Woodley-Cook Joel, Amaral Joao, Connolly Bairbre, Brandão Leonardo R
Diagnostic Imaging, Image Guided Therapy, The Hospital for Sick Children, Toronto, Canada.
Pediatr Radiol. 2015 Apr;45(5):727-35. doi: 10.1007/s00247-014-3207-6. Epub 2015 Feb 6.
Obtaining basic hemostatic laboratory investigations prior to peripherally inserted central catheter (PICC) insertion remains controversial, even if the procedure is converted to a tunneled central venous line (CVL) placement.
To determine the value of pre-procedural blood screening (hemoglobin level, platelet count, aPTT/INR) in hospitalized children without a known bleeding diathesis.
This retrospective review included pediatric patients undergoing PICC insertion who had both laboratory screening and post-PICC hemoglobin level. Two cohorts (A: 0-3 months; B: >3 months-18 years) were analyzed for procedural major/minor bleeding.
Of 1,441 consecutive children identified during a 3-year period, 832 patients (226 in cohort A, 606 in cohort B) fulfilled the inclusion criteria. Overall, 36% (300/832) of the patients had at least one abnormal laboratory result. Only 0.2% (3/1,441) of patients required conversion to a central venous line. In cohort A no major bleeding occurred; the minor bleeding frequency was 30% (68/226). Neither abnormal laboratory results nor correction of abnormal laboratory results was associated with minor bleeding complications. The positive and negative predictive values (PPV/NPV) of having abnormal laboratory screening were 0.22 and 0.68, respectively. In cohort B the major bleeding frequency was 1% (6/606) but no patient required any blood transfusion; minor bleeding occurred in 29% (174/606). Neither abnormal laboratory results nor correction of abnormal laboratory results was associated with minor bleeding complications. The PPV and NPV of abnormal laboratory screening results were 0.24 and 0.72, respectively.
Pre-procedural blood screening did not predict bleeding in hospitalized children without a known bleeding diathesis undergoing PICC insertion. The rarity of major bleeding complications and need for conversion to a central venous line did not support a need for laboratory screening.
在外周静脉穿刺中心静脉导管（PICC）置入术前进行基本的止血实验室检查仍存在争议，即便该操作改为置入带隧道的中心静脉导管（CVL）。
确定在无已知出血性疾病的住院儿童中，术前血液筛查（血红蛋白水平、血小板计数、活化部分凝血活酶时间/国际标准化比值）的价值。
这项回顾性研究纳入了接受PICC置入术且进行了实验室筛查及PICC置入术后血红蛋白水平检测的儿科患者。分析了两个队列（A组：0至3个月；B组：大于3个月至18岁）的手术严重/轻微出血情况。
在3年期间确定的1441例连续儿童中，832例患者（A组226例，B组606例）符合纳入标准。总体而言，36%（300/832）的患者至少有一项实验室检查结果异常。仅0.2%（3/1441）的患者需要改为置入中心静脉导管。A组未发生严重出血；轻微出血发生率为30%（68/226）。实验室检查结果异常及对异常结果的纠正均与轻微出血并发症无关。实验室筛查异常的阳性和阴性预测值（PPV/NPV）分别为0.22和0.68。B组严重出血发生率为1%（6/606），但无患者需要输血；轻微出血发生率为29%（174/606）。实验室检查结果异常及对异常结果的纠正均与轻微出血并发症无关。实验室筛查结果异常的PPV和NPV分别为0.24和0.72。
对于无已知出血性疾病且接受PICC置入术的住院儿童，术前血液筛查不能预测出血情况。严重出血并发症的罕见性以及改为置入中心静脉导管的必要性并不支持进行实验室筛查。
