Name of the Procedure:

Insertion of Peripherally Inserted Central Venous Access Device with Subcutaneous Port; Younger than 5 Years of Age
Common names: PICC line insertion with port, Pediatric central line insertion with port

Summary

This procedure involves placing a long thin tube, called a catheter, into a vein in a young child's arm, leg, or neck. The other end of the catheter connects to a small device called a port, which sits under the skin. The port allows easy access to the bloodstream for medications, fluids, or nutrition.

Purpose

The procedure is used to provide a reliable means of delivering intravenous medications, fluids, and nutrition directly into the bloodstream. It is often used in children who need long-term treatment, such as chemotherapy, intravenous antibiotics, or nutritional support.

Indications

• Children requiring long-term intravenous medication or therapy
• Conditions needing frequent blood draws
• Chronic illnesses such as cancer or severe infections

Preparation

• Fasting for several hours before the procedure (usually guided by the healthcare provider)
• Pre-procedure blood tests to ensure proper blood clotting
• Discussing current medications with the healthcare provider for potential adjustments

Procedure Description

1. The child receives sedation or general anesthesia to ensure comfort.
2. A small incision is made to access a vein in the arm, leg, or neck.
3. The catheter is inserted into the vein and guided towards a large central vein near the heart.
4. A subcutaneous pocket is created under the skin, typically on the chest, to place the port.
5. The other end of the catheter is connected to the port.
6. The incision is closed and the port is checked for proper function.

Duration

The procedure typically takes between 30 minutes to 1 hour.

Setting

The procedure is performed in a hospital setting, usually in an operating room or specialized procedural suite.

Personnel

• Pediatric surgeon or interventional radiologist
• Anesthesiologist
• Registered nurses
• Surgical technologist

Risks and Complications

• Infection at the catheter or port site
• Bleeding
• Blood clots
• Port or catheter malfunction
• Injury to surrounding structures

Benefits

• Reliable and easy access to the bloodstream for long-term treatment
• Reduced need for multiple needle sticks
• Less discomfort over time compared to repeated peripheral IV insertions

Recovery

• The child may need to stay in the hospital for a few hours or overnight for monitoring.
• Instructions on keeping the incision site clean and dry.
• Avoiding heavy lifting or vigorous activity for a few days.
• Follow-up appointments for port care and assessment.

Alternatives

• Multiple peripheral intravenous (IV) lines
• Central venous catheter without a port
• Subcutaneous injections or oral medications (if applicable) Pros and cons depend on the necessity for long-term access and the convenience versus the invasiveness of each option.

Patient Experience

During the procedure, the child will be under anesthesia and should not feel pain. Afterward, there might be some soreness at the incision site, managed with prescribed pain medications. The child may be drowsy for a few hours post-procedure due to anesthesia. Comfort measures like a soft bandage and careful handling will help ease recovery.