title: The safety of ultrasound guided central venous cannulation in patients with liver disease.
abstract: BACKGROUND
  Central venous cannulation (CVC) is frequently required during the management of patients with liver disease with deranged conventional coagulation parameters (CCP). Since CVC is known to be associated with vascular complications, it is standard practice to transfuse Fresh-Frozen Plasma or platelets to correct CCP. These CCP may not reflect true coagulopathy in liver disease. Additionally CVC when performed under ultrasound guidance (USG-CVC) in itself reduces the incidence of complications.
  
  
  OBJECTIVE
  To assess the safety of USG-CVC and to evaluate the incidence of complications among liver disease patients with coagulopathy.
  
  
  METHODS
  An audit of all USG-CVCs was performed among adult patients with liver disease in a tertiary care center.
  
  
  METHODS
  Data was collected for all the adult patients (18-60 years) of either gender suffering from liver disease who had required USG-CVC. Univariate and multivariate regression analysis was done to identify possible risk factors for complications.
  
  
  RESULTS
  The mean age of the patients was 42.1 ± 11.6 years. Mean international normalized ratio was 2.17 ± 1.16 whereas median platelet count was 149.5 (range, 12-683) × 10(9)/L. No major vascular or non-vascular complications were recorded in our patients. Overall incidence of minor vascular complications was 18.6%, of which 13% had significant ooze, 10.3% had hematoma formation and 4.7% had both hematoma and ooze. Arterial puncture and multiple attempts were independent risk factors for superficial hematoma formation whereas low platelet count and presence of ascites were independent risk factors for significant oozing.
  
  
  CONCLUSIONS
  Ultrasound guidance -CVC in liver disease patients with deranged coagulation is a safe and highly successful modality.
authors.affiliation: Department of Anesthesiology and Critical Care, Institute of Liver and Biliary Science, Vasant Kunj, New Delhi, India.
authors.forename: Shweta A
authors.initials: SA
authors.lastname: Singh
authors.affiliation: Department of Anesthesiology and Critical Care, Institute of Liver and Biliary Science, Vasant Kunj, New Delhi, India.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Sharma
authors.affiliation: Department of Anesthesiology and Critical Care, Institute of Liver and Biliary Science, Vasant Kunj, New Delhi, India.
authors.forename: Anshuman
authors.initials: A
authors.lastname: Singh
authors.affiliation: Department of Anesthesiology and Critical Care, Institute of Liver and Biliary Science, Vasant Kunj, New Delhi, India.
authors.forename: Anil K
authors.initials: AK
authors.lastname: Singh
authors.affiliation: Department of Anesthesiology and Critical Care, Institute of Liver and Biliary Science, Vasant Kunj, New Delhi, India.
authors.forename: Utpal
authors.initials: U
authors.lastname: Sharma
authors.affiliation: Department of Clinical Research, Institute of Liver and Biliary Science, Vasant Kunj, New Delhi, India.
authors.forename: Ajeet Singh
authors.initials: AS
authors.lastname: Bhadoria
keywords: Chronic liver disease; convention coagulation parameters; ultrasound guided central vein cannulation
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