Results:
Of the 52 patients, in 27 the CVL was removed while baseline platelet counts were below 10,000/uL. Only random donor platelets were transfused in 30 patients, single donor platelets alone were infused in 6 patients, both were used in 5 patients and 11 patients had no platelets transfusion on the day of line removal. In all, 9 patients who had a hemoglobin less than 8 gm/dL received packed red cell transfusions on the day of CVL removal. A hemoglobin drop of more than 1gm/dL was observed in 5 patients however none of them had any overt bleeding. No bleeding episodes or unplanned transfusions could be associated with CVL removal. No other complications were also reported. Table I summarises transfusions and significant bleeding. Figure I shows the distribution of central line removal at platelets less than 20,000/µl at each of the centre along with the nature of platelet transfusion given.
A total 31 patients were febrile at the time of CVL removal, of which 17 became afebrile within 2 days, 12 continued to have fever and 2 died. Among the 29 patients where the fever response could be evaluated, antibiotics were changed or escalated in 16 of the patients together with line removal. Among these, 10 became afebrile. Of the 13 patients who had no antibiotics escalation, 7 became afebrile. Fisher’s exact test performed to compare those whose antibiotic therapy was change/escalation versus those who did not, showed no difference in response (p=0.7). Positive blood cultures from CVL sampling were found in 16 patients of whom 7 became afebrile within 2 days of line removal. Table II summarises the Fever and infections status.
Only at one of the two centres were enough CRP and PCT reports available for patients who were febrile at the time of CVL removal to be able to determine if there was a response to line removal or not. Of the 18 patients with elevated CRP at CVL removal and follow-up values, 3 showed decrease within 2 days. Of the 5 patients with elevated PCT level and follow-up values 2 showed decrease within 2 days. Table III summarises the CRP and PCT response to line removal.