Cancer treatment often involves receiving chemotherapy, medications, blood products, and fluids. These products are usually given through a needle inserted into a vein. Today, many cancer patients, especially childhood cancer patients have a central line or “port” inserted in order to make these processes easier.
Various devices are available to make this process easier; which device chosen is dependent upon the type and duration of therapy and personal preference.
The video below demonstrates two types of port access in patients receiving chemotherapy and was designed to educate parents and caregivers by showing actual patients being accessed for treatment.
This activity is supported by a contribution from Lilly USA, LLC
Common Types of Central Lines
A Hickman line or Brovac Central Line (also called a tunnelled central venous catheter) is a long, thin, flexible, partially implanted silicone tube which extends outside the body and is the most commonly used semi-permanent, external catheter used.
The tube tunnels under the skin of the chest, enters a large vein near the collarbone and threads inside the vein into or near the right atrium of the heart. It comes out of the body, near the nipple line on the chest at what is called the exit site.
A small cuff on the catheter is positioned under the skin at the exit site and stitched in place to prevent the catheter becoming dislodged. Surrounding tissue attaches to the cuff over time, further ensuring that the catheter remains secure. The cuff also acts as a barrier against the entry of organisms which could cause infection.
A dressing is required to cover where the catheter comes through the skin at all times and needs to be changed at regular intervals.
This type of catheter requires maintenance; the dressing needs to be changed regularly and at the same time the catheter lumen must be flushed with sterile saline and heparin solution. The frequency administration will be determined by your child’s care team, and family members are generally taught how to maintain the line at home between hospital visits.
Subcutaneous (under the skin) ports, also known as mediport, port-a-cath, port, or infusaport are preferred for childhood cancer patients.
These devices are surgically implanted into the tissue that is directly under the skin (subcutaneous tissue) on the chest are under general anaesthetic.
A subcutaneous port has a small round metal chamber (portal) with a rubber top (septum) and a flexible tube (catheter). It is visible as a small raised area on the chest beneath the skin.
A special needle is inserted through the septum to deliver fluids. The fluid moves from the port through the catheter and into your bloodstream. When it is “accessed,” a dressing is required, similar to an external catheter.
Once the port-o-cath is in, it is out of sight and requires virtually no maintenance, which is great because it means that your child can bathe or swim when it is not being accessed.
Precautions for Children with External Ports
Since the tubing of external ports hangs outside of the body, your doctor might recommend that your child does not swim while it is in place. Special care must be taken while bathing. Special tape, or a stretchy net vest is the best way to hold the lines close to the body when not in use.
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 catheters can be pulled out during rough play; they may also contribute to a low-body image by the child.
Risks of Catheter Use
The most common complications include infection and occlusion (blockage in the line).
Infection: Ports can become infected, and thus your child’s temperature must be carefully monitored. Signs of infection include fever, redness, tenderness, pain, or a discharge from the site. If you notice any of these signs, contact your oncology team or doctor immediately; an evaluation will be done and appropriate treatment of the infection provided.
Occlusion: Occlusion refers to blockage of the catheter by a blood clot (also called a thrombus). The occlusion can be partial or complete. This must be reported to the healthcare team immediately so that they can evaluate and treat the problem.
Ports can sometimes also cause irritation at the implant site or the implant site may not heal well due to low counts associated with cancer treatment.