016/j.annemergmed.2013.07.202

Cited by 8 publications

(18 citation statements)

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“…Six studies combined the various coagulation test abnormalities into one group. [21][22][23][24][25][26][27][28][29][30] Abnormal coagulation parameters were combined in groups with different terms, such as "severe abnormalities," "high risk of bleeding," "coagulopathy," or "moderate-to-severe hemostatic disorders." Three studies did not report separate coagulation parameters and also did not specify the number of patients who had more than one abnormal laboratory value.…”

Section: Coagulopathymentioning

confidence: 99%

“…We identified eight studies that reported a total of 13 major bleeding complications (Table 3). 20,21,24,26,28,30,36,38 Eight major bleeding complications were observed in patients with severe coagulopathy, and five were reported in patients with mild-to-absent coagulopathy. Only one study provided detailed values of classical coagulation parameters.…”

Section: Bleeding Complicationsmentioning

confidence: 99%

“…19,23,24,42 More than one needle pass into the vein was associated with bleeding in three studies, 19,33,40 Other mechanical factors associated with bleeding complications included failed access at the initial site, failure to pass any guidewire, and documented arterial puncture. 24,30 Several studies reported no association of mechanical factors with bleeding. 26 20 Clinically evident bleeding: documented hematoma at the insertion site, line-related blood transfusion, any need for an intervention beyond local manual pressure, or any new radiographic opacity in the hemithorax (N 5 1) ( Table 3) No specific definition (no.…”

Section: Other Risk Factorsmentioning

confidence: 99%

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Central venous catheter placement in coagulopathic patients: risk factors and incidence of bleeding complications

Weerdt¹,

Biemond

Baake³

et al. 2017

Transfusion

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BACKGROUND Central venous catheters are frequently inserted into patients with coagulation disorders. It is unclear whether preprocedural correction of hemostasis is beneficial. We determined the incidence of bleeding complications after central venous catheter placement in patients who had severe coagulopathy and identified potential risk factors for bleeding. STUDY DESIGN AND METHODS The MEDLINE and Cochrane Library databases were systematically searched through November 2015. To be included, articles must have reported on hemorrhagic complications with specification of abnormal coagulation testing results. Severe coagulopathy was defined as a reduced platelet count of 50 × 109/L or less, and/or an elevated international normalized ratio of 1.5 or greater, and/or a partial thromboplastin time of 45 seconds or greater. RESULTS We included one randomized controlled trial and 21 observational studies. In total, there were 13,256 catheter insertions, including 4213 in patients with severe coagulopathy. Before 3150 central venous catheter placements, coagulopathy was not corrected. The bleeding incidence varied from 0 to 32%. The severity of coagulopathy did not predict the risk of bleeding. No study demonstrated a beneficial effect from the prophylactic administration of platelets or fresh‐frozen plasma to prevent bleeding complications. Retrospective observational studies suggested that no preprocedural correction is required up to a platelet count of 20 × 109/L and an international normalized ratio of 3.0. CONCLUSION The incidence of major bleeding complications after central venous catheter placement is low, even in coagulopathic patients. Based on a systematic research of the literature, strong evidence supporting the correction of hemostatic defects before central venous catheter insertion is lacking. However, well‐powered randomized controlled trials will be necessary to determine the minimal platelet count, the maximal international normalized ratio, and an activated partial thromboplastin time that is safe before central venous catheter insertion.

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Section: Coagulopathymentioning

confidence: 99%

Section: Bleeding Complicationsmentioning

confidence: 99%

Section: Other Risk Factorsmentioning

confidence: 99%

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Central venous catheter placement in coagulopathic patients: risk factors and incidence of bleeding complications

Weerdt¹,

Biemond

Baake³

et al. 2017

Transfusion

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“…The placing of CVCs is an invasive procedure that carries the risk of bleeding, although these risks have been described as fairly low, even in patients with abnormal haemostasis [25]. The placing of CVCs is an invasive procedure that carries the risk of bleeding, although these risks have been described as fairly low, even in patients with abnormal haemostasis [25].…”

Section: Discussionmentioning

confidence: 99%

“…On the other hand, there are some disadvantages to using CVC in haemophilia patients. The placing of CVCs is an invasive procedure that carries the risk of bleeding, although these risks have been described as fairly low, even in patients with abnormal haemostasis [25]. Furthermore, the treatment cost is increased by the price of the catheter.…”

Section: Discussionmentioning

confidence: 99%

The use of short‐term central venous catheters for optimizing continuous infusion of coagulation factor concentrate in haemophilia patients undergoing major surgical procedures

Boban

Lambert²,

Hermans³

2015

Haemophilia

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Platelet Transfusion before CVC Placement in Patients with Thrombocytopenia

van Baarle,

van de Weerdt,

van der Velden

et al. 2023

N Engl J Med

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BACKGROUNDTransfusion guidelines regarding platelet-count thresholds before the placement of a central venous catheter (CVC) offer conflicting recommendations because of a lack of good-quality evidence. The routine use of ultrasound guidance has decreased CVC-related bleeding complications. METHODSIn a multicenter, randomized, controlled, noninferiority trial, we randomly assigned patients with severe thrombocytopenia (platelet count, 10,000 to 50,000 per cubic millimeter) who were being treated on the hematology ward or in the intensive care unit to receive either one unit of prophylactic platelet transfusion or no platelet transfusion before ultrasound-guided CVC placement. The primary outcome was catheter-related bleeding of grade 2 to 4; a key secondary outcome was grade 3 or 4 bleeding. The noninferiority margin was an upper boundary of the 90% confidence interval of 3.5 for the relative risk. RESULTSWe included 373 episodes of CVC placement involving 338 patients in the perprotocol primary analysis. Catheter-related bleeding of grade 2 to 4 occurred in 9 of 188 patients (4.8%) in the transfusion group and in 22 of 185 patients (11.9%) in the no-transfusion group (relative risk, 2.45; 90% confidence interval [CI], 1.27 to 4.70). Catheter-related bleeding of grade 3 or 4 occurred in 4 of 188 patients (2.1%) in the transfusion group and in 9 of 185 patients (4.9%) in the no-transfusion group (relative risk, 2.43; 95% CI, 0.75 to 7.93). A total of 15 adverse events were observed; of these events, 13 (all grade 3 catheter-related bleeding [4 in the transfusion group and 9 in the no-transfusion group]) were categorized as serious. The net savings of withholding prophylactic platelet transfusion before CVC placement was $410 per catheter placement. CONCLUSIONSThe withholding of prophylactic platelet transfusion before CVC placement in patients with a platelet count of 10,000 to 50,000 per cubic millimeter did not meet the predefined margin for noninferiority and resulted in more CVC-related bleeding events than prophylactic platelet transfusion. (Funded by ZonMw; PACER Dutch Trial Register number, NL5534.

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Bleeding Complications of Central Venous Catheterization in Septic Patients With Abnormal Hemostasis

Cited by 8 publications

References 0 publications

Central venous catheter placement in coagulopathic patients: risk factors and incidence of bleeding complications

Central venous catheter placement in coagulopathic patients: risk factors and incidence of bleeding complications

The use of short‐term central venous catheters for optimizing continuous infusion of coagulation factor concentrate in haemophilia patients undergoing major surgical procedures

Platelet Transfusion before CVC Placement in Patients with Thrombocytopenia

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