Central venous catheter placement in patients with disorders of hemostasis

BACKGROUND: Patients requiring central venous access frequently have disord ers of hemostasis. The aim of this study was to identify factors predictive of bleeding complications after central venous catheterization in this gro up of patients. METHODS: A retrospective analysis of all central venous catheters placed ov er a 2-year period (1997 to 1999) at our institution were performed. The ag e, sex, clinical diagnosis, most recent platelet count, prothrombin interna tional normalized ratio (INR), activated partial thromboplastin time (aPTT) , catheter type, the number of passes to complete the procedure, and bleedi ng complications were retrieved from the medical records. RESULTS: In a e-year period, 2,010 central venous catheters were placed in 1,825 patients. Three hundred and thirty placements were in patients with d isorders of hemostasis. In 88 of the 330 patients, the underlying coagulopa thy was not corrected before catheter placement. In these patients, there w ere 3 bleeding complications requiring placement of a purse string suture a t the catheter entry site. In the remaining 242 patients, there was 1 bleed ing complication. Of the variables analyzed, only a low platelet count (<50 x 10(9)/L) was significantly associated with bleeding complications. CONCLUSION: Central venous access procedures can be safely performed in pat ients with underlying disorders of hemostasis. Even patients with tow plate let counts have infrequent (3 of 88) bleeding complications, and these prob lems are easily managed. (C) 2001 by Excerpta Medica, Inc.