Pediatric Radiology

, Volume 45, Issue 5, pp 727–735 | Cite as

Do children without a known bleeding tendency undergoing PICC placement require coagulation laboratory testing?

  • Joel Woodley-Cook
  • Joao Amaral
  • Bairbre Connolly
  • Leonardo R. BrandãoEmail author
Original Article



Obtaining basic hemostatic laboratory investigations prior to peripherally inserted central catheter (PICC) insertion remains controversial, even if the procedure is converted to a tunneled central venous line (CVL) placement.


To determine the value of pre-procedural blood screening (hemoglobin level, platelet count, aPTT/INR) in hospitalized children without a known bleeding diathesis.

Materials and methods

This retrospective review included pediatric patients undergoing PICC insertion who had both laboratory screening and post-PICC hemoglobin level. Two cohorts (A: 0–3 months; B: >3 months–18 years) were analyzed for procedural major/minor bleeding.


Of 1,441 consecutive children identified during a 3-year period, 832 patients (226 in cohort A, 606 in cohort B) fulfilled the inclusion criteria. Overall, 36% (300/832) of the patients had at least one abnormal laboratory result. Only 0.2% (3/1,441) of patients required conversion to a central venous line. In cohort A no major bleeding occurred; the minor bleeding frequency was 30% (68/226). Neither abnormal laboratory results nor correction of abnormal laboratory results was associated with minor bleeding complications. The positive and negative predictive values (PPV/NPV) of having abnormal laboratory screening were 0.22 and 0.68, respectively. In cohort B the major bleeding frequency was 1% (6/606) but no patient required any blood transfusion; minor bleeding occurred in 29% (174/606). Neither abnormal laboratory results nor correction of abnormal laboratory results was associated with minor bleeding complications. The PPV and NPV of abnormal laboratory screening results were 0.24 and 0.72, respectively.


Pre-procedural blood screening did not predict bleeding in hospitalized children without a known bleeding diathesis undergoing PICC insertion. The rarity of major bleeding complications and need for conversion to a central venous line did not support a need for laboratory screening.


Peripherally inserted central catheters Venous access Bleeding complications Coagulation values Children 


