VENOUS ACCESS IN PEDIATRIC ONCOLOGY PATIENTS

Long-term central venous access is an integral part of the management of many, but not all children with cancer. The proper selection of tho se children who require this access and which access device (external vs. totally implanted) is best suited to that child is important to mi nimize complications and obtain optimal results. Although most of thes e devices can be expected to last the duration of the treatment protoc ol or the patient's life, complications (infection, occlusion, dislodg ment) occur with higher than desired frequency, infection being the mo st common. No measures are clearly beneficial in preventing infection, but most infections can be treated successfully without device remova l. Premature removal or dislodgment occurs more frequently with extern al catheters and may be minimized by techniques used at insertion. Occ lusion, detected early, can be successfully managed by clot lysis in m ost children. (C) 1993 Wiley-Liss, Inc.