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Is Routine Preprocedural Bloodwork Needed for Elective Central Venous Access Device Removals in Children without
John Donnellan1, Christopher E Smith2, Philip John2
1Department of Pediatric Radiology, Diagnostic Imaging, McMaster Children's Hospital, 1200 Main St. W., Hamilton, ON L8N 3Z5, Canada.
Journal of Vascular and Interventional Radiology : JVIR
|December 30, 2019
Summary
Routine preprocedural bloodwork is not necessary before elective central venous access device (CVAD) removal in children without bleeding disorders. Bleeding complications are rare and not linked to bloodwork results.
Area of Science:
- Pediatric Interventional Radiology
- Vascular Access Management
- Clinical Pathology
Background:
- Central venous access devices (CVADs) are crucial for pediatric patient care.
- Routine preprocedural bloodwork is often performed before CVAD removal.
- The necessity of this testing for elective removals is debated.
Purpose of the Study:
- To evaluate the clinical utility of routine preprocedural bloodwork.
- To assess its impact on bleeding complications during elective CVAD removal in children.
Main Methods:
- Retrospective review of 802 elective CVAD removals (tunneled catheters and ports) from 2009-2013.
- Exclusion of cases with infection, malfunction, concurrent procedures, or bleeding dyscrasias.
- Analysis of preprocedural hemoglobin, platelet count, PTT, and INR.
Main Results:
- 6.1% (49/802) of patients experienced bleeding complications.
- Most complications (44/49) occurred despite normal bloodwork.
- No statistically significant difference in bleeding rates between normal and abnormal bloodwork groups (P=.7740).
Conclusions:
- Routine preprocedural bloodwork is unnecessary for elective CVAD removal in pediatric patients without bleeding disorders.
- Low incidence of postprocedural bleeding is not predicted by routine blood tests.
- Streamlining CVAD removal protocols can be considered.
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