Lowering platelet count threshold to 10,000/microL for peripherally inserted central catheter placement safely conserves blood products.
Lowering platelet count threshold to 10,000/microL for peripherally inserted central catheter placement safely conserves blood products.
- 2022
Despite the low risk of peripherally inserted central catheter (PICC) insertion-related bleeding, the practice of administering prophylactic platelets varies greatly. Limiting unnecessary blood product transfusions reduces transfusion-related adverse events, financial cost, and delays in care. We assessed the impact of lowering prophylactic platelet administration threshold on blood product utilization patterns and bleeding events. This quasi-experimental study was conducted in an urban academic tertiary medical center. The study population included patients with platelet counts >= 10,000/microL and < 50,000/microL undergoing PICC placement in 2018 and 2019 when the minimum platelet thresholds were 50,000/microL and 10,000/microL, respectively. The primary outcome was blood product utilization and the secondary outcome was PICC insertion-related bleeding complications. Thirty-five patients using the 10,000/microL (10 K) platelet threshold and 46 patients using the 50,000/microL (50 K) platelet threshold were enrolled. The 50 K group received more platelets before PICC insertion (0.870 +/- 0.885 and 0.143 +/- 0.430 pools of platelets-per-person, p < 0.001). No patients experienced clinically significant bleeding. Immediately following PICC insertion, minor bleeding occurred in five patients (two [4.3%] and three [8.6%] in the 50 K and 10 K groups, respectively). Bleeding rates between the two cohorts did not differ (p = 0.647). Lowering the minimum platelet threshold from 50,000/microL to 10,000/microL resulted in less prophylactic platelet and total blood product administration with no appreciable difference in PICC insertion-related bleeding. Copyright © 2022. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.
English
0939-5555
10.1007/s00277-022-04891-y [doi] 10.1007/s00277-022-04891-y [pii]
*Catheterization, Central Venous
*Catheterization, Peripheral
*Thrombocytopenia
Catheterization, Central Venous/ae [Adverse Effects]
Catheterization, Peripheral/ae [Adverse Effects]
Catheters/ae [Adverse Effects]
Hemorrhage/co [Complications]
Hemorrhage/pc [Prevention & Control]
Humans
Platelet Count
Platelet Transfusion/ae [Adverse Effects]
Thrombocytopenia/et [Etiology]
MedStar Washington Hospital Center
Emergency Medicine
Journal Article
Despite the low risk of peripherally inserted central catheter (PICC) insertion-related bleeding, the practice of administering prophylactic platelets varies greatly. Limiting unnecessary blood product transfusions reduces transfusion-related adverse events, financial cost, and delays in care. We assessed the impact of lowering prophylactic platelet administration threshold on blood product utilization patterns and bleeding events. This quasi-experimental study was conducted in an urban academic tertiary medical center. The study population included patients with platelet counts >= 10,000/microL and < 50,000/microL undergoing PICC placement in 2018 and 2019 when the minimum platelet thresholds were 50,000/microL and 10,000/microL, respectively. The primary outcome was blood product utilization and the secondary outcome was PICC insertion-related bleeding complications. Thirty-five patients using the 10,000/microL (10 K) platelet threshold and 46 patients using the 50,000/microL (50 K) platelet threshold were enrolled. The 50 K group received more platelets before PICC insertion (0.870 +/- 0.885 and 0.143 +/- 0.430 pools of platelets-per-person, p < 0.001). No patients experienced clinically significant bleeding. Immediately following PICC insertion, minor bleeding occurred in five patients (two [4.3%] and three [8.6%] in the 50 K and 10 K groups, respectively). Bleeding rates between the two cohorts did not differ (p = 0.647). Lowering the minimum platelet threshold from 50,000/microL to 10,000/microL resulted in less prophylactic platelet and total blood product administration with no appreciable difference in PICC insertion-related bleeding. Copyright © 2022. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.
English
0939-5555
10.1007/s00277-022-04891-y [doi] 10.1007/s00277-022-04891-y [pii]
*Catheterization, Central Venous
*Catheterization, Peripheral
*Thrombocytopenia
Catheterization, Central Venous/ae [Adverse Effects]
Catheterization, Peripheral/ae [Adverse Effects]
Catheters/ae [Adverse Effects]
Hemorrhage/co [Complications]
Hemorrhage/pc [Prevention & Control]
Humans
Platelet Count
Platelet Transfusion/ae [Adverse Effects]
Thrombocytopenia/et [Etiology]
MedStar Washington Hospital Center
Emergency Medicine
Journal Article