Acute complications of central line placement in profoundly thrombocytopenic cancer patients Journal Article

Authors: Barrera, R.; Mina, B.; Huang, Y.; Groeger, J. S.
Article Title: Acute complications of central line placement in profoundly thrombocytopenic cancer patients
Abstract: 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, 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 (5%) 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 109/L for the subclavian group and 14.3 ± 4.8 x 109/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 109/L and 24.6 ± 15 x 109/L, respectively. In the subclavian group, seven patients (6%) experienced minor complications. There were 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.
Keywords: adult; aged; aged, 80 and over; middle aged; major clinical study; cancer patient; prospective studies; thrombocytopenia; incidence; risk factor; postoperative complication; quality assurance, health care; pneumothorax; thrombocyte count; catheterization; complications; catheterization, central venous; cannulation; hematothorax; jugular veins; vein puncture; humans; human; male; female; priority journal; article; central line; subclavian vein
Journal Title: Cancer
Volume: 78
Issue: 9
ISSN: 0008-543X
Publisher: Wiley Blackwell  
Date Published: 1996-11-01
Start Page: 2025
End Page: 2030
Language: English
DOI: 10.1002/(sici)1097-0142(19961101)78:9<2025::aid-cncr26>;2-y
PUBMED: 8964028
PROVIDER: scopus
Notes: Article -- Export Date: 22 November 2017 -- Source: Scopus
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MSK Authors
  1. Rafael Barrera
    26 Barrera
  2. Ying Huang
    21 Huang
  3. Jeffrey Groeger
    46 Groeger