Cardiac/Hemodynamics/MonitoringCentral line placement in patients with and without prophylactic plasma

Central line placement (CLP) is a common life-saving intervention in critically ill patients, and patients with coagulation abnormalities as identified by an abnormal international normalized ratio (INR) may receive prophylactic plasma transfusion before the procedure despite previously published data that such a practice is not efficacious. Over a 14-month period, 287 CLPs were performed in the intensive care unit. The use of plasma preprocedure in patients with an elevated INR was generally discouraged but left to the discretion of the operator. A total of 100 lines were placed in patients with a preprocedure INR greater than 1.5, 27 of whom received prophylactic fresh frozen plasma. Only 1 case of bleeding was observed in a patient with an INR of 3.9, who received fresh frozen plasma preprocedure (0/73 vs 1/27; P = .6). The occurrence of bleeding was very low overall with CLP (0.3%; 95% confidence interval, 0%-2%), and no benefit of prophylactic plasma was observed.