Skip to main content

Advertisement

SpringerLink
Log in

Port Implantation in Patients with Severe Thrombocytopenia is Safe with Interventional Radiology

  • Clinical Investigation
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

Abstract

Purpose

Platelet counts <50/nl are often considered a contraindication for surgical and interventional radiology procedures. Yet, there are patients requiring totally implantable venous access ports (TIVAP) in whom normalization of the coagulation state is not feasible. This retrospective study evaluates the safety of interventional radiological TIVAP implantation in patients with severe thrombocytopenia.

Materials and Methods

From 12/2010 to 12/2014, a total 1200 consecutive radiological TIVAP implantations were performed and retrospectively analyzed. Among those 181 patients had platelet counts (PC) below the reference value of 150–350 thrombocytes/nl: 55 patients with mild (PC: 100–150/nl), 58 patients with moderate (PC: 50–100/nl) and 68 patients with severe thrombocytopenia (PC <50/nl). All patients diagnosed with severe thrombocytopenia received platelet concentrates before or during the procedure according to a fixed preparation protocol. All patients were assessed at least 2 weeks before and up to 12 months after intervention. Outcome parameters were recorded with a particular focus on bleeding complications. Data were statistically analyzed with a p value <0.05 considered statistically significant.

Results

The technical success rate for TIVAP implantation was 100%. Patients were followed for a mean of 833 indwelling catheter days in patients with thrombocytopenia (total: 150.923 days) and for 936 indwelling catheter days in patients with normal platelet counts (total: 953.760 days). No significant differences in complication rates between patients with normal platelet counts and patients with mild to severe thrombocytopenia under platelet substitution were found (p > 0.05), especially no bleeding complications occurred during acute, early or late phase.

Conclusion

With individualized platelet substitution, patients with severe thrombocytopenia may receive radiological TIVAP implantation without an increased risk of bleeding complications.

Level of Evidence

IV.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Subscribe and save

Springer+ Basic
$34.99 /Month
  • Get 10 units per month
  • Download Article/Chapter or eBook
  • 1 Unit = 1 Article or 1 Chapter
  • Cancel anytime
Subscribe now

Buy Now

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Dariushnia SR, Wallace MJ, Siddiqi NH, Towbin RB, et al. Quality improvement guidelines for central venous access. J Vasc Interv Radiol. 2010;21:976–81.

    Article  PubMed  Google Scholar 

  2. Lewis CA, Allen TE, Burke DR, Cardella JF, et al. Quality improvement guidelines for central venous access. J Vasc Interv Radiol. 2003;14:231–5.

    Google Scholar 

  3. Bishop L, Dougherty L, Bodenham A, Mansi J, et al. Guidelines on the insertion and management of central venous access devices in adults. Int J Lab Hematol. 2007;29:261–78.

    Article  CAS  PubMed  Google Scholar 

  4. Smith RN, Nolan JP. Central venous catheters. BMJ. 2013;347:f6570.

    Article  PubMed  Google Scholar 

  5. Hsu CCT, Kwan GN, van Driel ML, Rophael JA. Venous cutdown versus the Seldinger technique for placement of totally implantable venous access ports. The Cochrane Library 2011.

  6. Nocito A, Wildi S, Rufibach K, Clavien PA, et al. Randomized clinical trial comparing venous cutdown with the Seldinger technique for placement of implantable venous access ports. Br J Surg. 2009;96:1129–34.

    Article  CAS  PubMed  Google Scholar 

  7. Walser EM. Venous access ports: indications, implantation technique, follow-up, and complications. Cardiovas Interv Radiol. 2003;35:751–64.

    Article  Google Scholar 

  8. Marcy PY, Magne N, Castadot P, Bailet C, et al. Radiological and surgical placement of port devices: a 4-year institutional analysis of procedure performance, quality of life and cost in breast cancer patients. Breast Cancer Res Treat. 2005;92:61–7.

    Article  PubMed  Google Scholar 

  9. Estcourt, LJ, Desborough M, Hopewell S, Doree C, Stanworth SJ. Comparison of different platelet transfusion thresholds prior to insertion of central lines in patients with thrombocytopenia. The Cochrane Library 2015.

