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Peripherally inserted central catheter placement in patients with coagulation disorders: A retrospective analysis
J Potet1, F-X Arnaud1, A Thome1
1Radiology Department, Percy Military Hospital, avenue Henri-Barbusse, 92140 Clamart, France.
Insights
Peripherally inserted central venous catheter (PICC) placement is safe in patients with bleeding risks. This procedure does not require correcting coagulation parameters or stopping antiplatelet therapy.
Area of Science:
- Vascular Access Procedures
- Interventional Radiology
- Hematology
Background:
- Peripherally inserted central venous catheters (PICCs) are crucial for long-term intravenous access.
- Patients with hemostatic disorders or on antiplatelet therapy present challenges for safe PICC placement.
- Existing guidelines often recommend correcting coagulation parameters or discontinuing antiplatelet agents before PICC insertion.
Purpose of the Study:
- To evaluate the safety and feasibility of non-tunneled PICC placement in patients with uncorrected coagulation abnormalities or on antiplatelet therapy.
- To determine if pre-procedural correction of hemostasis parameters or interruption of antiplatelet agents is necessary for PICC insertion.
Main Methods:
- Retrospective review of medical charts for patients undergoing non-tunneled PICC placement between December 2009 and December 2013.
- Inclusion criteria: major/combined hemostasis disorders (platelet count ≤50×10(9)/L, INR ≥ 2, or aPTT ≥66s) or antiplatelet therapy.
- Coagulation parameters were not corrected, and antiplatelet therapy was not interrupted prior to PICC placement.
Main Results:
- 378 PICCs were placed in 271 patients with coagulation disorders; 89 (23%) were on antiplatelet therapy.
- Thrombocytopenia (71%) and prolonged INR/aPTT (11.1%) were common.
- Successful PICC placement was achieved in all patients with a mean of 1.14 attempts, with no reported early or late complications.
Conclusions:
- PICC placement is a feasible and safe procedure in patients with severe hemostasis disorders or on antiplatelet therapy.
- Correction of coagulation parameters or discontinuation of antiplatelet therapy is not required for safe PICC insertion.
- This approach expands the options for vascular access in high-risk patient populations.
Objective:
To assess the safety of peripherally inserted central venous catheter (PICC) placement in patients with altered and uncorrected coagulation parameters or receiving antiplatelet therapy.
Materials And Methods:
Medical charts of all patients with major primary and secondary hemostasis disorders, combined hemostasis disorders or on antiplatelet therapy and who had undergone non-tunneled PICC placement from December 2009 to December 2013, were retrospectively reviewed. A hemostatic disorder was defined as a platelet count (PC)≤50×10(9)/L, an international normalized ratio (INR) ≥ 2, or an activated partial thromboplastin time (aPTT)≥66s, alone or in combination. Underlying hemostasis disorders were not corrected and antiplatelet therapy was not interrupted before PICC placement in any patient. 4, and 5-Fr single and dual lumen PICCs were used.
Results:
A total of 378 PICCs were placed in 271 patients (180 men and 91 women; mean age=62±13.4years; range, 18-93 years)) with coagulation disorders. Eighty-nine (23%) PICCs were placed in patients who were receiving antiplatelet therapy (aspirin, clopidogrel, rivaroxaban). Thrombocytopenia was noted in 269PICC placements (71%). Among these patients, 23 had disseminated intravascular coagulation. Prolonged INR and aPTT were observed in 42 procedures (11.1%). PICC placement was achieved in all patients, with a mean number of 1.14 attempts. Peripheral venous access was obtained through the basilic and the brachial vein respectively in 295 (79.1%) and 83 (20.9%) of patients. The placements were performed by residents and fellows in 108 (28.5%) and 270 (71.5%) procedures, respectively. No early or late complications were reported after any procedure. No accidental puncture of the brachial artery occurred.
Conclusion:
In patients with severe primary and secondary hemostasis disorders, combined hemostasis disorders or on antiplatelet therapy, PICC placement is a feasible and safe procedure and does not require correction of coagulation parameters or discontinuation of antiplatelet therapy.
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