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Acute complications of central line placement in profoundly thrombocytopenic cancer patients
1Department of Anesthesiology and Critical Care Medicine, Memorial Sloan-Kettering Cancer Center Cornell University Medical College, New York, New York 10021, USA.
Background:
Morbidities associated with the insertion of central venous catheters in severely thrombocytopenic cancer patients were analyzed in this prospective observational study. One hundred fifteen consecutive thrombocytopenic patients requiring central venous access (internal jugular or subclavian vein cannulation by a modified Seldinger technique) were evaluated.
Methods:
One hundred fifteen catheters were inserted. For each patient, the following factors were documented: age; sex; diagnosis; previous catheterization; prior neck, chest, breast, or axillary surgery or radiation therapy; presence of other lines prior to venipuncture; site and indication for line insertion; complications; PT and PTT; platelet counts; and hematocrit.
Results:
Of the total number of catheters inserted, 63 (55%) were subclavian and 52 (45%) were internal jugular. Successful cannulations with no complications (n = 91; 79% of the total) were achieved with 1.2 +/- 0.5 attempts. Twenty-four major and minor complications (20%) occurred with an average of 1.6 +/- 1 attempts (P = 0.003). The mean preprocedure platelet counts were 14.8 +/- 4.5 x 10(9)/L for the subclavian group and 14.3 +/- 4.8 x 10(9)/L for the internal jugular group. With platelet transfusion, the mean postprocedure platelet counts for the subclavian and internal jugular groups were 23.9 +/- 12.8 x 10(9)/L and 24.6 +/- 15 x 10(9)/L, respectively. In the subclavian group, seven patients (6%) experienced minor complications. There were 17 minor complications (15%) and 1 pneumothorax in the internal jugular group. Patients experiencing more than one attempt at cannulation had more complications (P = 0.003).
Conclusions:
With the appropriate precautions and platelet transfusions, central venous catheters can be inserted safely with minimal complications into thrombocytopenic cancer patients. Fewer attempts are associated with fewer complications. High risk procedures should be attempted only by experienced personnel or under their direct and strict supervision.