  10. Cameron B, Rock G, Olberg B, Neurath D. Evaluation of platelet transfusion triggers in a tertiary-care hospital. Transfusion. 2007;47(2):206–11.

    Article  PubMed  Google Scholar 

  11. Greeno E, McCullough J, Weisdorf D. Platelet utilization and the transfusion trigger: a prospective analysis. Transfusion. 2007;47(2):201–5.

    Article  PubMed  Google Scholar 

  12. British Committee for Standards in Haematology. Blood transfusion task force. Guidelines for the use of platelet transfusions. Br J Haematol. 2003;122(1):10–23.

    Article  Google Scholar 

  13. Kaufman RM, Djulbegovic B, Gernsheimer T, Kleinman S, et al. Platelet transfusion: a clinical practice guideline from the AABB. Ann Intern Med. 2015;162(3):205–13.

    Article  PubMed  Google Scholar 

  14. The Board of the German Medical Association on the recommendation of the Scientific Advisory Board Platelet transfusions. Transfusion Medicine and Hemotherapy. 2009;36:372–82.

  15. Venkatesan AM, Kundu S, Sacks D, Wallace MJ, et al. Practice guideline for adult antibiotic prophylaxis during vascular and interventional radiology procedures. J Vasc Interv Radiol. 2010;21:1611–30.

    Article  PubMed  Google Scholar 

  16. Ryan JM, Ryan BM, Smith T. Antibiotic prophylaxis in interventional radiology. J Vasc Interv Radiol. 2004;15:547–56.

    Article  PubMed  Google Scholar 

  17. Marcy PY. Central venous access: techniques and indications in oncology. Eur Radiol. 2008;18:2333–44.

    Article  PubMed  Google Scholar 

  18. Frykholm P, Pikwer A, Hammarskjöld F, Larsson AT, et al. Clinical guidelines on central venous catheterisation. Acta Anaesthesiol Scand. 2014;58(5):508–24.

    Article  CAS  PubMed  Google Scholar 

  19. Society of Interventional Radiology Standards of Practice Committee, Omary RA, Bettmann MA, Cardella JF, Curtis WB, et al. Quality improvement guidelines for the reporting and archiving of interventional radiology procedures. J Vasc Interv Radiol. 2003;14:293–5.

    Article  Google Scholar 

  20. Konkle BA. Percutaneous interventions in the coagulopathic patient. Semin Interv Radiol. 2005;22:88–94.

    Article  Google Scholar 

  21. Patel IJ, Davidson JC, Nikolic B, Salazar GM, et al. Standards of Practice Committee: Cardiovascular and Interventional Radiological Society of Europe (CIRSE) Endorsement. Consensus guidelines for periprocedural management of coagulation status and hemostasis risk in percutaneous image-guided interventions. J Vasc Interv Radiol. 2012;23:727–36.

    Article  PubMed  Google Scholar 

  22. Hall DP, Estcourt LJ, Doree C, Hopewell S, et al. Plasma transfusions prior to insertion of central lines for people with abnormal coagulation. The Cochrane Library 2016.

  23. Fonseca A, Nagel K, Decker K, Pukulakatt M, et al. Central venous access device insertion and perioperative management of patients with severe haemophilia A: a local experience. Blood Coagul Fibrinolysis. 2016;27(2):156–9.

    Article  CAS  PubMed  Google Scholar 

  24. Doerfler ME, Kaufman B, Goldenberg AS. Central venous catheter placement in patients with disorders of hemostasis. Chest. 1996;110:185–8.

    Article  CAS  PubMed  Google Scholar 

  25. Ray CE Jr, Shenoy SS. Patients with thrombocytopenia: outcome of radiologic placement of central venous access devices. Radiology. 1997;204:97–9.

    Article  PubMed  Google Scholar 

  26. Schiffer CA, Anderson KC, Bennett CL, et al. Platelet transfusion for patients with cancer: clinical practice guidelines of the American Society of Clinical Oncology. J Clin Oncol. 2001;19:1519–38.

    Article  CAS  PubMed  Google Scholar 

  27. Patel GS, Jain K, Kumar R, Strickland AH, et al. Comparison of peripherally inserted central venous catheters (PICC) versus subcutaneously implanted port-chamber catheters by complication and cost for patients receiving chemotherapy for non-haematological malignancies. Support Care Cancer. 2014;22(1):121–8.

