Central venous catheterization in cancer patients with severe thrombocytopenia: Ultrasound‑guide improves safety avoiding prophylactic platelet transfusion

Abstract

Prior research has revealed that ultrasound (US) guided central venous catheterization (CVC) is associated with a reduction in the complication rate such as pneumothorax and an improved first-pass success placing CVC in the internal jugular vein. The present study investigated if US-guided CVC, in a subset of cancer patients with severe thrombocytopenia, reduced bleeding risk and avoided prophylactic platelet transfusion. The efficacy and safety of US-guided CVC placement in cancer patients with severe thrombocytopenia was retrospectively analyzed over a period of 9 years (Dec 2000-Jan 2009), 1,660 and 207 patients with cancer underwent US-guided CVC placement into internal jugular vein respectively at the Department of Onco-Haematology, Hospital of Piacenza. The first group of patients included patients in active antitumor treatment, while the second group included patients in the palliative phase. A total of 110 (5.89%) of these 1,867 patients exhibited severe thrombocytopenia defined as platelet count ≤20x10 9 /l, and formed the basis of this study. All procedures were evaluated for bleeding complications as defined by the National Institute of Health Common Terminology Criteria for Adverse Events (CTCAE 3.0). In the subgroup of the 110 patients with severe thrombocytopenia a single needle puncture of the vein was employed in 121 of the 122 procedures (99.18%) and no attempt failures were registered. No pneumothorax, no major bleeding and no nerve and arterial puncture were reported, only one self-limiting hematoma (0.90%) at the site of CVC insertion was reported (CTCAE 3.0 grade 1). No platelet transfusions were performed in the 110 patients, pre and post CVC placement. We believe that US-guided CVC insertion procedures into the internal jugular vein makes the difference in safety, also in thrombocytopenic patients avoiding prophylactic or post procedure platelet transfusion.

Central venous catheter–related infections in hematology and oncology: 2020 updated guidelines on diagnosis, management, and prevention by the Infectious Diseases Working Party (AGIHO) of the German Society of Hematology and Medical Oncology (DGHO)

“…DTTP, differential time to positivity; CVC, central venous catheter using a large sterile drape and implementing aseptic bundles as they decrease the risk of CRI [102,118]. Ultrasound (US)-guided central venous catheterization is associated with lower rates of pneumothorax and other mechanical complications and may reduce the number of cannulation attempts [119][120][121]. Although the impact on the incidence of CRI is less clear, central venous cannulation using US is recommended for the avoidance of mechanical complications and the reduction of cannulation attempts with a possible positive impact on the incidence of CRI [119,122].…”

Lower Limb Tendinopathy Tissue Changes Assessed through Ultrasound: A Narrative Review

“…The main advantage of ultrasound is the cost-effectiveness compared to MRI and flexibility of setting in which it can be used, moreover, it is demonstrated that ultrasound allows a higher spatial resolution than MRI thanks to modern high-frequency transducers (10–15 Mhz) [ 19 ], and the main disadvantage is represented by the accuracy that is operator-dependent. Another point not to forget is that ultrasound is used also to assess ultrasound-guide treatments, whose use has been widely adopted in many fields of medicine, such as catheterization in cancer patients [ 20 ], stem cell transplantation [ 21 ] and local anaesthetic infiltration [ 22 ]. Ultrasound became popular for its advantages, such as being minimally invasive, fast, easy to use and controlling the effectiveness of treatments.…”

Central venous catheter‐related complications in hematologic patients: An observational study

“…Both variables have previously been described as risk factors for mechanical complications in general cohorts. 2,12,[14][15][16] Moreover, preprocedural coagulopathy was associated with grades 2-4 bleeding. In the majority of these bleedings, the patients were preprocedurally given platelets (Tables 4 and 5; Figure 2; File S1), yet coagulopathy was still correlated with moderate to severe bleeding.…”