Conflicts of interest



  1. 1.
    Abi-Nader JA (1993) Peripherally inserted central venous catheters in critical care patients. Heart Lung J Crit Care 22:428–434Google Scholar
  2. 2.
    Cardella JF, Fox PS, Lawler JB (1993) Interventional radiologic placement of peripherally inserted central catheters. J Vasc Int Radiol 4:653–660CrossRefGoogle Scholar
  3. 3.
    Gabriel J (1996) Peripherally inserted central catheters: expanding UK nurses’ practice. Br J Nurs 5:71–74CrossRefPubMedGoogle Scholar
  4. 4.
    Gamulka B, Mendoza C, Connolly B (2005) Evaluation of a unique, nurse-inserted, peripherally inserted central catheter program. Pediatrics 115:1602–1606CrossRefPubMedGoogle Scholar
  5. 5.
    Horattas MC, Trupiano J, Hopkins S et al (2001) Changing concepts in long-term central venous access: catheter selection and cost savings. Am J Infect Control 29:32–40CrossRefPubMedGoogle Scholar
  6. 6.
    Merrell SW, Peatross BG, Grossman MD et al (1994) Peripherally inserted central venous catheters. Low-risk alternatives for ongoing venous access. West J Med 160:25–30PubMedCentralPubMedGoogle Scholar
  7. 7.
    Ng PK, Ault MJ, Ellrodt AG et al (1997) Peripherally inserted central catheters in general medicine. Mayo Clin Proc Mayo Clin 72:225–233CrossRefGoogle Scholar
  8. 8.
    Ryder MA (1993) Peripherally inserted central venous catheters. Nurs Clin N Am 28:937–971Google Scholar
  9. 9.
    Patel IJ, Davidson JC, Nikolic B et al (2012) Consensus guidelines for periprocedural management of coagulation status and hemostasis risk in percutaneous image-guided interventions. J Vasc Int Radiol 23:727–736CrossRefGoogle Scholar
  10. 10.
    Rapaport SI, Vermylen J, Hoylaerts M et al (2004) The multiple faces of the partial thromboplastin time APTT. J Thromb Haemost 2:2250–2259CrossRefPubMedGoogle Scholar
  11. 11.
    Peyvandi F, Palla R, Menegatti M et al (2012) Coagulation factor activity and clinical bleeding severity in rare bleeding disorders: results from the European network of rare bleeding disorders. J Thromb Haemost 10:615–621CrossRefPubMedGoogle Scholar
  12. 12.
    Puetz J, Witmer C, Huang YS et al (2012) Widespread use of fresh frozen plasma in US children’s hospitals despite limited evidence demonstrating a beneficial effect. J Pediatr 160:210–215Google Scholar
  13. 13.
    Yang RY, Moineddin R, Filipescu D et al (2012) Increased complexity and complications associated with multiple peripherally inserted central catheter insertions in children: the tip of the iceberg. J Vasc Int Radiol 23:351–357CrossRefGoogle Scholar
  14. 14.
    Davidson SJ, Burman JF, Rutherford LC et al (2001) High molecular weight kininogen deficiency: a patient who underwent cardiac surgery. Thromb Haemost 85:195–197PubMedGoogle Scholar
  15. 15.
    Chait PG, Temple M, Connolly B et al (2002) Pediatric interventional venous access. Tech Vasc Interv Radiol 5:95–102CrossRefPubMedGoogle Scholar
  16. 16.
    McVay PA, Toy PT (1991) Lack of increased bleeding after paracentesis and thoracentesis in patients with mild coagulation abnormalities. Transfusion 31:164–171CrossRefPubMedGoogle Scholar
  17. 17.
    Mausner JSKS (1985) Mausner and Bahn epidemiology: an introductory text. WB Saunders, PhiladelphiaGoogle Scholar
  18. 18.
    Committee on Standards and Practice Parameters, Apfelbaum JL, Connis RT et al (2012) Practice advisory for preanesthesia evaluation: an updated report by the American society of anesthesiologists task force on preanesthesia evaluation. Anesthesiology 116:522–538Google Scholar
  19. 19.
    Doerfler ME, Kaufman B, Goldenberg AS (1996) Central venous catheter placement in patients with disorders of hemostasis. Chest 110:185–188CrossRefPubMedGoogle Scholar
  20. 20.
    Weigand K, Encke J, Meyer FJ et al (2009) Low levels of prothrombin time (INR) and platelets do not increase the risk of significant bleeding when placing central venous catheters. Med Klin 104:331–335CrossRefGoogle Scholar
  21. 21.
    (1996) A randomized trial comparing the effect of prophylactic intravenous fresh frozen plasma, gelatin or glucose on early mortality and morbidity in preterm babies. The Northern Neonatal Nursing Initiative [NNNI] Trial Group. Eur J Pediatr 155:580–588Google Scholar
  22. 22.
    Shaw PH, Reynolds S, Gunawardena S et al (2008) The prevalence of bleeding disorders among healthy pediatric patients with abnormal preprocedural coagulation studies. J Pediatr Hematol Oncol 30:135–141CrossRefPubMedGoogle Scholar
  23. 23.
    Zwack GC, Derkay CS (1997) The utility of preoperative hemostatic assessment in adenotonsillectomy. Int J Pediatr Otorhinolaryngol 39:67–76CrossRefPubMedGoogle Scholar
  24. 24.
    Thomas GK, Arbon RA (1970) Preoperative screening for potential T&A bleeding. Arch Otolaryngol 91:453–456CrossRefPubMedGoogle Scholar
  25. 25.
    Watson HG, Greaves M (2008) Can we predict bleeding? Semin Thromb Hemost 34:97–103CrossRefPubMedGoogle Scholar
  26. 26.
    Stanworth SJ (2007) The evidence-based use of FFP and cryoprecipitate for abnormalities of coagulation tests and clinical coagulopathy. Hematology Am Soc Hematol Educ Program. 2007:179–186Google Scholar
  27. 27.
    Stanworth SJ, Brunskill SJ, Hyde CJ et al (2004) Is fresh frozen plasma clinically effective? A systematic review of randomized controlled trials. Br J Haematol 126:139–152CrossRefPubMedGoogle Scholar
  28. 28.
    Shander A, Hofmann A, Ozawa S et al (2010) Activity-based costs of blood transfusions in surgical patients at four hospitals. Transfusion 50:753–765CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Joel Woodley-Cook
    • 1
  • Joao Amaral
    • 1
  • Bairbre Connolly
    • 1
  • Leonardo R. Brandão
    • 2
    Email author
  1. 1.Diagnostic Imaging, Image Guided TherapyThe Hospital for Sick ChildrenTorontoCanada
  2. 2.Division of Haematology/OncologyThe Hospital for Sick ChildrenTorontoCanada

Personalised recommendations