Safer Access With Fewer Transfusions: Revisiting Platelet Thresholds in Pediatric Central Venous Catheterization

Central venous catheters (CVCs) are essential in pediatric hematology-oncology, for the administration of chemotherapy and supportive therapy. Thrombocytopenia increases the risk of bleeding and current guidelines recommend prophylactic platelet transfusions below 40-50 × 10⁹/L, though evidence is limited and transfusions entail risks and costs. Advances in procedural bundles and simulation-based training may enhance safety, enabling lower thresholds.

This retrospective observational cohort study analyzed 274 pediatric patients undergoing CVC insertion (PICC, CICC, and FICC) at a tertiary center (2020-2023). Patients were stratified by platelet count using 50 × 10⁹/L and 30 × 10⁹/L thresholds. Postoperative complications, including bleeding and thrombosis, were compared between groups. All procedures employed pediatric-specific bundles, and operators received simulation-based ultrasound-guided PICC training to optimize safety.

Complication rates did not differ significantly with platelets above or below 50 × 10⁹/L (32.8% vs. 26.3%, p = 0.29) or 30 × 10⁹/L (32.6% vs. 27.1%, p = 0.29). Findings indicate lowering the transfusion threshold to 30 × 10⁹/L is safe. Bundles and simulation-based training likely contributed to low complication rates.

A 30 × 10⁹/L platelet transfusion threshold appears safe for pediatric CVC insertion. Emphasizing procedural bundles and simulation-based operator training may reduce transfusion needs, associated risks, and costs. Prospective multicenter studies are warranted to confirm safety and explore lower thresholds.