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Coagulopathy screening in children with heparinized central venous catheters

M R Ellis1

  • 1Department of Oncology, Johns Hopkins University School of Medicine, Baltimore, MD.

Pediatrics
|June 1, 1993
PubMed

Insights

A new method using protamine can screen for coagulopathy in blood drawn from heparinized central venous catheters, reducing patient discomfort by avoiding venipuncture.

Area of Science:

  • Hematology
  • Clinical Pathology

Background:

  • Central venous catheters are frequently used in clinical practice.
  • Blood draws from heparinized catheters can be contaminated with heparin, affecting coagulation test results.
  • Venipuncture for coagulation testing can cause discomfort and increase infection risk in patients with indwelling catheters.

Purpose of the Study:

  • To develop and validate a screening method for coagulopathy using blood samples obtained from heparinized central venous catheters.
  • To assess the efficacy of protamine in neutralizing heparin contamination in catheter-drawn blood for coagulation testing.

Main Methods:

  • Paired blood samples were analyzed for prothrombin time (PT) and activated partial thromboplastin time (APTT) with and without protamine.
  • Protamine was added at a concentration of 4 µg/mL to neutralize heparin in catheter samples.
  • Samples were drawn from patients without known coagulopathy and from patients with coagulopathy.

Main Results:

  • Uncorrected catheter samples showed a high rate of prolonged PT (44%) and APTT (52%).
  • After protamine addition and correction, the rates of prolonged PT and APTT significantly decreased to 12% and 4%, respectively.
  • The protamine-supplemented method correctly identified all four patients with known coagulopathy.

Conclusions:

  • Protamine-supplemented APTT testing on blood from heparinized catheters is a viable screening method for coagulopathy.
  • This approach minimizes patient discomfort by eliminating the need for venipuncture.
  • It offers a practical alternative for monitoring coagulation status in patients with central venous catheters.
Abstract

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