ACUTE COMPLICATIONS OF CENTRAL LINE PLACEMENT IN PROFOUNDLY THROMBOCYTOPENIC CANCER-PATIENTS

BACKGROUND. Morbidities associated with the insertion of central venou s catheters in severely thrombocytopenic cancer patients were analyzed in this prospective observational study. One hundred fifteen consecut ive thrombocytopenic patients requiring central venous access (interna l jugular or subclavian vein cannulation by a modified Seldinger techn ique) were evaluated. METHODS. One hundred fifteen catheters were inse rted. For each patient, the following factors were documented: age; se x; diagnosis; previous catheterization; prior neck, chest, breast, or axillary surgery or radiation therapy; presence of other lines prior t o venipuncture; site and indication for line insertion; complications; PT and PTT; platelet counts; and hematocrit. RESULTS. Of the total nu mber 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 w ere 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, th e mean postprocedure platelet counts for the subclavian and internal j ugular 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 I pn eumothorax in the internal jugular group. Patients experiencing more t han one attempt at cannulation had more complications (P = 0.003). CON CLUSIONS. With the appropriate precautions and platelet transfusions, central venous catheters can be inserted safely with minimal complicat ions into thrombocytopenic cancer patients. Fewer attempts are associa ted with fewer complications. High risk procedures should be attempted only by experienced personnel or under their direct and strict superv ision. (C) 1996 American Cancer Society.