title: Do children without a known bleeding tendency undergoing PICC placement require coagulation laboratory testing?
abstract: BACKGROUND
  Obtaining basic hemostatic laboratory investigations prior to peripherally inserted central catheter (PICC) insertion remains controversial, even if the procedure is converted to a tunneled central venous line (CVL) placement.
  
  
  OBJECTIVE
  To determine the value of pre-procedural blood screening (hemoglobin level, platelet count, aPTT/INR) in hospitalized children without a known bleeding diathesis.
  
  
  METHODS
  This retrospective review included pediatric patients undergoing PICC insertion who had both laboratory screening and post-PICC hemoglobin level. Two cohorts (A: 0-3 months; B: >3 months-18 years) were analyzed for procedural major/minor bleeding.
  
  
  RESULTS
  Of 1,441 consecutive children identified during a 3-year period, 832 patients (226 in cohort A, 606 in cohort B) fulfilled the inclusion criteria. Overall, 36% (300/832) of the patients had at least one abnormal laboratory result. Only 0.2% (3/1,441) of patients required conversion to a central venous line. In cohort A no major bleeding occurred; the minor bleeding frequency was 30% (68/226). Neither abnormal laboratory results nor correction of abnormal laboratory results was associated with minor bleeding complications. The positive and negative predictive values (PPV/NPV) of having abnormal laboratory screening were 0.22 and 0.68, respectively. In cohort B the major bleeding frequency was 1% (6/606) but no patient required any blood transfusion; minor bleeding occurred in 29% (174/606). Neither abnormal laboratory results nor correction of abnormal laboratory results was associated with minor bleeding complications. The PPV and NPV of abnormal laboratory screening results were 0.24 and 0.72, respectively.
  
  
  CONCLUSIONS
  Pre-procedural blood screening did not predict bleeding in hospitalized children without a known bleeding diathesis undergoing PICC insertion. The rarity of major bleeding complications and need for conversion to a central venous line did not support a need for laboratory screening.
authors: Diagnostic Imaging, Image Guided Therapy, The Hospital for Sick Children, Toronto, Canada.
authors: Joel
authors: J
authors: Woodley-Cook
authors: Joao
authors: J
authors: Amaral
authors: Bairbre
authors: B
authors: Connolly
authors: Leonardo R
authors: LR
authors: Brandão
mesh_terms: D000293:Adolescent; D001778:Blood Coagulation Disorders / Q000175:diagnosis* / Q000453:epidemiology*; D002406:Catheterization, Peripheral; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors
references: Transfusion. 2010 Apr;50(4):753-65
references: 20003061
references: Mayo Clin Proc. 1997 Mar;72(3):225-33
references: 9070197
references: Br J Nurs. 1996 Jan 25-Feb 7;5(2):71-4
references: 8680249
references: Hematology Am Soc Hematol Educ Program. 2007;:179-86
references: 18024627
references: Br J Haematol. 2004 Jul;126(1):139-52
references: 15198745
references: Am J Infect Control. 2001 Feb;29(1):32-40
references: 11172316
references: West J Med. 1994 Jan;160(1):25-30
references: 8128698
references: J Thromb Haemost. 2004 Dec;2(12):2250-9
references: 15613038
references: Pediatrics. 2005 Jun;115(6):1602-6
references: 15930222
references: Thromb Haemost. 2001 Feb;85(2):195-7
references: 11246531
references: Arch Otolaryngol. 1970 May;91(5):453-6
references: 5445322
references: J Pediatr Hematol Oncol. 2008 Feb;30(2):135-41
references: 18376266
references: J Vasc Interv Radiol. 2012 Jun;23(6):727-36
references: 22513394
references: J Vasc Interv Radiol. 1993 Sep-Oct;4(5):653-60
references: 8219560
references: J Thromb Haemost. 2012 Apr;10(4):615-21
references: 22321862
references: Chest. 1996 Jul;110(1):185-8
references: 8681626
references: Anesthesiology. 2012 Mar;116(3):522-38
references: 22273990
references: Semin Thromb Hemost. 2008 Feb;34(1):97-103
references: 18393146
references: Nurs Clin North Am. 1993 Dec;28(4):937-71
references: 8265431
references: Eur J Pediatr. 1996 Jul;155(7):580-8
references: 8831082
references: Med Klin (Munich). 2009 May 15;104(5):331-5
references: 19444412
references: Tech Vasc Interv Radiol. 2002 Jun;5(2):95-102
references: 12489048
references: Transfusion. 1991 Feb;31(2):164-71
references: 1996485
references: J Vasc Interv Radiol. 2012 Mar;23 (3):351-7
references: 22365294
references: Int J Pediatr Otorhinolaryngol. 1997 Feb 14;39(1):67-76
references: 9051441
references: Heart Lung. 1993 Sep-Oct;22(5):428-34
references: 8226007
references: J Pediatr. 2012 Feb;160(2):210-215.e1
references: 21924435