Large-bore Tunneled Central Venous Catheter Insertion in Patients with Coagulopathy

Abstract

To evaluate the safety of tunneled central venous catheter (TCVC) insertion in patients with an International Normalized Ratio (INR) of greater than or equal to 1.5 or a platelet count lower than 50,000/dL. Our division's criteria for acceptable coagulation parameters in patients undergoing TCVC insertion is INR no greater than 2 and platelet count of at least 25,000/dL. Three-thousand one-hundred and eighty-eight TCVCs (8-14.5 F) placed between July 2001 and July 2008 were identified. After excluding incomplete records, 2,514 patients undergoing 3,170 TCVC placements were identified. The most current platelet count and INR at the time of TCVC insertion were identified. Bleeding complications were compared between patients with platelet counts lower than 50,000/dL and/or INR of at least 1.5 and published standards for complication rates for TCVC insertion. Of the total of 3,170 TCVCs placed, 428 were in patients whose most current platelet count was lower than 50,000/dL and 361 were in patients with an INR of 1.5 or greater. After exclusion of intercurrent blood product transfusion, 626 TCVCs placed in 567 patients with a platelet count lower than 50,000/dL and/or an INR of at least 1.5 were identified. There were 27 complications in the entire study population (0.85%); three were in patients with platelet counts lower than 50,000/dL and/or INR of at least 1.5. There were three bleeding complications in the study population (0.095%), none in patients with platelet count lower than 50,000/dL and/or INR of at least 1.5. Placement of TCVCs in patients with a platelet count between 25,000/dL and 50,000/dL and/or an INR between 1.5 and 2 is safe even without coagulation product transfusions.