The practice of platelet transfusion prior to central venous catheterization in presence of coagulopathy: a national survey among clinicians.
Vox Sang
; 112(4): 343-351, 2017 May.
Article
in En
| MEDLINE
| ID: mdl-28261815
ABSTRACT
BACKGROUND:
Correction of coagulopathy prior to central venous catheter (CVC) placement is advocated by guidelines, while retrospective studies support restrictive use of transfusion products. STUDY DESIGN ANDMETHODS:
We conducted a mixed vignette and questionnaire web survey to investigate current practice and preferences for CVC placement. Clinical vignettes were used to quantify the tendency to administer platelet concentrate. A positive ß-coefficient is in favour of administering platelet concentrate.RESULTS:
Ninety-seven physicians answered the survey questions (36 critical care physicians, 14 haematologists, 20 radiologists and 27 anaesthesiologist). Eighty-six physicians subsequently completed the clinical vignettes (response rate 71%). Preferences in favour of correcting thrombocytopenia prior CVC placement were platelet counts of 10 × 109 /L and 20 × 109 /L (ß = 3·9; ß = 3·2, respectively), the subclavian insertion site (ß = 0·8). An elevated INR (INR = 3; ß = 0·6) and an elevated aPTT (aPTT = 60 s; ß = 0·4) showed a positive trend towards platelet transfusion. Platelet transfusion was less likely in an emergency setting (ß = -0·4). Reported transfusion thresholds for CVC placement varied from <10 × 109 /L to 80 × 109 /L for platelet count, from 1·0 to 10·0 for INR and from 25 s to 150 s for aPTT. Implementation of ultrasound guidance as standard practice was limited.CONCLUSION:
Current transfusion practice prior to CVC placement is highly variable. Physicians adjust the decision to correct coagulopathy prior CVC placement based on clinical parameters, insertion site and technique applied.Key words
Full text:
1
Collection:
01-internacional
Database:
MEDLINE
Main subject:
Physicians
/
Thrombocytopenia
/
Blood Coagulation Disorders
/
Catheterization, Central Venous
/
Platelet Transfusion
Type of study:
Guideline
/
Observational_studies
/
Prognostic_studies
/
Qualitative_research
Limits:
Adult
/
Humans
/
Middle aged
Language:
En
Journal:
Vox Sang
Year:
2017
Document type:
Article
Affiliation country: