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Central venous catheter placement in patients with disorders of hemostasis
M E Doerfler1, B Kaufman, A S Goldenberg
1Division of Pulmonary Critical Care Medicine, New York University School of Medicine, USA.
Objective:
To define the incidence of bleeding complications from central venous access procedures performed by a critical care service in patients with disorders of hemostasis.
Design:
Prospective, consecutive sample, collection of clinical data.
Setting:
University teaching hospital.
Patients:
Seventy-six consecutive patients with disorders of hemostasis who required central venous access for clinical management between October 1992 and October 1993.
Measurements:
Age, sex, clinical diagnosis, most recent platelet count, prothrombin time (PT), and activated partial thromboplastin time (aPTT) were recorded from the medical record of patients with known coagulation or platelet abnormalities. The site of central venous catheter placement, the number of needle passes necessary to complete the procedure, and the occurrence of complications were reported by the critical care attending physician performing or supervising the procedure.
Results:
One hundred four central venous access procedures were performed on 76 patients with disorders of hemostasis. Seventy-three percent of catheters were placed in patients with platelet counts less than 100,000/mL and 40% of catheters were placed in patients with abnormalities of PT, aPTT, or both. Thirteen percent of patients had abnormalities of both platelets and coagulation profile. There were no serious complications. Bleeding complicated 7 (6.5% of the procedures; 5 patients had bleeding from the skin (from the suture sites in four), and 2 patients developed small periosteal hematomas. All patients with bleeding complications had thrombocytopenia with mean platelet counts of 22,000/mL and a range of 6,000 to 37,000/mL. Most patients with platelet counts in this range did not have clinically evident bleeding.
Conclusions:
Central venous access procedures can be done safely in patients with disorders of hemostasis by skilled physicians who frequently perform these procedures. Patients most likely to experience bleeding from these procedures are patients with severe thrombocytopenia. In this series, only a single patient, with a platelet count of 6,000/mL, required therapeutic blood product administration.