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Editorials: POINT/COUNTERPOINT EDITORIALS |

Point: Should Coagulopathy Be Repaired Prior to Central Venous Line Insertion? YesRequire Coagulotherapy for Central Venous Line: Why Take Chances?

Rebecca M. Baron, MD
Author and Funding Information

From the Pulmonary/Critical Care Division, Brigham and Women’s Hospital.

Correspondence to: Rebecca M. Baron, MD, Pulmonary/Critical Care Division, Brigham and Women’s Hospital, 75 Francis St, Boston, MA 02115; e-mail: rbaron@partners.org


Financial/nonfinancial disclosures: The author has reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2012 American College of Chest Physicians


Chest. 2012;141(5):1139-1142. doi:10.1378/chest.11-3225
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Extract

Although the number of studies in the literature that address the question of coagulopathy reversal prior to central venous catheter (CVC) insertion is small, and the question has been a difficult one to address with large trials, the issue is an extremely important one. Rather than operating based on experiential data and “gut feelings” (as we often do), a review of the existing literature in the context of my personal experience practicing in an ICU that cares for many patients with coagulopathy leads me to conclude that reversal of coagulopathy should be pursued prior to central line insertion (when feasible to do so). Given the increasing availability of peripherally inserted central catheters for more stable patients, the insertion of traditional central venous lines is increasingly used more exclusively in critically ill patients for monitoring and support in the ICU. Thus, the risk of any mechanical complication is heightened in critically ill patients with coagulopathy who have little reserve to tolerate additional hemodynamic derangements. I will first review the small pool of existing recent literature describing the risks of mechanical complications following central line insertion with ultrasound guidance; then, for comparison, I will briefly review the risks of life-threatening complications for patients after receipt of blood products for reversal of coagulopathy. Finally, I will conclude that the data support my experience and gut feelings that the risk-to-benefit ratio for our critically ill patients favors reversing a coagulopathy prior to central line insertion.

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