DVT a threat in children with diabetic ketoacidosis and a venous catheter

Children with diabetic ketoacidosis (DKA) who receive intensive fluid management via a femoral central venous catheter are at heightened risk for developing deep venous thrombosis (DVT), results from a retrospective cohort study indicate. Based on these findings, which mirror other findings reported recently, “we would encourage avoidance of femoral venous lines in children with DKA (diabetic ketoacidosis) who require central access,” Dr. James D. Fortenberry told Reuters Health.

Children with diabetic ketoacidosis (DKA) who receive intensive fluid management via a femoral central venous catheter are at heightened risk for developing deep venous thrombosis (DVT), results from a retrospective cohort study indicate. Based on these findings, which mirror other findings reported recently, “we would encourage avoidance of femoral venous lines in children with DKA (diabetic ketoacidosis) who require central access,” Dr. James D. Fortenberry told Reuters Health. Of 113 children with DKA admitted to the pediatric ICU at Children’s Healthcare of Atlanta at Egleston between 1998 and 2002, 6 (5.3%) required a femoral central venous catheter (CVC).Three of them (50%) developed ipsilateral DVT within 48 hours of catheter placement, Dr. Fortenberry and colleagues report in the electronic pages of the January issue of Pediatrics. All three patients needed long-term treatment with low molecular weight heparin for persistent leg swelling. The investigators matched each DKA patient with two pediatric ICU patients who underwent femoral CVC placement for other reasons. None of these control children developed DVT. “Children with DKA who receive a femoral central venous catheter were significantly more likely to develop a venous thrombus than case-matched children without DKA who received femoral lines,” Dr. Fortenberry noted in comments to Reuters Health. Dr. Fortenberry said that this risk for DVT may represent a tendency towards hypercoagulability in patients with DKA.DKA patients who developed DVT were considerably younger than the other DKA patients who did not, and they had significantly higher glucose, corrected sodium concentrations, and lower pH and serum bicarbonate. If femoral CVCs are “absolutely necessary” in children with DKA, they should be “removed or replaced as soon as possible after immediate resuscitation,” Dr. Fortenberry’s team suggests. “If continued use of a CVC is required, prophylaxis with low molecular weight heparin should be considered given the documented risk for DVT,” they add.By Megan Rauscher