Central venous catheter-associated thromboembolism: still a frequent
complication with no reliable predictive indicators in young children
with diabetic ketoacidosis
Abstract
Objective: Children presenting in diabetic ketoacidosis (DKA) may
require a central venous catheter (CVC) to adequately manage their
supportive care. These children are at increased risk of developing
CVC-associated venous thromboembolism (VTE), but no predictive
indicators have been identified to foretell which patients are at
greatest risk. We analyzed demographic and laboratory data from children
with DKA undergoing CVC placement to determine which patients may be at
increased risk of CVC-associated VTE. Design: A retrospective chart
review was conducted for patients aged 0-5 years admitted with DKA, CVC
placement, and possible subsequent VTE development over ten years at a
single institution. Reported demographic and laboratory variables were
compared amongst patients that developed VTE and those that did not
using Mann-Whitney rank sum tests. CVC-associated VTE incidence was also
compared between children with DKA and all other patients undergoing CVC
placement. Results: We identified 149 children with DKA, 17 underwent
CVC placement, and 9/17 (52.9%) developed CVC-associated VTE. Length of
hospital stay was the only significant difference between those that
developed VTE and those that did not. Also, the prevalence of catheter
associated VTE in DKA (1.7%) was significantly higher than that for CVC
placement for any other reason (p<0.001). Conclusions: Careful
consideration for CVC placement and minimizing duration of catheter use
is suggested in this high risk population. Given the extremely high risk
and lack of identifiable predictors, anticoagulation prophylaxis should
be strongly considered for all young children with DKA requiring CVC
placement.