Association between Platelet Count and Bleeding during Central Line Placement in Critically Ill Children

To evaluate the association between platelet count and procedure-related bleeding at the time of central venous line (CVL) placement in critically ill children.

A retrospective cohort study was performed capturing patient admissions to the pediatric intensive care unit between January 1, 2012 to March 1, 2022. Critically ill children between 0 months and 19 years who underwent bedside CVL placement were included. A total of 363 were included in the final analysis.

Patients' platelet counts prior to line placement ranged from 11 000/uL to 735 000/uL. Bleeding was identified in 26 of 363 (7.2%) of patients, and was categorized as 24 (92%) minimal, 2 (8%) moderate, and none severe. Platelet count and platelet transfusion before line placement were both significantly different between bleeding and non-bleeding patients (P = .04 and P = .032). Patients with lower platelet counts had a higher proportion of bleeding events. There were no significant differences between the bleeding and non-bleeding groups in age, sex, history of bleeding, or number of attempts at CVL. Patients with bleeding were not significantly sicker. Regression analysis determined that female sex and transfusion before CVL placement were both significantly associated with bleeding.

We found that the platelet count prior to CVL placement was not associated with bleeding events in critically ill pediatric patients. Bleeding was more common in patients receiving platelet transfusions. Additional studies are needed to evaluate further the effect of platelet transfusions on procedure-related bleeding.