Portacath in Children

1. Prakash Agarwal
Professor & HOD, Paediatric Surgery,
Sri Ramachandra University

2. • VADs have a paramount role
throughout the management of the
oncology patient
- in the initial phases for surgery or
chemotherapy,
- in the advanced stages for chronic
treatment,
- and in the last stages for palliative
measures.

3. • A central venous access device (CVAD) is made of a
non-irritant material, e.g; silicone, which means it
can be left in place for several weeks or months.
• It has a tip which lies at the junction of SVC & RA.
The other end has a hub or port for injection.
• It can be used to give fluids and drugs. It may also
be used to take blood samples.
• The CVAD will save the patient from having
repeated needle pricks from blood taking or
insertion of cannulas during treatment.

4. • Tunnelled central venous
catheter(Hickmann/ Broviac)
• Subcutaneous port (Port-a-
cath)
• Peripherally inserted central
catheter(PICC) or peripheral
access port (PAP)

5. Things to
consider
Tunnelled
central venous
catheter
Subcutaneous
port
Peripherally
inserted
central
catheter (PICC)
Infection rate higher lower higher
Maintenance daily monthly daily
Body image tube outside
body
lump under skin tube outside
body
Pain dressing
changes
•dressing
changes
•needle poke to
access port
dressing
changes
Risk of drugs
leaking into
tissues
lowest low low

6. • Receive chemotherapy drugs
• Receive intravenous (IV) fluids
• Receive antibiotics
• Receive blood and platelet
transfusions
• Receive nutrition (total parenteral
nutrition or TPN)
• Provide blood samples

7. • Ports have lower reported rates of
catheter-related bloodstream
infections.
• Best suited for long term
intermittent chemotherapy
• Ports allow better bathing and
swimming.

8. • An implanted port (sometimes called a
‘Portacath’) is inserted under the skin.
• The usual position is on the chest. It is
connected via a thin tube (catheter)
inserted into one of the IJV going to the
SVC . The port can be felt through the
skin.
• Entry to the port is gained by puncturing
the silicone membrane with a special
type of needle, which is attached to a
length of tubing
• This will allow to receive fluids and drugs
or have blood samples taken from it.
• Puncturing the port is similar to pricking
the skin with a pin. It takes some time
getting used to.

11. Advantages
• It only needs to have
the needle put in
when we need to use
it.
• The needle is
removed in between
treatments and there
is no need of any
dressings or flushing
the catheter.
• It doesn’t restrict
normal activities
including swimming.
Disadvantages
• A needle need to be
inserted each time the
port is used. The port can
sometimes be difficult to
access
• Insertion & removal of the
port needs GA & OT.
• Leaves a scar
• Cannot be accessed by
untrained staff.

12. Early Complications
(6.2% to 11.7%)
• Pneumothorax,
• Hemothorax,
• Primary
malposition,
• Arrhythmias,
• Air embolism,
• Arterial
perforation
LATE COMPLICATIONS
• Mechanical
complications (pinch
off, fractures,
dislodgement, or
migration);
• Extravasation injuries;
• Infections (including
phlebitis of the
cannulated vessel);
• Catheter and vein
thrombosis/
occlusion (including
deep vein
thrombosis,pulmonary
embolism, or SVC
syndrome)

13. • 2005-2017 = 11 years
• 118 ports
• 1-12months = 26
• 1year – 5 years = 63
• 5 year – 16 years = 24
• Adults = 5

14. 45.83%
54.16%
40.00%
42.00%
44.00%
46.00%
48.00%
50.00%
52.00%
54.00%
56.00%
FEMALE CHILD
MALE CHILD

15. 59%
4%
8%
13%
8%
4% 4%
ALL
Hepatoblastoma
AML
PNET
Germ cell tumor
Sarcoma
Osteomyelitis

16. 10
22
11
24 22
14

18. • 5 year old boy with stage 4
Neuroblastoma
• Underwent biopsy with Autologous
bone marrow transplant.
• Port-a-cath was placed in right
internal jugular vein
• During last cycle of chemotherapy
mother noticed a bulge in chest wall
while injecting drug
• Admitted for port-a-cath removal

19. On exploration
• Port with only 5cms of catheter was found
• Distal end not palpable in jugular vein
• On table fluoroscopy was done
• Interventional cardiologist and radiologist
opinion sought

22. Uneventful
Started on feeds
on the day
Discharged next
day

24. • Chemoports are very convenient for
patients undergoing long-term
chemotherapy.
• They can be accessed multiple times
with minimal pain.
• They have very low risk of
extravastation and blood stream
infection if handled properly.
• Though complications have been
described but negligible in
experienced hands.