Peripherally inserted central catheter for long-term vascular access in patients with hemorrhagic syndrome

The hemorrhagic syndrome is the relative contraindication for the central venous access. However, in the clinical practice, many patients with hemorrhagic syndrome need a long-term vascular access.

Purpose of the study was to investigate the use of Peripherally Inserted Central Catheters (PICC)  in patients with severe hemostatic disorders.

Results. In total, 16 PICCs were implanted in 12 patients with hemorrhagic syndrome (6 hemophilia  patients, 4 of them with inhibitor to FVIII, 1 patient with breast cancer and Willebrand disease, 3 patients with acute promyelocytic leukemia, 1 patient with multiple myeloma and 1 patient with myelodysplastic  syndrome). Hemostasis was provided by recombinant activated factor VII (rFVIIa), platelet and cryoprecipitate transfusions. The period of use of PICCs varied from 5 days to 1 year and 3 months.  There were no thrombotic and infectious complications. PICC can be considered as a method of choice for long-term vascular access  in patients with hemorrhagic syndrome.

1. van de Weerdt E.K., Biemond B.J., Baake B., Vermin B., Binnekade J.M., van Lienden K.P., et al. Central venous catheter placement in coagulopathic patients: risk factors and incidence of bleeding complications. Transfusion. 2017; 57(10): 2512–25.

2. Doerfler M.E., Kaufman B., Goldenberg A.S. Central venous catheter placement in patients with disorders of hemostasis. Chest. 1996; 110(1): 185–8.

3. Fisher N.C., Mutimer D.J. Central venous cannulation in patients with liver disease and coagulopathy – a prospective audit. Intensive Care Med. 1999; 25(5): 481–5.

4. Mumtaz H., Williams V., Hauer-Jensen M., Rowe M., Henry-Tillman R.S., Heaton K., et al. Central venous catheter placement in patients with disorders of hemostasis. Am. J. Surg. 2000; 180(6): 503–5.

5. Zeidler K., Arn K., Senn O., Schanz U., Stussi G.. Optimal preprocedural platelet transfusion threshold for central venous catheter insertions in patients with thrombocytopenia. Transfusion. 2011; 51(11): 2269–76.

6. Haas B., Chittams J.L., Trerotola S.O. Large-bore tunneled central venous catheter insertion in patients with coagulopathy. J. Vasc. Interv. Radiol. 2010; 21(2): 212–7.

7. Kander T., Frigyesi A., Kjeldsen-Kragh J., Karlsson H., Rolander F., Schött U.. Bleeding complications after central line insertions: relevance of pre-procedure coagulation tests and institutional transfusion policy. Acta Anaesthesiol. Scand. 2013; 57(5): 573–9.

8. Tomoyose T., Ohama M., Yamanoha A., Masuzaki H., Okudaira T., Tokumine J. Real-time ultrasound-guided central venous catheterization reduces the need for prophylactic platelet transfusion in thrombocytopenic patients with hematological malignancy. Transfus. Apher. Sci. 2013; 49(2): 367–9.

9. Estcourt L.J., Birchall J., Allard S., Bassey S.J., Hersey P., Kerr J.P., et al. Guidelines for the use of platelet transfusions. Br. J. Haematol. 2017; 176(3): 365–94.

10. Müller M.C., Arbous M.S., Spoelstra-de Man A.M., Vink R., Karakus A., Straat M., et al. Transfusion of fresh-frozen plasma in critically ill patients with a coagulopathy before invasive procedures: a randomized clinical trial (CME). Transfusion. 2015; 55(1): 26–35.

11. Weigand K., Encke J., Meyer F.J., Hinkel U.P., Munder M., Stremmel W., Zahn A. Low levels of prothrombin time (INR) and platelets do not increase the risk of significant bleeding when placing central venous catheters. Med. Klin. (Munich). 2009; 104(5): 331–5.

12. Tercan F., Ozkan U., Oguzkurt L. US-guided placement of central vein catheters in patients with disorders of hemostasis. Eur. J. Radiol. 2008; 65(2): 253–6.

13. DeLoughery T.G., Liebler J.M., Simonds V., Goodnight S.H. Invasive line placement in critically ill patients: do hemostatic defects matter? Transfusion. 1996; 36(9): 827–31.

