Venous access in cancer child

Children with cancer require long-term treatment. To administer intravenous drugs of chemotherapy, antibiotics or blood products, pricking every time is not a good option.
For this purpose, there are central lines, which are long tubes, placed through a peripheral vein or central vein into heart. These lines generally stay for longer duration & patient can move around with these catheters.

Types: 1. PICC (peripherally inserted central catheter)
2. Central venous tunneled catheter
3. Implantable ports

PICC- These catheters are inserted through a vein in elbow & advanced into heart. Advantages are they require local anaesthesia, easy to insert, not much expertise required, can be done bedside. Disadvantages are in very small child (less than year) peripheral veins are not big so difficult to put, require proper care time to time to avoid breakage & infection by a trained person.

Central venous tunneled catheter- Centrally inserted tunneled catheters are one of the mostly opted options. It is inserted under anaesthesia through a big vein in the neck or collarbone & the catheter is taken out through a tunneled subcutaneous tract. Advantages are it can be inserted in any age group, can be kept for longer duration until the treatment is over. Disadvantages are require anaesthesia, require aseptic care to avoid tract/ catheter related infection & require expertise to insert.

Implantable ports- Implantable ports are one of the best-suited options for child. There is small port along with a tube. The tube is inserted as any other central catheter & the attached port is placed in the subcutaneous space. Advantages are there is less risk of infection, no disturbances in day-to-day activities & require little care. The disadvantages are require anaesthesia, expertise & repeated needle pricks to access port.