Central venous catheters are associated with thrombosis among adult inpatients undergoing therapeutic plasma exchange.

Abstract

For inpatients undergoing therapeutic plasma exchange (TPE) in the United States, the primary mode of venous access is the central venous catheter (CVC). To evaluate the impact of CVC on thrombosis outcomes of patients undergoing TPE, we analyzed the National Inpatient Sample (NIS) database. In a cross-sectional analysis of the NIS, we identified hospital discharges of adult patients treated with TPE. Cases were classified into two groups based on CVC status. The primary outcome was thrombosis. Secondary outcomes were major bleeding, packed red blood cell (PRBC) transfusion, in-hospital mortality, hospital length of stay (LOS), and charges. Among 9863 TPE-treated discharges, CVC was used in 5988 (60%). These numbers correspond to weighted national estimates of 49 315 and 29 940, respectively. There was a positive and significant association between CVC and thrombosis (OR=1.23, 95% 1.04-1.46, P=0.0174), PRBC transfusion (OR=1.15, 95% 1.03-1.29, P=0.0121), in-hospital mortality (OR=1.36, 95% 1.10-1.68, P=0.0043), hospital LOS (15.63 vs 12.45days, P<0.0001) and hospital charges ($166 387 vs. $132 655, P<0.0001). In hospitalized patients undergoing TPE, CVC use is associated with increased rates of thrombosis. Future studies are needed to investigate strategies to decrease CVC use and/or prevent CVC-associated complications in TPE-treated inpatients.