1461: Dialysis Catheter Placement in Patients With Severe Refractory Thrombocytopenia Transfusion Practice

Introduction: Prophylactic platelet transfusions are recommended for central venous catheter placement, including dialysis catheters when platelet counts are below 20,000/mm3. Patients with hematological malignancies have severe thrombocytopenia (< 10,000/mm3) refractory to transfusion and pose challenges for invasive procedures. Using a clinical vignette-based survey, we sought to understand the current platelet transfusion practices among intensive care unit (ICU) providers at our cancer center for patients with severe thrombocytopenia refractory to transfusions, who required hemodialysis catheter (HDC) placement. Methods: Using the Research Electronic Data Capture (REDCap) platform, a 22 question, anonymous, clinical vignette-based survey was administered to all ICU fellows, attending and advance practice providers. The scenario describes an ICU patient with myelodysplastic syndrome and platelet counts 5,000/mm3 despite multiple platelet transfusions requiring HDC placement for urgent renal replacement therapy. Respondents were asked about platelet transfusion practices, preference of timing of platelets transfusion, and methods used for safe HDC placement as ultrasound and additional hemostatic agents use, insertion site selection. Results: The survey response rate was 59% (65/110) mean age 38 yr (25–67) mean ICU experience 8 yr (1–39) 59% of respondents placed > 50 CVCs and encountered patients with severe refractory thrombocytopenia on weekly basis. The majority (74%) chose to transfuse platelets during HDC placement, while 10% transfused to a target threshold beforehand, another 10% transfused prior to placement without specifying a threshold, and 6% proceeded without any transfusion. All respondents opted for ultrasound guided placement; the preferred insertion site was internal jugular vein (63%) followed by femoral vein (25%); 55% chose to administer desmopressin before HDC placement, 25% chose no hemostatic agent (prothrombin complex concentrate, plasma, tranexamic acid). Most (58%) did not seek any consultation; 40% consulted hematology or transfusion medicine. Conclusions: While there was some variability in practice, most providers chose to transfuse one unit of platelets during HDC placement, consistently used ultrasound guidance, and preferred the internal jugular vein insertion site.