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Note: This section has health/medical information. It was not written by a health care professional. The medical references are: the web sites listed in the text below at the individual topics, the author's personal experience as well as that of members of the online ALL discussion list, a booklet that Children's Hosptial sent home with the author's family, and the book/website:
- Childhood Leukemia: A Guide for Families, Friends, and Caregivers, 4th ed., by Nancy Keene, 2010.
- Wikipedia (accessed 2011)
A surgically implanted device called a "right atrial catheter", "central line", or "port" was developed in the 1970s and modified by Robert O. Hickman, a pediatric nephrologist at Seattle Children's Hospital. (See the Wikipedia entry.) This device lessens the number of needle pokes that our cancer kids have to endure. It is a small tube that goes through the skin of the chest, into a large vein that leads to the heart, and ends in the right atrial chamber of the heart.
Besides lessening patient discomfort from needle pokes, this method of delivering chemotherapy prevents possible side effects that could be caused by the chemo drugs coming into contact with the skin. Also, constant access to veins in the arms can cause leakage to tissues surrounding the injection site. The right atrial catheter remains in place throughout the treatment phase, unless it becomes infected. It can also be used to withdraw blood for tests, eliminating yet another needle poke.
Central lines come in two basic varieties: external and subcutaneous. At the time of implant, your oncodoc will discuss the type of treatment, age of the child, and personality and activities of the child to help you decide together which type of port will be best for the patient. (Some patients also have PICC lines and Omya reservoirs, see below.)
Ports can become infected, and thus your child's temperature must be carefully monitored. Your doctor will give you a specific temperature at which you must call the clinic. If your child sees a dentist while he/she has a port, your oncologist will probably prescribe an antibiotic to prevent infections (bacteria released during a dental exam can become lodged on the tubing of the port).
External right atrial catheters
In external catheters, the end of the tube comes out through the skin and hangs several inches outside the body. They can have either one or two tubes, although the tubes may be joined to look like they have only one tube. The reason for two tubes is for delivering two drugs at the same time. This is especially important if the two drugs are incompatible. Double tube catheters are called "double lumens".
Precautions for children with external ports
Since the tubing parts of external ports hang outside the chest, your doctor might (or might not) recommend that your child not go swimming while it is in place. Special care must also be taken while bathing. Special tape, or better yet a stretchy net vest, is available to hold the lines close to the body when not in use. Catheters must be flushed daily and the implant site dressing changed twice a week, either by the parent or by the child if the child is old enough and willing.
External ports must be watched very closely for line infections. Also, ports can cause irritation at the implant site or the implant site may not heal well due to low counts associated with cancer treatment. Catheters can be pulled out during rough play; they also may contribute to a low-body image by the child.
Subcutaneous right atrial catheters
Subcutaneous catheters are called either medi-ports or port-a-caths. Like the external catheters, they can have one or two tubes. In this type of catheter, instead of coming outside the skin, the tube ends in a metal chamber that is implanted under the skin. The part of the chamber just under the skin is rubber. To access the port, the nurse pokes through the skin covering the port and then through the rubber of the port using a special needle called a "Huber". This may sound like a needle poke to be avoided, but the skin covering the port soon becomes quite tough and insensitive; also, Emla works great to further de-sensitize the skin.
Medi-ports only have to be flushed once a month, become infected less often than catheters that are external, and there is no dressing at the implant site to be changed. Since they are only visible as a small lump under the skin on the upper chest, they do not contribute to a negative body image. Normal activities can be continued by the patient, even including playing football in high school, as well as swimming.
Note: If your child has a port and wants to play sports, you can obtain a sports-protector pad. See the section in the Survivors' page on sports protection.
A PICC line (peripherally inserted central catheter) is sometimes used instead of a port. This type of catheter is inserted into a vein in the arm and threaded until the tip is near the heart. More info:
An Ommya reservoir is a device placed under the scalp through which chemotherapy can be administered to the central nervous system. Information at Wikipedia.
Click on the above link to go to parents' comments on issues of ports:
- A port or not?
- Which type to choose?
- Why it's good to learn how to access them yourself.
- Port care: if the Tegaderm causes a rash.
- Problems getting a port to draw.
These pages are intended for informational purposes only and are not intended to render medical advice. The information provided on Ped Onc Resource Center should not be used for diagnosing or treating a health problem or a disease. It is not a substitute for professional care. If you suspect your child has a health problem, you should consult your health care provider.