Bleeding Risk of Central Venous Catheterization in Adults: A Systematic Review and Meta-analysis

Area of Science:

• Medical Procedures
• Patient Safety
• Hematology

Background:

• Central venous catheter (CVC) insertion is common in critically ill adults.
• Patients often have bleeding risks due to coagulopathy, thrombocytopenia, liver disease, or hematologic malignancies.
• The actual bleeding risk and effectiveness of preventive measures in these patients are unclear.

Purpose of the Study:

• To systematically evaluate the incidence of bleeding during CVC placement in adults at increased hemorrhagic risk.
• To assess the effectiveness of periprocedural preventive strategies for CVC insertion.

Main Methods:

• Searched PubMed, Embase, Cochrane Library, and Web of Science (Jan 2000-Mar 2025).
• Included randomized trials and observational studies of adults with elevated bleeding risk undergoing CVC placement.
• Performed data extraction, risk of bias assessment, GRADE certainty rating, and meta-analyses.

Main Results:

• Analyzed 41 studies (7,603 patients, 8,796 CVC insertions).
• Major bleeding: 0.57%; Minor bleeding: 8.1%; Any bleeding: 6.8%.
• Bleeding higher in hematologic malignancies, severe thrombocytopenia, or critical illness. Ultrasound guidance reduced complications; platelet transfusion effective below 30x10^9/L; FFP showed no clear benefit.

Conclusions:

• CVC placement is generally safe in adults with coagulopathy or thrombocytopenia.
• Ultrasound guidance, restrictive transfusion thresholds, and thromboelastography enhance safety.
• These strategies reduce unnecessary transfusions and improve procedural outcomes.