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Background: Patients with severe thrombocytopenia are considered at risk for bleeding during invasive procedures as thoracentesis. The use of ultrasound (US) significantly reduces the rate of pneumothorax from thoracentesis, but there is a lack of data on safety and efficacy of US guidance in reducing bleeding complications in thoracentesis performed on patients with severe thrombocytopenia., Methods: We retrospectively analysed the efficacy and safety of thoracentesis in cancer patients with severe thrombocytopenia. From January 2005 to December 2011, 462 patients underwent thoracentesis. Procedures were divided into 2 groups: performed without or with US guidance. All procedures were evaluated for bleeding complications as defined by the National Institutes of Health Common Terminology Criteria for Adverse Events., Results: A total of 436 consecutive evaluable thoracentesis were analysed. Thoracentesis was performed with US guidance in 310 cases. Forty-one patients (9.40%) had severe thrombocytopenia. In 32 of these 41 patients, thoracentesis was performed under US guidance while in 9 cases the procedure was performed without US guidance. Three mild haemorrhagic complications (0.69% of the procedures performed) were observed and all occurred in group of the 9 (33.33%) patients with severe thrombocytopenia who underwent thoracentesis without US guidance. No haemorrhagic complications were recorded in the 427 patients, including the 32 patients with severe thrombocytopenia, in whom thoracentesis was performed with US guidance., Conclusions: US guided thoracentesis is a safe and effective approach in cancer patients with severe thrombocytopenia. Our results indicate that this procedure, when US-guided, can be safety performed even in patients with platelet count below 30 × 10 9 /L., (© 2017 John Wiley & Sons Ltd.)

Prior research has revealed that ultrasound (US) guided central venous catheterization (CVC) is associated with a reduction in the complication rate such as pneumothorax and an improved first-pass success placing CVC in the internal jugular vein. The present study investigated if US-guided CVC, in a subset of cancer patients with severe thrombocytopenia, reduced bleeding risk and avoided prophylactic platelet transfusion. The efficacy and safety of US-guided CVC placement in cancer patients with severe thrombocytopenia was retrospectively analyzed over a period of 9 years (Dec 2000-Jan 2009), 1,660 and 207 patients with cancer underwent US-guided CVC placement into internal jugular vein respectively at the Department of Onco-Haematology, Hospital of Piacenza. The first group of patients included patients in active antitumor treatment, while the second group included patients in the palliative phase. A total of 110 (5.89%) of these 1,867 patients exhibited severe thrombocytopenia defined as platelet count ≤20x109/l, and formed the basis of this study. All procedures were evaluated for bleeding complications as defined by the National Institute of Health Common Terminology Criteria for Adverse Events (CTCAE 3.0). In the subgroup of the 110 patients with severe thrombocytopenia a single needle puncture of the vein was employed in 121 of the 122 procedures (99.18%) and no attempt failures were registered. No pneumothorax, no major bleeding and no nerve and arterial puncture were reported, only one self-limiting hematoma (0.90%) at the site of CVC insertion was reported (CTCAE 3.0 grade 1). No platelet transfusions were performed in the 110 patients, pre and post CVC placement. We believe that US-guided CVC insertion procedures into the internal jugular vein makes the difference in safety, also in thrombocytopenic patients avoiding prophylactic or post procedure platelet transfusion. [ABSTRACT FROM AUTHOR]