Safer Access With Fewer Transfusions: Revisiting Platelet Thresholds in Pediatric Central Venous Catheterization

Background Central venous catheters (CVCs) are essential in pediatric hematology‐oncology, for the administration of chemotherapy and supportive therapy. Thrombocytopenia increases the risk of bleeding and current guidelines recommend prophylactic platelet transfusions below 40–50 × 10 9 /L, though evidence is limited and transfusions entail risks and costs. Advances in procedural bundles and simulation‐based training may enhance safety, enabling lower thresholds. Methods This retrospective observational cohort study analyzed 274 pediatric patients undergoing CVC insertion (PICC, CICC, and FICC) at a tertiary center (2020–2023). Patients were stratified by platelet count using 50 × 10 9 /L and 30 × 10 9 /L thresholds. Postoperative complications, including bleeding and thrombosis, were compared between groups. All procedures employed pediatric‐specific bundles, and operators received simulation‐based ultrasound‐guided PICC training to optimize safety. Results Complication rates did not differ significantly with platelets above or below 50 × 10 9 /L (32.8% vs. 26.3%, p = 0.29) or 30 × 10 9 /L (32.6% vs. 27.1%, p = 0.29). Findings indicate lowering the transfusion threshold to 30 × 10 9 /L is safe. Bundles and simulation‐based training likely contributed to low complication rates. Conclusions A 30 × 10 9 /L platelet transfusion threshold appears safe for pediatric CVC insertion. Emphasizing procedural bundles and simulation‐based operator training may reduce transfusion needs, associated risks, and costs. Prospective multicenter studies are warranted to confirm safety and explore lower thresholds.