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Central venous access in thrombocytopenia — SCE Acute Medicine MCQ

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HardCritical care medicineCentral venous access in thrombocytopeniaSCE Acute Medicine

A 58-year-old woman with sepsis has received fluids and antibiotics but remains hypotensive. A central venous catheter is planned for vasopressors. Her platelets are 18 × 10^9/L, INR 1.4 and fibrinogen is normal. The procedure is not immediately life-saving because peripheral vasopressors can be used temporarily. What is the most appropriate procedural decision?

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Correct answer: A — Use peripheral vasopressor support initially and correct thrombocytopenia before central line insertion if feasible

Central venous access in severe thrombocytopenia carries bleeding risk, especially at non-compressible sites, and ultrasound guidance with correction should be considered when feasible. Peripheral vasopressors through a suitable cannula can be used as a temporary bridge in many protocols while definitive access is arranged. Blind subclavian insertion is a poor choice because complications are less compressible.

Reference: FICM GPICS; BSH Platelet Transfusion Guideline