14. Singh S.A., Sharma S., Singh A., Singh A.K., Sharma U., Bhadoria A.S. The safety of ultrasound guided central venous cannulation in patients with liver disease. Saudi J. Anaesth. 2015; 9(2): 155–60.

15. Troianos C.A., Hartman G.S., Glas K.E., Skubas N.J., Eberhardt R.T., Walker J.D., et al.; Councils on Intraoperative Echocardiography and Vascular Ultrasound of the American Society of Echocardiography. Guidelines for performing ultrasound guided vascular cannulation: recommendations of the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists. J. Am. Soc. Echocardiogr. 2011; 24(12): 1291–318.

16. Rykov M.Yu., Petrash A.A., Polyakov V.G. PICC in the treatment of children with cancer: the first experience. Oncopediatrics. Russian journal (Onkopediatriya). 2016; 3(2): 106–12. (in Russian)

17. Tsepenshchikov L.V., Lyadov V.K. Peripherally inserted central catheter: literature review. Clinical Oncohematology. Basic Research and Clinical Practice. Russian journal (Klinicheskaya onkogematologiya. Fundamentalnyye issledovaniya i klinicheskaya praktika). 2014; 7(2): 220–8. (in Russian)

18. Ewenstein B.M., Valentino L.A., Journeycake J.M., Tarantino M.D., Shapiro A.D., Blanchette V.S., et al. Consensus recommendations for use of central venous access devices in haemophilia. Haemophilia. 2004; 10(5): 629–48.

19. Morado M., Jimenez-Yuste V., Villar A., Quintana M., Del Castillo F., Garzon G., et al. Complications of central venous catheters in patients with haemophilia and inhibitors. Haemophilia. 2001; 7(6): 551–6.

20. Valentino L.А., Ewenstein B., Navickis R.J., Wilkes M.M. Central venous access devices in haemophilia. Haemophilia. 2004; 10(2): 134–46.

21. Miller K., Buchanan G.R., Zappa S., Cochran C., Laufenberg J., Medeiros D., et al. Implantable venous access devices in children with hemophilia: a report of low infection rates. J. Pediatr. 1998; 132(6): 934–8.

22. Damiano M.L., Hutter J.J. Immune tolerance for haemophilia patients with inhibitors: analysis of the western United States experience. The Tri-Regional Nursing Group. Haemophilia. 2000; 6(5): 526–32.

23. Bollard C.M., Teague L.R., Berry E.W., Ockelford P.A. The use of central venous catheters (portacaths) in children with haemophilia. Haemophilia. 2000; 6(2): 66–70.

24. Park Y. Avialability of peripheral inserted central catheters in severe hemophilia patients with inhibitors. Korean J. Pediatr. 2008; 41(12): 1360–2.

25. Choudhry A., Deloughery T.G. Bleeding and thrombosis in acute promyelocytic leukemia. Am. J. Hematol. 2012; 87(6): 596–603.

26. Greer J.P., Arber D.A., Glader B., List A.F., Means R.T.J., eds. Wintrobe’s clinical hematology. Lippincott Williams and Wilkins; Wolters Kluwer; 2013: 2419–898.

27. Serna J.D., Montesinos P., Vellenga E., Rayo C., Parody R., Leo A., et al. Causes and prognostic factors of remission induction failure in patients with acute promyelocytic leukemia treated with all-trans retinoic acid and idarubicin. Blood. 2008; 111(7): 3395–402.

28. Tallman M.S., Kwaan H.C. Reassessing the hemostatic disorder associated with acute promyelocytic leukemia. Blood. 1992; 79(3): 543–53.

29. Tallman M.S., Altman J.K. How I treat How I treat acute promyelocytic leukemia. Blood. 2009; 114(25): 5126–35.

30. Galstyan G.M., Budyansky V.M., Shulutko E.M., Pavlova O.A., Danishyan K.I., Vasiliev C.A., et al. The case of a severe hemorrhagic complication during central venous catheterization in a patient with acute promyelocytic leukemia. Problems of hematology and blood transfusion, Russian journal (Problemy gematologii i perelivaniya krovi). 1997; 4: 32–4. (in Russian)

31. McAuliffe E., O’Shea S., Khan M.I. Retrospective audit of the Peripherally Inserted Central Catheter (PICC) associated thrombosis in patients with haematological malignancies at Cork University Hospital. Thromb. Res. 2016; 140 (Suppl. 1): S176.