title: Low levels of prothrombin time (INR) and platelets do not increase the risk of significant bleeding when placing central venous catheters.
abstract: OBJECTIVE
  Central venous catheters are frequently placed in intensive care medicine for multiple indications. The risk of severe bleeding after cannulation is considered to be increased in patients with abnormal coagulation, common in critically ill patients.
  
  
  METHODS
  This open prospective trial, performed at two medical intensive care units and one hematology intermediate care ward, investigated whether insertion of a central venous catheter in patients with coagulopathy (prothrombin time <or= 50% [International Normalized Ratio, INR, >or= 1.5] and/or platelets <or= 50 x 10(9)/l) bears an increased risk of bleeding.
  
  
  RESULTS
  In 196 patients with and without severe disorders of hemostasis, no significant difference in decrease of hemoglobin after catheter placement was observed. In addition, no correlation between a significant drop in hemoglobin and increased levels of creatinine or urea was seen. Mechanical complications were similar in frequency compared to previous publications.
  
  
  CONCLUSIONS
  These findings demonstrate that coagulation disorders with altered prothrombin time (INR) or platelets do not increase the risk of significant bleeding when inserting a central venous catheter. Therefore, the prophylactic correction of coagulation by transfusion of blood products or coagulation factors is not necessary before central venous catheter insertion.
authors.affiliation: Medizin IV, Department of Gastroenterology and Hepatology, University Hospital Heidelberg, Heidelberg, Germany. kilian_weigand@med.uni-heidelberg.de
authors.forename: Kilian
authors.initials: K
authors.lastname: Weigand
authors.forename: Jens
authors.initials: J
authors.lastname: Encke
authors.forename: F Joachim
authors.initials: FJ
authors.lastname: Meyer
authors.forename: Ulrich Paul
authors.initials: UP
authors.lastname: Hinkel
authors.forename: Markus
authors.initials: M
authors.lastname: Munder
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Stremmel
authors.forename: Alexandra
authors.initials: A
authors.lastname: Zahn
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016913:Blood Component Transfusion; D001806:Blood Urea Nitrogen; D002405:Catheterization, Central Venous; D003401:Creatine / Q000097:blood; D005260:Female; D006452:Hemoglobinometry; D006470:Hemorrhage / Q000097:blood* / Q000517:prevention & control; D006801:Humans; D007362:Intensive Care Units; D019934:International Normalized Ratio; D008297:Male; D008875:Middle Aged; D010976:Platelet Count; D011446:Prospective Studies; D011517:Prothrombin Time; D012307:Risk Factors
chemical_list: D003401:Creatine