Central line placement in patients with and without prophylactic plasma

Carino, Gerardo; Tsapenko, Arseniy; Sweeney, Joseph D.

doi:10.1016/j.jcrc.2011.12.016

Cited by 17 publications

(20 citation statements)

References 22 publications

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“…Carino and colleagues 20 observed 287 central venous catheter insertions, 100 of which were placed in patients with an INR greater than 1.5. Of the 100 central venous catheters inserted for patients with coagulopathies, 77 did not receive FP, and 23 were transfused with FP prophylactically.…”

Section: The Role Of Coagulation Tests In Predicting Bleeding Risk Fomentioning

confidence: 99%

Plasma transfusion for bedside, radiologically guided, and operating room invasive procedures

Desborough

Stanworth

2012

Transfusion

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Plasma transfusion for bedside, radiologically guided, and operating room invasive procedures_ 3691 20..29 Michael Desborough and Simon StanworthFrozen plasma (FP) is commonly used in an attempt to correct coagulation defects before performing bedside, radiologically guided, or operating room procedures. A recurring theme for transfusion of plasma is variation in practice and uncertainty around the evidence-based indications informing appropriate use. Plasma for transfusion is given primarily for two indications: to prevent bleeding (prophylaxis) or to stop bleeding (therapeutic) (Fig. 1). This article will present a review of the prophylactic use of plasma, in the context of bedside or radiologically guided invasive procedures or for surgeries in the operating room. The role of plasma in the management of bleeding is the topic for a different article in this supplement. DEFINITION OF FPFrozen plasma (FP) is human plasma that has been obtained either from a single, whole blood donation or from plasmapheresis. It contains a heterogenous group of proteins, including procoagulant and inhibitory components of the coagulation system, acute-phase proteins, immunoglobulins, and albumin. For the purposes of this review, fresh-frozen plasma (FFP; frozen within a short specified time period after collection before storage) and plasma frozen at later intervals (typically up to 24 hr) after collection (FP or FP24), will be covered by the common term FP. Before transfusion, it is thawed to room temperature. FP can be stored at 1 to 6°C for up to 5 days without evidence of a marked decrease in clotting factors. The only plasma protein, which is quality controlled in the United Kingdom and European Union, is Factor (F)VIII.1 Monitoring FVIII levels is not a requirement under the AABB standards in the United States.To reduce the risk of transfusion-transmitted infections, pathogen inactivation technologies have been applied to plasma. These include treatment with methylene blue (a phenothiazide dye) and light, solvent and detergent (S/D plasma), and amotosalen treatment, when psoralens are added to plasma, which is then exposed to UVA light. But these techniques cause more coagulation factors and other plasma proteins to be lost during the manufacturing process, 2,3 although the clinical consequences of these changes are not fully appreciated.

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Section: The Role Of Coagulation Tests In Predicting Bleeding Risk Fomentioning

confidence: 99%

Plasma transfusion for bedside, radiologically guided, and operating room invasive procedures

Desborough

Stanworth

2012

Transfusion

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“…Therefore, PT has limited value in predicting bleeding risk . In addition, retrospective studies suggest that commonly performed invasive procedures in the critically ill, such as central venous catheter placement, percutaneous tracheostomy, and thoracocentesis, carry a low bleeding risk …”

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confidence: 99%

Transfusion of fresh‐frozen plasma in critically ill patients with a coagulopathy before invasive procedures: a randomized clinical trial (CME)

et al. 2014

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“…Nearly all of these thoracic central lines were performed without pre-procedural correction of the thrombocytopenia or coagulopathy. In fact, attempted correction of hemostatic abnormalities in patients without active bleeding may incur greater risks than benefits 42,44,55. The diverse clinical conditions represented in these studies do not directly mirror our clinical situation, however, as few patients in these case series were septic and few proceduralists were EPs.…”

Section: Discussionmentioning

confidence: 83%

Predictors of Unattempted Central Venous Catheterization in Septic Patients Eligible for Early Goal-directed Therapy

Vinson

Ballard

Stevenson

et al. 2014

WestJEM

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IntroductionCentral venous catheterization (CVC) can be an important component of the management of patients with severe sepsis and septic shock. CVC, however, is a time- and resource-intensive procedure associated with serious complications. The effects of the absence of shock or the presence of relative contraindications on undertaking central line placement in septic emergency department (ED) patients eligible for early goal-directed therapy (EGDT) have not been well described. We sought to determine the association of relative normotension (sustained systolic blood pressure >90 mmHg independent of or in response to an initial crystalloid resuscitation of 20 mL/kg), obesity (body mass index [BMI] ≥30), moderate thrombocytopenia (platelet count <50,000 per μL), and coagulopathy (international normalized ratio ≥2.0) with unattempted CVC in EGDT-eligible patients.MethodsThis was a retrospective cohort study of 421 adults who met EGDT criteria in 5 community EDs over a period of 13 months. We compared patients with attempted thoracic (internal jugular or subclavian) CVC with those who did not undergo an attempted thoracic line. We also compared patients with any attempted CVC (either thoracic or femoral) with those who did not undergo any attempted central line. We used multivariate logistic regression analysis to calculate adjusted odd ratios (AORs).ResultsIn our study, 364 (86.5%) patients underwent attempted thoracic CVC and 57 (13.5%) did not. Relative normotension was significantly associated with unattempted thoracic CVC (AOR 2.6 95% confidence interval [CI], 1.6–4.3), as were moderate thrombocytopenia (AOR 3.9; 95% CI, 1.5–10.1) and coagulopathy (AOR 2.7; 95% CI, 1.3–5.6). When assessing for attempted catheterization of any central venous site (thoracic or femoral), 382 (90.7%) patients underwent attempted catheterization and 39 (9.3%) patients did not. Relative normotension (AOR 2.3; 95% CI, 1.2–4.5) and moderate thrombocytopenia (AOR 3.9; 95% CI, 1.5–10.3) were significantly associated with unattempted CVC, whereas coagulopathy was not (AOR 0.6; 95% CI, 0.2–1.8). Obesity was not significantly associated with unattempted CVC, either thoracic in location or at any site.ConclusionSeptic patients eligible for EGDT with relative normotension and those with moderate thrombocytopenia were less likely to undergo attempted CVC at any site. Those with coagulopathy were also less likely to undergo attempted thoracic central line placement. Knowledge of the decision-making calculus at play for physicians considering central venous catheterization in this population can help inform physician education and performance improvement programs.

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Central line placement in patients with and without prophylactic plasma

Cited by 17 publications

References 22 publications

Plasma transfusion for bedside, radiologically guided, and operating room invasive procedures

Plasma transfusion for bedside, radiologically guided, and operating room invasive procedures

Transfusion of fresh‐frozen plasma in critically ill patients with a coagulopathy before invasive procedures: a randomized clinical trial (CME)

Predictors of Unattempted Central Venous Catheterization in Septic Patients Eligible for Early Goal-directed Therapy

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