title: Ultrasonography-guided central venous catheterisation in haematological patients with severe thrombocytopenia.
abstract: BACKGROUND
  Cannulation of the internal jugular vein (CVC) is a blind surface landmark-guided technique that could be potentially dangerous in patients with very low platelet counts. In such patients, ultrasonography (US)-guided CVC may be a valid approach. There is a lack of published data on the efficacy and safety of urgent US-guided CVC performed in haematological patients with severe thrombocytopenia.
  
  
  METHODS
  We retrospectively studied the safety of urgent CVC procedures in haematological patients including those with severe thrombocytopenia (platelet count <30×10(9)/L). From January 1999 to June 2009, 431 CVC insertional procedures in 431 consecutive patients were evaluated. Patients were included in the study if they had a haematological disorder and required urgent CVC insertion. Patients were placed in Trendelenburg's position, an 18-gauge needle and guide-wire were advanced under real-time US guidance into the last part of the internal jugular vein; central venous cannulation of the internal jugular vein was performed using the Seldinger technique in all the procedures. Major and minor procedure-related complications were recorded.
  
  
  RESULTS
  All 431 patients studied had haematological disorders: 39 had severe thrombocytopenia, refractory to platelet transfusion (group 1), while 392 did not have severe thrombocytopenia (group 2). The general characteristics of the patients in the two groups differed only for platelet count. The average time taken to perform the procedure was 4 minutes. Success rates were 97.4% and 97.9% in group 1 and group 2, respectively. No major complications occurred in either group.
  
  
  CONCLUSIONS
  US-guided CVC is a safe and effective approach in haematological patients with severe thrombocytopenia requiring urgent cannulation for life support, plasma-exchange, chemotherapy and transfusion.
authors: Haematology and Transplant Unit, Department of Internal and Specialist Medicine, University of Palermo, Palermo, Italy.
authors: Mariasanta
authors: M
authors: Napolitano
authors: Haematology and Transplant Unit, Department of Internal and Specialist Medicine, University of Palermo, Palermo, Italy.
authors: Alessandra
authors: A
authors: Malato
authors: Division of General and Thoracic Surgery, Department of Surgery and Oncology, University of Palermo, Palermo, Italy.
authors: Francesco
authors: F
authors: Raffaele
authors: Division of General and Thoracic Surgery, Department of Surgery and Oncology, University of Palermo, Palermo, Italy.
authors: Manuela
authors: M
authors: Palazzolo
authors: Division of General and Thoracic Surgery, Department of Surgery and Oncology, University of Palermo, Palermo, Italy.
authors: Giorgio
authors: G
authors: Lo Iacono
authors: Division of General and Thoracic Surgery, Department of Surgery and Oncology, University of Palermo, Palermo, Italy.
authors: Roberto
authors: R
authors: Pinna
authors: Division of General and Thoracic Surgery, Department of Surgery and Oncology, University of Palermo, Palermo, Italy.
authors: Girolamo
authors: G
authors: Geraci
authors: Division of General and Thoracic Surgery, Department of Surgery and Oncology, University of Palermo, Palermo, Italy.
authors: Giuseppe
authors: G
authors: Modica
authors: Haematology and Transplant Unit, Department of Internal and Specialist Medicine, University of Palermo, Palermo, Italy.
authors: Giorgia
authors: G
authors: Saccullo
authors: Haematology and Transplant Unit, Department of Internal and Specialist Medicine, University of Palermo, Palermo, Italy.
authors: Sergio
authors: S
authors: Siragusa
authors: Division of General and Thoracic Surgery, Department of Surgery and Oncology, University of Palermo, Palermo, Italy.
authors: Massimo
authors: M
authors: Cajozzo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002405:Catheterization, Central Venous / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012720:Severity of Illness Index; D013921:Thrombocytopenia / Q000000981:diagnostic imaging* / Q000473:pathology / Q000628:therapy*; D014463:Ultrasonography
references: Crit Care Med. 1991 Dec;19(12):1516-9
references: 1959371
references: Transfus Apher Sci. 2004 Dec;31(3):199-202
references: 15556467
references: Acta radiol. 1953 May;39(5):368-76
references: 13057644
references: Arch Intern Med. 1986 Feb;146(2):259-61
references: 3947185
references: AJR Am J Roentgenol. 1990 Nov;155(5):1097-9
references: 2120941
references: Pediatr Emerg Care. 1989 Jun;5(2):120-7
references: 2664721
references: J Surg Oncol. 2004 Dec 15;88(4):267-8
references: 15565588
references: Support Care Cancer. 1993 Mar;1(2):92-7
references: 8143107
references: Semin Vasc Surg. 1997 Sep;10(3):130-4
references: 9304728
references: Br J Radiol. 1996 Feb;69(818):178-81
references: 8785648
references: Crit Care Med. 1983 Jul;11(7):515-7
references: 6861498
references: Cathet Cardiovasc Diagn. 1982;8(1):23-9
references: 7060113
references: Br J Haematol. 2008 Jul;142(3):348-60
references: 18510692
references: World J Surg Oncol. 2010 Oct 19;8:91
references: 20958986
references: Chest. 1990 Jul;98(1):157-60
references: 2193776
references: Circulation. 1993 May;87(5):1557-62
references: 8491011