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The safety of ultrasound guided central venous cannulation in patients with liver disease.

Singh SA, Sharma S, Singh A, Singh AK, Sharma U, Bhadoria AS - Saudi J Anaesth (2015 Apr-Jun)

Bottom Line: Additionally CVC when performed under ultrasound guidance (USG-CVC) in itself reduces the incidence of complications.Arterial puncture and multiple attempts were independent risk factors for superficial hematoma formation whereas low platelet count and presence of ascites were independent risk factors for significant oozing.Ultrasound guidance -CVC in liver disease patients with deranged coagulation is a safe and highly successful modality.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology and Critical Care, Institute of Liver and Biliary Science, Vasant Kunj, New Delhi, India.

ABSTRACT

Background: Central venous cannulation (CVC) is frequently required during the management of patients with liver disease with deranged conventional coagulation parameters (CCP). Since CVC is known to be associated with vascular complications, it is standard practice to transfuse Fresh-Frozen Plasma or platelets to correct CCP. These CCP may not reflect true coagulopathy in liver disease. Additionally CVC when performed under ultrasound guidance (USG-CVC) in itself reduces the incidence of complications.

Aim: To assess the safety of USG-CVC and to evaluate the incidence of complications among liver disease patients with coagulopathy.

Setting and design: An audit of all USG-CVCs was performed among adult patients with liver disease in a tertiary care center.

Materials and methods: Data was collected for all the adult patients (18-60 years) of either gender suffering from liver disease who had required USG-CVC. Univariate and multivariate regression analysis was done to identify possible risk factors for complications.

Results: The mean age of the patients was 42.1 ± 11.6 years. Mean international normalized ratio was 2.17 ± 1.16 whereas median platelet count was 149.5 (range, 12-683) × 10(9)/L. No major vascular or non-vascular complications were recorded in our patients. Overall incidence of minor vascular complications was 18.6%, of which 13% had significant ooze, 10.3% had hematoma formation and 4.7% had both hematoma and ooze. Arterial puncture and multiple attempts were independent risk factors for superficial hematoma formation whereas low platelet count and presence of ascites were independent risk factors for significant oozing.

Conclusion: Ultrasound guidance -CVC in liver disease patients with deranged coagulation is a safe and highly successful modality.

No MeSH data available.


Related in: MedlinePlus

Receiver operating curves for international normalized ratio to predict hematoma formation and for platelet counts to predict oozing
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Figure 1: Receiver operating curves for international normalized ratio to predict hematoma formation and for platelet counts to predict oozing

Mentions: Technical success was achieved in 100% of the cases. 86.3% of the cannulations were successful in single attempt with average number of attempt being 1.6 ± 0.51. Overall incidence of arterial puncture was 1.3%. There was no major vascular or non-vascular complication recorded in our patients. Overall incidence of minor vascular complication was 18.6% of which 13% had significant ooze, 10.3% had hematoma formation and 4.7% had both hematoma and ooze. Table 2 describes minor vascular complications according to site and other possible risk factors. Multivariate logistic regression analysis showed that arterial puncture and multiple attempts were independent risk factors for superficial hematoma formation whereas low platelet count and presence of ascites came out as independent risk factors for significant oozing. 3.3% of the central lines were found to be misplaced on the check chest X-ray. Figure 1 provides the ROC predicting hematoma formation and ooze for INR and platelet count, respectively. Calculating youden's index for each ROC provides INR of >3 and platelet count <30,000/μL as cut-offs. Table 3 describes the coagulation indices of patients with and without vascular complications.


The safety of ultrasound guided central venous cannulation in patients with liver disease.

Singh SA, Sharma S, Singh A, Singh AK, Sharma U, Bhadoria AS - Saudi J Anaesth (2015 Apr-Jun)

Receiver operating curves for international normalized ratio to predict hematoma formation and for platelet counts to predict oozing
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4374220&req=5

Figure 1: Receiver operating curves for international normalized ratio to predict hematoma formation and for platelet counts to predict oozing
Mentions: Technical success was achieved in 100% of the cases. 86.3% of the cannulations were successful in single attempt with average number of attempt being 1.6 ± 0.51. Overall incidence of arterial puncture was 1.3%. There was no major vascular or non-vascular complication recorded in our patients. Overall incidence of minor vascular complication was 18.6% of which 13% had significant ooze, 10.3% had hematoma formation and 4.7% had both hematoma and ooze. Table 2 describes minor vascular complications according to site and other possible risk factors. Multivariate logistic regression analysis showed that arterial puncture and multiple attempts were independent risk factors for superficial hematoma formation whereas low platelet count and presence of ascites came out as independent risk factors for significant oozing. 3.3% of the central lines were found to be misplaced on the check chest X-ray. Figure 1 provides the ROC predicting hematoma formation and ooze for INR and platelet count, respectively. Calculating youden's index for each ROC provides INR of >3 and platelet count <30,000/μL as cut-offs. Table 3 describes the coagulation indices of patients with and without vascular complications.

Bottom Line: Additionally CVC when performed under ultrasound guidance (USG-CVC) in itself reduces the incidence of complications.Arterial puncture and multiple attempts were independent risk factors for superficial hematoma formation whereas low platelet count and presence of ascites were independent risk factors for significant oozing.Ultrasound guidance -CVC in liver disease patients with deranged coagulation is a safe and highly successful modality.

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology and Critical Care, Institute of Liver and Biliary Science, Vasant Kunj, New Delhi, India.

ABSTRACT

Background: Central venous cannulation (CVC) is frequently required during the management of patients with liver disease with deranged conventional coagulation parameters (CCP). Since CVC is known to be associated with vascular complications, it is standard practice to transfuse Fresh-Frozen Plasma or platelets to correct CCP. These CCP may not reflect true coagulopathy in liver disease. Additionally CVC when performed under ultrasound guidance (USG-CVC) in itself reduces the incidence of complications.

Aim: To assess the safety of USG-CVC and to evaluate the incidence of complications among liver disease patients with coagulopathy.

Setting and design: An audit of all USG-CVCs was performed among adult patients with liver disease in a tertiary care center.

Materials and methods: Data was collected for all the adult patients (18-60 years) of either gender suffering from liver disease who had required USG-CVC. Univariate and multivariate regression analysis was done to identify possible risk factors for complications.

Results: The mean age of the patients was 42.1 ± 11.6 years. Mean international normalized ratio was 2.17 ± 1.16 whereas median platelet count was 149.5 (range, 12-683) × 10(9)/L. No major vascular or non-vascular complications were recorded in our patients. Overall incidence of minor vascular complications was 18.6%, of which 13% had significant ooze, 10.3% had hematoma formation and 4.7% had both hematoma and ooze. Arterial puncture and multiple attempts were independent risk factors for superficial hematoma formation whereas low platelet count and presence of ascites were independent risk factors for significant oozing.

Conclusion: Ultrasound guidance -CVC in liver disease patients with deranged coagulation is a safe and highly successful modality.

No MeSH data available.


Related in: MedlinePlus