The safety of ultrasound guided central venous cannulation in patients with liver disease

BACKGROUND: Central venous cannulation (CVC) is frequently required during the management of patients with liver disease with deranged conventional coagulation parameters (CCP). Since CVC is known to be associated with vascular complications, it is standard practice to transfuse Fresh-Frozen Plasma or platelets to correct CCP. These CCP may not reflect true coagulopathy in liver disease. Additionally CVC when performed under ultrasound guidance (USG-CVC) in itself reduces the incidence of complications. AIM: To assess the safety of USG-CVC and to evaluate the incidence of complications among liver disease patients with coagulopathy. SETTING AND DESIGN: An audit of all USG-CVCs was performed among adult patients with liver disease in a tertiary care center. MATERIALS AND METHODS: Data was collected for all the adult patients (18-60 years) of either gender suffering from liver disease who had required USG-CVC. Univariate and multivariate regression analysis was done to identify possible risk factors for complications. RESULTS: The mean age of the patients was 42.1 ± 11.6 years. Mean international normalized ratio was 2.17 ± 1.16 whereas median platelet count was 149.5 (range, 12-683) × 10(9)/L. No major vascular or non-vascular complications were recorded in our patients. Overall incidence of minor vascular complications was 18.6%, of which 13% had significant ooze, 10.3% had hematoma formation and 4.7% had both hematoma and ooze. Arterial puncture and multiple attempts were independent risk factors for superficial hematoma formation whereas low platelet count and presence of ascites were independent risk factors for significant oozing. CONCLUSION: Ultrasound guidance -CVC in liver disease patients with deranged coagulation is a safe and highly successful modality.