    Article  CAS  PubMed  Google Scholar 

  28. Kabsy Y, Baudin G, Vinti H, Novellas S, et al. Peripherally inserted central catheters (PICC) in onco-hematology. PICC line in onco-hematology. Bull Cancer. 2010;97(9):1067–71.

    CAS  PubMed  Google Scholar 

  29. Chopra V, Anand S, Hickner A, Buist M, et al. Risk of venous thromboembolism associated with peripherally inserted central catheters: a systematic review and meta-analysis. Lancet. 2013;382:311–25.

    Article  PubMed  Google Scholar 

  30. Pektaş A, Kara A, Gurgey A. Cohort study: central venous catheter-related complications in children with hematologic diseases at a single center. Turk J Hematol. 2015;32(2):144.

    Article  Google Scholar 

  31. Morado M, Jimenez-Yuste V, Villar A, et al. Complications of central venous catheters in patients with haemophilia and inhibitors. Haemophilia. 2001;7:551–6.

    Article  CAS  PubMed  Google Scholar 

  32. Pittiruti M, Hamilton H, Biffi R, MacFie J, et al. ESPEN Guidelines on Parenteral Nutrition: central venous catheters (access, care, diagnosis and therapy of complications). Clin Nutr. 2009;28:365–77.

    Article  PubMed  Google Scholar 

  33. Gebauer B, El-Sheik M, Vogt M, Wagner HJ. Combined ultrasound and fluoroscopy guided port catheter implantation—high success and low complication rate. Eur J Radiol. 2009;69:517–22.

    Article  PubMed  Google Scholar 

  34. Vardy J, Engelhardt K, Cox K, Jacquet J, et al. Long-term outcome of radiological-guided insertion of implanted central venous access port devices (CVAPD) for the delivery of chemotherapy in cancer patients: institutional experience and review of the literature. Br J Cancer. 2004;91:1045–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Teichgräber UK, Nagel SN, Kausche S, Enzweiler C. Clinical benefit of power-injectable port systems: a prospective observational study. Eur J Radiol. 2012;81:528–33.

    Article  PubMed  Google Scholar 

  36. Tercan F, Ozkan U, Oguzkurt L. US-guided placement of central vein catheters in patients with disorders of hemostasis. Eur J Radiol. 2008;65:253–6.

    Article  PubMed  Google Scholar 

  37. Vigna PD, Monfardini L, Bonomo G, et al. Coagulation disorders in patients with cancer: nontunneled central venous catheter placement with US guidance—a single institution retrospective analysis. Radiology. 2009;253:149–52.

    Google Scholar 

  38. Wiegand K, Encke J, Meyer FJ, Hinkel UP, et al. Low levels of prothrombin time (INR) and platelets do not increase the risk of significant bleeding when placing central venous catheters. Med Klin. 2009;104:331–5.

    Article  Google Scholar 

  39. Fisher NC, Mutimer DJ. Central venous cannulation in patients with liver disease and coagulopathy—a prospective audit. Intensive Care Med. 1999;25:481–5.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Author notes

  1. Annika R. Keulers

    Present address: Department of Diagnostic and Interventional Neuroradiology, RWTH University Hospital Aachen, Pauwelsstr. 30, 52074, Aachen, Germany

Authors and Affiliations

  1. Department of Diagnostic and Interventional Radiology, UKGM University Hospital Marburg, Philipps University Marburg, Baldingerstr. 1, 35043, Marburg, Germany

    Annika R. Keulers, Lilian Kiesow & Andreas H. Mahnken

Authors
  1. Annika R. Keulers
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lilian Kiesow
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Andreas H. Mahnken
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Annika R. Keulers.

Ethics declarations

Conflict of interest

On behalf of all authors, the corresponding author states that there is no conflict of interest.

Ethical Standard

For this type of study, formal consent is not required. Yet, all procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed Consent

Prior to intervention, informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Keulers, A.R., Kiesow, L. & Mahnken, A.H. Port Implantation in Patients with Severe Thrombocytopenia is Safe with Interventional Radiology. Cardiovasc Intervent Radiol 41, 80–86 (2018). https://doi.org/10.1007/s00270-017-1794-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00270-017-1794-y

Keywords

Search

Navigation