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Central venous catheterization in patients with liver disease and coagulopathy

Background: Patients with end-stage liver disease frequently acquired complex disorders in hemostasis secondary to liver dysfunction. Objectives: This study aims to determine the incidence of vascular complications associated with central venous catheterization (CVC) in patients with coagulopathy and liver disease. Methods and Subjects: This multicentric, retrospective, cross-sectional study was performed on 993 patients undergoing liver transplantation who required central venous access (CVA) for their clinical management between October 2006 and October 2016. The age, sex, most recent platelet count, prothrombin time, international normalized ratio (INR), activated partial thromboplastin time, site of central venous catheter placement, and bleeding complications were retrieved from their medical records. Results: In these 993 cases, the mean age was 57.46 (standard deviation = 7.46) years, and 635 (63.9%) were male. Selected sites were the internal jugular (n = 889; 89.5%), subclavian (n = 93; 9.4%), and femoral (n = 11; 1.1%) veins. First attempt was successful in 925 cases (93.2%), in which 1 case had major bleeding, and 84 cases had minor bleeding. About 83% of the patients with liver failure take CVC procedure without any complications. None of the vascular complications occurred in 53% of the patients with low platelets and INR >1.5. Conclusion: We demonstrated major vascular complications following CVC in patients with liver disease and coagulopathy has low incidence in this audit. CVA procedures can be done safely in patients with disorders of hemostasis by skilled physicians who frequently perform these procedures.