ABSTRACTS (250 words)
Background : Patients with tunnelled CVL may develop blood stream
infections which at times are difficult to control without line removal.
Concomitant severe thrombocytopenia with platelet transfusion
refractoriness is often considered a hard contraindication to any
procedure involving a major blood vessel. There is very little
literature on the actual clinical risks of tunnelled central line
removal in febrile pancytopenic patients.
Procedure : We analysed complications and outcomes in all or
patients, a total of 52, who underwent CVL removal with platelets
<20,000/uL.
Results : No bleeding episodes or unplanned transfusions could be
associated with CVL removal. No other complications were also reported.
All patients had time to hemostasis within 5 minutes of catheter
removal. A total 31 patients were febrile at the time of CVL removal, of
which 17 became afebrile within 2 days. We found no difference in
response when comparing those whose antibiotic therapy was
change/escalation versus those who did not. Removal of CVL under local
anaesthesia remained complication-free even at platelets counts less
than 20.000/uL. With only RDP support 17 lines were pulled out without
any complications when platelets were below 5.000.
Conclusion : Our findings suggest that central lines can be safely
removed with platelet counts less than 20.000/ul and that this may
result in enhanced blood stream infection control. This might be
particularly relevant to neutropenic patients in this day and age of MDR
germs emergence and paucity of new effective antibiotics.