{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T02:12:02Z","timestamp":1787019122607,"version":"build-2736575974"},"reference-count":29,"publisher":"SAGE Publications","issue":"5","license":[{"start":{"date-parts":[[2024,8,26]],"date-time":"2024-08-26T00:00:00Z","timestamp":1724630400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Vasc Access"],"published-print":{"date-parts":[[2025,9]]},"abstract":"<jats:sec>\n                    <jats:title>Introduction:<\/jats:title>\n                    <jats:p>Recently, the rising incidence of trauma, cancer, and critical illnesses has led to a growing necessity for Central Venous Access Devices (CVADs). Inserting CVADs in thrombocytopenic patients is still challenging. This study tries to shed light on the safety and associated risks of CVADs insertion in this high-risk group, with the ultimate goal of informing clinical practice and aiding in decision-making processes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>This study was conducted as prospective cohort study from September 2020 to September 2023 in Mazandaran University of Medical Sciences, Iran. Individuals aged 18\u201380\u2009years with a platelet count of less than 50,000\/dL included and those designated for subcutaneous port procedures or on anticoagulant and antiplatelet therapy, excluded. Ultrasound-guided CVAD insertion using the Seldinger technique and SIC\/FIC strategies performed for participants. Incidence of hemorrhagic complications post-CVAD insertion, requirement for blood product transfusions to amend platelet counts, frequency of non-bleeding complications, and complications related to blood product transfusions monitored.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>The study comprised 137 participants, 54% of whom were men, with an average age of 46.90\u2009\u00b1\u200915.70\u2009years. No significant correlation was found between the site of CVAD placement (jugular vs femoral) and the incidence of major or minor bleeding. Femoral catheters were associated with a higher rate of infection. No complications related to transfusion of blood products or mortality seen, indicating that CVAD implantation can be safely performed in patients with thrombocytopenia or coagulation disorders.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>\n                      CVAD insertion in thrombocytopenic patients, even with platelet counts below 10\u2009\u00d7\u200910\n                      <jats:sup>9<\/jats:sup>\n                      \/L, is safe and associated with minimal complications when performed under ultrasound guidance by experienced surgeons. This finding supports the use of a lower platelet count threshold for CVAD insertion than currently recommended in guidelines, potentially reducing the need for platelet transfusions prior to CVAD placement.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/11297298241273612","type":"journal-article","created":{"date-parts":[[2024,8,26]],"date-time":"2024-08-26T06:12:16Z","timestamp":1724652736000},"page":"1556-1562","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Optimizing central venous access devices insertion in thrombocytopenic patients: Balancing efficacy and safety"],"prefix":"10.1177","volume":"26","author":[{"given":"Hossein","family":"Farsavian","sequence":"first","affiliation":[{"name":"Department of Surgery, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahdi","family":"Davoodi","sequence":"additional","affiliation":[{"name":"Department of Surgery, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7374-2783","authenticated-orcid":false,"given":"Mohammad Javad","family":"Najafi","sequence":"additional","affiliation":[{"name":"Clinical Research Development Unit of Imam Khomeini Hospital, Mazandaran University of Medical Science, Sari, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahmoud","family":"Manouchehri Amoli","sequence":"additional","affiliation":[{"name":"Virginia Commonwealth University, Richmond, VA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahmad","family":"Zahmatkesh","sequence":"additional","affiliation":[{"name":"Department of Surgery, Faculty of Medicine, Mazandaran University of Medical Sciences, Sari, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7324-9590","authenticated-orcid":false,"given":"Mahmoud","family":"Nazarpour","sequence":"additional","affiliation":[{"name":"Clinical Research Development Unit of Imam Khomeini Hospital, Mazandaran University of Medical Science, Sari, Iran"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2024,8,26]]},"reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra011883"},{"key":"e_1_3_2_3_2","doi-asserted-by":"publisher","DOI":"10.3109\/10428190309178770"},{"key":"e_1_3_2_4_2","doi-asserted-by":"publisher","DOI":"10.1097\/00000658-197102000-00002"},{"key":"e_1_3_2_5_2","doi-asserted-by":"publisher","DOI":"10.1001\/archinte.1986.00360140065007"},{"key":"e_1_3_2_6_2","doi-asserted-by":"publisher","DOI":"10.1213\/00000539-197401000-00030"},{"key":"e_1_3_2_7_2","doi-asserted-by":"publisher","DOI":"10.1378\/chest.98.1.157"},{"key":"e_1_3_2_8_2","first-page":"168","article-title":"Fatal bacterial infections associated with platelet tranfusions United States 2004","volume":"54","author":"Centers for Disease Control and Prevention (CDC)","year":"2005","unstructured":"Centers for Disease Control and Prevention (CDC). Fatal bacterial infections associated with platelet tranfusions United States 2004. MMWR Morb Mortal Wkly Rep 2005; 54: 168\u2013170.","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"e_1_3_2_9_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1537-2995.2011.03160.x"},{"key":"e_1_3_2_10_2","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2008-10-167643"},{"key":"e_1_3_2_11_2","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(12)62197-7"},{"key":"e_1_3_2_12_2","doi-asserted-by":"publisher","DOI":"10.3109\/09540261.2011.606538"},{"key":"e_1_3_2_13_2","unstructured":"Roberts DJ Yazer MH Murphy MF. Practical transfusion medicine. Wiley Online Library 2013."},{"key":"e_1_3_2_14_2","volume-title":"A compendium of transfusion practice guidelines","author":"Quraishy N","year":"2010","unstructured":"Quraishy N, Bachowski G, Benjamin R, et al. A compendium of transfusion practice guidelines. 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Interventional vascular radiology and interventional neurovascular radiology: a report of the National Confidential Enquiry Into Perioperative Deaths; Data collection period 1 April 1998 to 31 March 1999. National confidential enquiry into perioperative deaths, 2000.","journal-title":"National confidential enquiry into perioperative deaths"},{"key":"e_1_3_2_21_2","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-030-59295-0_3"},{"key":"e_1_3_2_22_2","doi-asserted-by":"publisher","DOI":"10.1111\/bjh.14423"},{"key":"e_1_3_2_23_2","doi-asserted-by":"publisher","DOI":"10.1179\/acb.2007.006"},{"key":"e_1_3_2_24_2","doi-asserted-by":"publisher","DOI":"10.1159\/000262400"},{"key":"e_1_3_2_25_2","doi-asserted-by":"publisher","DOI":"10.1177\/11297298211072407"},{"key":"e_1_3_2_26_2","doi-asserted-by":"publisher","DOI":"10.1177\/11297298241227248"},{"key":"e_1_3_2_27_2","doi-asserted-by":"publisher","DOI":"10.1177\/11297298211036002"},{"key":"e_1_3_2_28_2","doi-asserted-by":"publisher","DOI":"10.1177\/11297298211041442"},{"key":"e_1_3_2_29_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1537-2995.2011.03147.x"},{"key":"e_1_3_2_30_2","first-page":"435","article-title":"Central venous catheterization in cancer patients with severe thrombocytopenia: ultrasound-guide improves safety avoiding prophylactic platelet transfusion","volume":"12","author":"Cavanna L","year":"2020","unstructured":"Cavanna L, Citterio C, Di Nunzio C, et al. Central venous catheterization in cancer patients with severe thrombocytopenia: ultrasound-guide improves safety avoiding prophylactic platelet transfusion. 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