Name of the Procedure:

Insertion of Tunneled Centrally Inserted Central Venous Access Device with Subcutaneous Port (Port-A-Cath) for Patients Younger Than 5 Years

Summary

In this procedure, a central venous access device, commonly known as a Port-A-Cath, is surgically inserted beneath the skin and connected to a vein. This device provides a reliable way to deliver medications, nutrients, or draw blood samples in young children.

Purpose

This procedure addresses the need for long-term intravenous access. It is used for children who require frequent or continuous administration of intravenous medications, chemotherapy, blood transfusions, or frequent blood sample collection. The goal is to provide a durable and convenient access point while minimizing discomfort and the risk of infection associated with repeated needle sticks.

Indications

• Chronic illnesses requiring long-term IV therapy (e.g., cancer, cystic fibrosis).
• Frequent blood transfusions.
• Difficult venous access due to small or fragile veins.
• Hemodialysis.
• Nutritional support through total parenteral nutrition (TPN).

Preparation

• The patient may need to fast for several hours before the procedure.
• Any ongoing medications should be discussed with the healthcare provider for potential adjustments.
• Pre-procedure assessments may include blood tests and imaging studies to plan the insertion site.

Procedure Description

1. The child is usually given general anesthesia to ensure they are asleep and pain-free.
2. A small incision is made on the chest for the port placement and another at the venous access point.
3. A tunnel is created under the skin from the chest incision to the vein access point.
4. The catheter is inserted into a central vein, and the port is positioned under the skin and secured.
5. Both incisions are closed with sutures, and the area is covered with a sterile dressing.

Tools and equipment used include surgical instruments, the catheter, subcutaneous port, and imaging guidance (such as X-ray or ultrasound) to ensure proper placement.

Duration

The procedure typically takes around 1 to 2 hours.

Setting

This procedure is usually performed in a hospital setting, typically in an operating room or a specialized surgical center.

Personnel

• Pediatric surgeon or interventional radiologist
• Anesthesiologist
• Surgical nurses
• Radiology technician (if imaging is used)

Risks and Complications

• Infection at the insertion site or along the catheter.
• Bleeding or hematoma formation.
• Catheter occlusion or dislodgement.
• Venous thrombosis (blood clot).
• Pneumothorax (collapsed lung) if nearby structures are injured.
• Allergic reaction to anesthesia.

Benefits

• Provides reliable and long-term venous access.
• Reduces the need for repeated needle sticks.
• Can improve the comfort and quality of life for the child.
• Decreases the risk of vein damage from frequent IV insertions.

Recovery

• Post-procedure care includes monitoring for signs of infection or complications.
• Pain management typically involves over-the-counter pain relievers or prescribed medication.
• The child may resume normal activities gradually, following specific instructions from healthcare providers.
• Follow-up appointments are necessary to check the port site and functionality of the device.

Alternatives

• Peripheral IV lines: less invasive but can be painful and need frequent replacement.
• Peripherally Inserted Central Catheter (PICC line): less durable for long-term use.
• Subcutaneous injections: less reliable for continuous therapy. Each alternative has its limitations and benefits, which should be discussed with the healthcare provider to determine the best option for the child's condition.

Patient Experience

During the procedure, the child will be under general anesthesia and will not feel pain. Post-surgery, some discomfort or soreness around the incision sites is common. Pain management strategies and comforting measures will be used to ensure the child’s comfort. An adjustment period is expected as the child and caregivers become accustomed to the port.