SUMMARY Twelve totally implantable subcutaneous central venous catheter systems were used in paediatric oncology patients. Complications were few-namely, blockage and four infective episodes, all of which were successfully treated. Infective rate was 0-189 episodes per 100 days' use, which is substantially lower than that reported with other central venous catheters.The problems of long term venous access in patients, particularly children, who are receiving prolonged or intensive chemotherapy are well known. Tunnelled central venous catheters were introduced in an attempt to circumvent these problems.1 2 Such catheters are liable to be colonised by skin microorganisms, such as coagulase negative staphylococci, and can result in serious infection, especially in immunocompromised patients.3For the last year a totally implantable subcutaneous central venous catheter and portal with a self sealing septum for hypodermic needle entry (Port-a-Cath) has been employed in managing children with malignant disease. We have analysed our experience, particularly in relation to the number of infective episodes, patient acceptability, and complications necessitating removal.
Materials and methodThe system. The Port-a-Cath system (Pharmacia) consists of a silastic catheter, which is inserted usually through the subclavian vein into the superior vena cava. The catheter is connected distally to a metal reservoir, which has a self sealing septum on the top (Figure). The whole system was implanted subcutaneously under general anaesthesia by one of two surgeons. Access to the system is a sterile procedure, using a Huber point needle, which is pushed through the subcutaneously placed self sealing septum. The system can be used from the day of insertion and was in several of our patients. Maintenance of the system consists of monthly heparinisation, which was carried out by ward staff certified to give intravenous treatment. Before use, the system was flushed with Hepsal (Hepsal, Weddel Pharmaceuticals Ltd), any blood samples that were required were obtained, and then reflushed before connecting to a continuous infusion. The system was used for sampling, to administer chemotherapy, continuously or by bolus, and for delivery of blood or blood products.Complications. Complications related to the maintenance and use of the systems were recorded both by unit staff and by parents. All febrile episodes, defined as a temperature reading B380C, were investigated by blood cultures both from the catheter and a peripheral site. Infections related to the catheter were defined as febrile episodes when micro-organisms were recovered from the catheter or when pus was obtained from the site of insertion of the Port-a-Cath.Results
