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Is it safe to remove central lines in patients with platelets less than 20,000/uL
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  • Priya Marwah,
  • Stalin Ramprakash,
  • Sai Prasad T R,
  • Mane Gizhlaryan,
  • Deepa Trivedi,
  • Vaibhav Shah,
  • Amit Chitaliya,
  • Sandeep Elizabeth,
  • Rakesh Dhanya,
  • Rajat Agarwal,
  • Lawrence Faulkner
Priya Marwah
Mahatma Gandhi University of Medical Sciences and Technology
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Stalin Ramprakash
Sankalp-People Tree Centre for Pediatric BMT
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Sai Prasad T R
Sankalp India Foundation
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Mane Gizhlaryan
Sankalp-People Tree Centre for Pediatric BMT
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Deepa Trivedi
Sankalp-CIMS Centre for Pediatric BMT
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Vaibhav Shah
Sankalp-CIMS Centre for Pediatric BMT
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Amit Chitaliya
Sankalp-CIMS Centre for Pediatric BMT
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Sandeep Elizabeth
Sankalp-People Tree Centre for Pediatric BMT
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Rakesh Dhanya
Sankalp India Foundation
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Rajat Agarwal
Sankalp India Foundation
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Lawrence Faulkner
Cure2Children Foundation
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Abstract

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.