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Central venous catheter-associated thromboembolism: still a frequent complication with no reliable predictive indicators in young children with diabetic ketoacidosis
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  • Gary Woods,
  • Sarah O'Brien,
  • Bryce Kerlin,
  • Melissa Rose
Gary Woods
Emory University School of Medicine
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Sarah O'Brien
The Ohio State University College of Medicine
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Bryce Kerlin
The Ohio State University College of Medicine
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Melissa Rose
The Ohio State University College of Medicine
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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.