Vascular Access Conversation - IVUPDATE Podcast from IVTEAM

"Bleeding complications associated with the insertion of central venous catheter and the suspected disorder of hemostasis given by BUN levels >70 mg/dl are common" Diaz et al (2023).
Bleeding after ultrasound-guided CVC placement

Abstract:

Introduction: Bleeding associated with elevated blood urea nitrogen (BUN) is a known complication. Patients with uremia require a central venous catheter insertion by dialysis. The relation between BUN and bleeding complications during central venous catheter insertion is not yet clear.

Objective: We described the frequency of complications associated with central venous catheter implantation in uremic patients and evaluated the statistical relationship between bleeding complications and catheter type, number of punctures, and catheter insertion site. Also, we determined if any value of BUN is associated with bleeding complications.

Methods: We included patients with a serum value of BUN >70 mg/dl that required insertion of a central venous catheter. The quantitative variables were expressed through the measure of central tendency. A bivariate analysis and a ROC curve were performed.

Results: A total of 273 catheters were included in this study. Bleeding complications were detected in 69 cases (25.3%), and local bleeding was the most frequent complication in 51/69 cases. Statistically significant association was not established. We did not find a specific cut-off value directly related to BUN levels and the rate of complications.

Conclusion: Bleeding complications associated with the insertion of central venous catheter and the suspected disorder of hemostasis given by BUN levels >70 mg/dl are common. It was not possible to determine a BUN cut-off value to predict complications. The association analysis was not conclusive. High BUN levels should not be considered a high-risk condition for central venous cannulation under ultrasound guidance performed by trained personnel.

Reference:

Diaz C, Quintero JA, Zarama V, Bustamante-Cristancho LA. Bleeding Complications in Uremic Patients After Ultrasound-Guided Central Venous Catheter Placement. Open Access Emerg Med. 2023 Jan 12;15:21-28. doi: 10.2147/OAEM.S384081. PMID: 36660271; PMCID: PMC9843503.