Femoral central venous catheter-associated deep venous thrombosis in children with diabetic ketoacidosis

Objective: To describe the incidence of clinical deep venous thrombosis associated with femoral central venous catheters (CVC-DVT) in children with diabetic ketoacidosis (DKA). Design: Retrospective case-matched control series. Setting: Pediatric intensive care units of two university-affiliated hospitals. Patients: All eight pediatric DKA patients with femoral central venous catheters between 1998 and 2001, and 16 age-matched control patients with femoral central venous catheters and circulatory shock. Interventions: None. Measurements and Main Results: The records of all children with DKA and the control patients were reviewed. CVC-DVT was defined as persistent ipsilateral leg swelling after removal of a femoral central venous catheter. Control patients with coagulopathies, thrombocytopenia, cancer, and hyperglycemia were excluded. Four of eight patients with DKA developed CVC-DVT compared with none of the 16 control patients (p = .007, Fisher's exact test). All four patients with DKA and CVC-DVT were <3 yrs old. Doppler ultrasound examination was performed on three of the four patients with clinical CVC-DVT, confirming the diagnosis in each case. Conclusions: This study suggests that young children with DKA have an increased incidence of clinical DVT associated with the placement of femoral central venous catheters.