title: Time to hemostasis after traction removal of tunneled cuffed central venous catheters.
abstract: OBJECTIVE
  Many patients undergo placement of tunneled cuffed central venous catheters (TCCVCs) for indications including administration of medical therapy and hemodialysis. They are removed when no longer needed or if there is a device complication. There is no consensus regarding the necessity of routine preremoval coagulation studies or platelet count, so this study was performed to determine if abnormal coagulation status affects the time to hemostasis (TH) after traction removal of TCCVCs.
  
  
  METHODS
  Adult patients referred to our group for removal of a TCCVC placed via a jugular or subclavian route were considered candidates for inclusion. Blood was submitted for evaluation of prothrombin time (PT) and International Normalized Ratio (INR), activated partial thromboplastin time (aPTT), and platelet count. Catheters were removed with the traction technique, and presence of hemostasis was assessed at 5-minute intervals of manual compression.
  
  
  RESULTS
  Between November 19, 2001, and April 20, 2004, 179 subjects were enrolled and completed the study. There were 165 subjects in whom TH was within the first 5-minute interval and 14 in whom more than 5 minutes was required. Statistically significant factors associated with prolonged TH were primary diagnosis of end-stage renal disease (P = .005), use of antiplatelet agents (P = .03), and procedure performed by a "low-volume" operator (P = .002).
  
  
  CONCLUSIONS
  Routine preremoval evaluation of coagulation parameters is not necessary. Patients who are likely to have abnormal platelet function but not abnormal platelet number appear to be at risk for prolonged TH, but even in those cases, the THs are rarely more than 15 minutes.
authors.affiliation: Department of Radiology, Division of Angiography and Interventional Radiology, Brigham and Women's Hospital, 75 Francis Street, Boston, Massachusetts 02115, USA. mstecker@partners.org
authors.forename: Michael S
authors.initials: MS
authors.lastname: Stecker
authors.forename: Matthew S
authors.initials: MS
authors.lastname: Johnson
authors.forename: Jun
authors.initials: J
authors.lastname: Ying
authors.forename: Gordon
authors.initials: G
authors.lastname: McLennan
authors.forename: David M
authors.initials: DM
authors.lastname: Agarwal
authors.forename: Jan
authors.initials: J
authors.lastname: Namyslowski
authors.forename: Iftikhar
authors.initials: I
authors.lastname: Ahmad
authors.forename: Himanshu
authors.initials: H
authors.lastname: Shah
authors.forename: Sabah
authors.initials: S
authors.lastname: Butty
authors.forename: Thomas
authors.initials: T
authors.lastname: Casciani
mesh_terms: D000328:Adult; D000368:Aged; D001777:Blood Coagulation; D002405:Catheterization, Central Venous / Q000295:instrumentation*; D002408:Catheters, Indwelling; D002983:Clinical Competence; D020878:Device Removal / Q000009:adverse effects* / Q000379:methods; D005260:Female; D006470:Hemorrhage / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D006487:Hemostasis; D006489:Hemostatic Techniques; D006801:Humans; D019934:International Normalized Ratio; D007676:Kidney Failure, Chronic / Q000150:complications; D008297:Male; D008875:Middle Aged; D010314:Partial Thromboplastin Time; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects; D010976:Platelet Count; D011312:Pressure; D011446:Prospective Studies; D011517:Prothrombin Time; D012307:Risk Factors; D013997:Time Factors; D014143:Traction / Q000009:adverse effects*
chemical_list: D010975:Platelet Aggregation Inhibitors