Ultrasound-guided central venous access: what’s new?

Abstract Purpose: To study the occurrence of bleeding complications in patients with severe thrombocytopenia (platelet count <20x103/µL) subjected to ultrasound-guided central venous access (UG-CVA) while receiving or not routine prophylactic platelet transfusion (PPLT).Research Question: What is the frequency of bleeding complications related to the placement of ultrasound-guided central venous access in patients with severe thrombocytopenia between 2011 and 2019 at high complexity hospital?Methods: A total of 221 patients with severe thrombocytopenia subjected to UG-CVA from January 2.011 to November 2.019 were selected. They were classified as positive (P-PPLT) or negative (N-PPLT) recipients of PPLT. Then, P-PPLT (n=72) were 1:1 propensity matched to N-PPLT based on catheter diameter, anatomical insertion site, presence of hematologic malignancy, absolute platelet count and whether the health care provider performing the procedure was an attending or a trainee. Bleeding complications were graded according to the Common Terminology Criteria for Adverse Events (CTCAE) score and adapted to central venous catheter placement. A logistic regression analysis was then performed using “bleeding complications” as a binary compound outcome of major (Grades 3-4) and minor bleeding (Grades 1-2) vs. no bleeding.Results: Seventy-two patients were classified as P-PPLT, while 149 as N-PPLT. No grades 3-4 of bleeding events were identified in the entire population. No significant differences were observed between N-PPLT and P-PPLT for bleeding Grades 1-2 in both pre-matched (53[35.5%] vs. 26[36.1%], p=0.90) and propensity-matched populations (27[37.5%] vs. 26[36.1%], p=0.80). Logistic regression demonstrated that PPLT did not influence any bleeding complication (OR 0.9, 95%CI 0.42-1.92, p=0.791)Conclusions: Bleeding complications related to central venous catheterization in acutely ill patients with severe thrombocytopenia are not influenced by routine prophylactic platelet transfusion when catheter placement is performed under ultrasound guidance.

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Efficacy and safety of ultrasound-guided central venous access in oncological and haematological patients: Results of a monocenter series of 519 consecutive patients

Journal of Clinical Oncology ◽

10.1200/jco.2005.23.16_suppl.8152 ◽

2005 ◽

Vol 23 (16_suppl) ◽

pp. 8152-8152

Author(s):

A. Lazzaro ◽

D. Vallisa ◽

R. Bertè ◽

C. F. Moroni ◽

A. Arcari ◽

...

Keyword(s):

Central Venous Access ◽

Venous Access ◽

Efficacy And Safety ◽

Ultrasound Guided ◽

Central Venous ◽

Haematological Patients

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Midline catheters for extracorporeal photopheresis in hematological patients

The Journal of Vascular Access ◽

10.1177/11297298211041450 ◽

2021 ◽

pp. 112972982110414

Author(s):

Bruno Marche ◽

Sonia D’Arrigo ◽

Maria Giuseppina Annetta ◽

Andrea Musarò ◽

Alessandro Emoli ◽

...

Keyword(s):

Central Venous Access ◽

Venous Access ◽

Extracorporeal Photopheresis ◽

Ultrasound Guided ◽

Central Venous ◽

Graft Versus Host ◽

Single Lumen ◽

Peripheral Venous Access ◽

Preliminary Study ◽

Venous Access Devices

Introduction: Peripheral venous access for extracorporeal photopheresis (ECP) may be difficult in graft versus host disease (GVHD) patients, because of previous intravenous therapies and multiple peripheral cannulations; in this population of patients, ultrasound guided midline catheters may be an alternative option to central venous access. Methods: In this single-center, prospective preliminary study, we enrolled all consecutive patients with a diagnosis of GVHD and candidate to ECP, over a period of 10 months. We used inserted power injectable, non-valved, polyurethane, 20–25 cm single lumen midline catheters (MC). Results: Sixty-nine ECP procedures were carried out in six patients, using single-lumen MCs for outflow (5Fr in 74% and 4Fr in 26% of cases). For inflow, we used 5Fr or 4Fr MCs, or central venous access devices previously placed for other clinical reasons. There were no catheter-related complications during the entire period of ECP treatment. Mean outflow was significantly higher for 5Fr than for 4Fr MCs (35.8 ± 7.3 vs 29.2 ± 7.8 ml/min; p = 0.0008) and the procedure time was significantly shorter (92.9 ± 9.2 vs 108 ± 13.2 min; p < 0.0001). Conclusion: In GVHD patients, ECP can be performed efficiently and safely using single lumen polyurethane power injectable MCs. The best results are obtained with 5Fr rather than with 4Fr catheters. This strategy of venous access should be implemented in DIVA patients requiring ECP treatments, and probably also in other types of apheresis.

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