Central lines in coagulopathic patients

If a patient needs a central line, he/she needs one. Often low platelets or a deranged coagulation profile are cited as reasons for omitting or delaying the procedure, but this is not based on evidence of increased complications. A recent Best Evidence Topic Review concludes:

…insertion of CVC lines do not require correction of haemostatic abnormalities prior to intervention. Rates of haemorrhage are low in patients with elevated PT, APTT or low thrombocyte count and appear to be closely related to the level of experience of the physician … rather than the defects of haemostasis.

Links to the abstracts of a couple of relevant articles reviewed are included below.
Central line insertion in deranged clotting
Emerg Med J. 2011 Jun;28(6):536-7 Full text
Low levels of prothrombin time (INR) and platelets do not increase the risk of significant bleeding when placing central venous catheters.
Med Klin (Munich). 2009 May 15;104(5):331-5
US-guided placement of central vein catheters in patients with disorders of hemostasis
Eur J Radiol. 2008 Feb;65(2):253-6

2 thoughts on “Central lines in coagulopathic patients”

  1. I agree that coagulopathy is no longer a contraindication to central line insertion, especially now that we use ultrasound guidance. Last week, I put an IJ line in a patient with a platelet count of 2,000. There were no complications.

  2. If it is an urgent line then I do not reverse the coagulopathy. I will mention that the level of comfort with the level of platelets or coagulopathy is dependant on who is doing the insertion (me or the resident).
    Della Vigna Radiology Vol 253 No 1 2009 249-252: coagulopathic cancer patients who received central venous access stratified by level of coagulopathy. They did fine with no correction and line placement.
    Of note though in plane needle guidance as shown in the article.

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