Radiology: Coagulation disorder not deterrent for US-guided CVC

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The placement of nontunneled central venous catheters (CVC)--using ultrasound (US) for guidance--in patients with cancer who had coagulation disorders is safe and feasible, according to a study in this month's Radiology.

According to Paulo Della Vigna, MD, from the interventional radiology unit at the European Institute of Oncology and School of Medicine in Milan, Italy and colleagues, having adequate vascular access is important in patients with cancer since central venous access is often required when treating those patients.

In patients with a low-platelet count and prolonged prothrombin time, partial thromboplastin time or international normalized ratio, there are concerns about patient bleeding during placed placement of a tunneled or nontunneled CVC. The goal of the study was to assess the safety of using ultrasound guidance for nontunneled CVC insertion in patients with cancer who had altered but uncorrected coagulation parameters.

The authors retrospectively reviewed the cases of patients who underwent CVC placement at the European Institute of Oncology between September 2001 and August 2008. A total of 239 nontunneled CVCs were placed in 157 patients with malignancy, 130 of whom had hematologic malignancy and 27 who were affected by solid tumors.

Coagulation disorders or alteration of platelet count were observed in 122 procedures, including 67 defined as intermediate and at high risk for potential bleeding during the procedure. Of the 239 implanted catheters, 233 were placed in the subclavian vein, and six in the internal jugular vein. In one patient, blood was seen oozing around the insertion point, but no late complications occurred. Arterial puncture didn’t occur in any of the cases.

“The complete absence of complications makes us confident in stating that US-guided placement of nontunneled catheters in patients at risk for bleeding appears to be safe and correction of coagulation parameters probably is not needed,” the authors reported, adding that 45 patients who were considered to be at high risk of bleeding did not suffer any bleeding complications.

The authors concluded the ultrasound guided placement of nontunneled CVCs in patients with coagulation disorders is “feasible and safe” and doesn’t require any correction of coagulation parameters. In addition, the authors suggested that their results should reduce the unneeded transfusion of blood products, with their related complications and costs, as well as costs associated with the repetition of coagulation tests.