title: The practice of platelet transfusion prior to central venous catheterization in presence of coagulopathy: a national survey among clinicians.
abstract: BACKGROUND
  Correction of coagulopathy prior to central venous catheter (CVC) placement is advocated by guidelines, while retrospective studies support restrictive use of transfusion products.
  
  
  METHODS
  We conducted a mixed vignette and questionnaire web survey to investigate current practice and preferences for CVC placement. Clinical vignettes were used to quantify the tendency to administer platelet concentrate. A positive ß-coefficient is in favour of administering platelet concentrate.
  
  
  RESULTS
  Ninety-seven physicians answered the survey questions (36 critical care physicians, 14 haematologists, 20 radiologists and 27 anaesthesiologist). Eighty-six physicians subsequently completed the clinical vignettes (response rate 71%). Preferences in favour of correcting thrombocytopenia prior CVC placement were platelet counts of 10 × 109/L and 20 × 109/L (ß = 3·9; ß = 3·2, respectively), the subclavian insertion site (ß = 0·8). An elevated INR (INR = 3; ß = 0·6) and an elevated aPTT (aPTT = 60 s; ß = 0·4) showed a positive trend towards platelet transfusion. Platelet transfusion was less likely in an emergency setting (ß = -0·4). Reported transfusion thresholds for CVC placement varied from <10 × 109/L to 80 × 109/L for platelet count, from 1·0 to 10·0 for INR and from 25 s to 150 s for aPTT. Implementation of ultrasound guidance as standard practice was limited.
  
  
  CONCLUSIONS
  Current transfusion practice prior to CVC placement is highly variable. Physicians adjust the decision to correct coagulopathy prior CVC placement based on clinical parameters, insertion site and technique applied.
authors.affiliation: Department of Intensive Care Medicine, Academic Medical Centre, Amsterdam, The Netherlands.|Laboratory of Experimental Intensive Care and Anaesthesiology (L.E.I.C.A.), Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: E K
authors.initials: EK
authors.lastname: van de Weerdt
authors.affiliation: Department of Intensive Care Medicine, Academic Medical Centre, Amsterdam, The Netherlands.|Laboratory of Experimental Intensive Care and Anaesthesiology (L.E.I.C.A.), Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: A L
authors.initials: AL
authors.lastname: Peters
authors.affiliation: Department of Intensive Care Medicine, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: E J
authors.initials: EJ
authors.lastname: Goudswaard
authors.affiliation: Department of Intensive Care Medicine, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: J M
authors.initials: JM
authors.lastname: Binnekade
authors.affiliation: Department of Interventional Radiology, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: K P
authors.initials: KP
authors.lastname: van Lienden
authors.affiliation: Department of Haematology, Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: B J
authors.initials: BJ
authors.lastname: Biemond
authors.affiliation: Department of Intensive Care Medicine, Academic Medical Centre, Amsterdam, The Netherlands.|Laboratory of Experimental Intensive Care and Anaesthesiology (L.E.I.C.A.), Academic Medical Centre, Amsterdam, The Netherlands.
authors.forename: A P J
authors.initials: APJ
authors.lastname: Vlaar
mesh_terms: D000328:Adult; D001778:Blood Coagulation Disorders / Q000097:blood / Q000628:therapy*; D002405:Catheterization, Central Venous; D006801:Humans; D008875:Middle Aged; D010314:Partial Thromboplastin Time; D010820:Physicians; D010976:Platelet Count; D017713:Platelet Transfusion; D017410:Practice Guidelines as Topic; D011795:Surveys and Questionnaires; D013921:Thrombocytopenia / Q000097:blood / Q000628:therapy*
keywords: bleeding; central venous catheter; coagulopathy; platelets; transfusion; trombocytopenia