Is it safe to remove central lines in patients with platelets less than
20,000/uL
Abstract
Background: Patients with tunnelled CVL may develop blood stream
infections which at times are difficult to control without line removal.
Concomitant severe thrombocytopenia with platelet transfusion
refractoriness is often considered a hard contraindication to any
procedure involving a major blood vessel. There is very little
literature on the actual clinical risks of tunnelled central line
removal in febrile pancytopenic patients. Procedure: We analysed
complications and outcomes in all or patients, a total of 52, who
underwent CVL removal with platelets <20,000/uL. Results: No
bleeding episodes or unplanned transfusions could be associated with CVL
removal. No other complications were also reported. All patients had
time to hemostasis within 5 minutes of catheter removal. A total 31
patients were febrile at the time of CVL removal, of which 17 became
afebrile within 2 days. We found no difference in response when
comparing those whose antibiotic therapy was change/escalation versus
those who did not. Removal of CVL under local anaesthesia remained
complication-free even at platelets counts less than 20.000/uL. With
only RDP support 17 lines were pulled out without any complications when
platelets were below 5.000. Conclusion: Our findings suggest that
central lines can be safely removed with platelet counts less than
20.000/ul and that this may result in enhanced blood stream infection
control. This might be particularly relevant to neutropenic patients in
this day and age of MDR germs emergence and paucity of new effective
antibiotics.