Resources and information for parents of children with cancer . . . by parents of children with cancer.

Ports

A surgically implanted device called a "right atrial catheter", "central line", or "port" was developed in the 1970s and modified by Robert O. Hickman, a pediatric nephrologist at Seattle Children's Hospital. (See the Wikipedia entry.) This device lessens the number of needle pokes that our cancer kids have to endure. It is a small tube that goes through the skin of the chest, into a large vein that leads to the heart, and ends in the right atrial chamber of the heart.

Besides lessening patient discomfort from needle pokes, this method of delivering chemotherapy prevents possible side effects that could be caused by the chemo drugs coming into contact with the skin. Also, constant access to veins in the arms can cause leakage to tissues surrounding the injection site. The right atrial catheter remains in place throughout the treatment phase, unless it becomes infected. It can also be used to withdraw blood for tests, eliminating yet another needle poke.

Central lines come in two basic varieties: external and subcutaneous. At the time of implant, your oncodoc will discuss the type of treatment, age of the child, and personality and activities of the child to help you decide together which type of port will be best for the patient. (Some patients also have PICC lines and Omya reservoirs, see below.)

Ports can become infected, and thus your child's temperature must be carefully monitored. Your doctor will give you a specific temperature at which you must call the clinic. If your child sees a dentist while he/she has a port, your oncologist will probably prescribe an antibiotic to prevent infections (bacteria released during a dental exam can become lodged on the tubing of the port).

External right atrial catheters

In external catheters, the end of the tube comes out through the skin and hangs several inches outside the body. They can have either one or two tubes, although the tubes may be joined to look like they have only one tube. The reason for two tubes is for delivering two drugs at the same time. This is especially important if the two drugs are incompatible. Double tube catheters are called "double lumens".

Precautions for children with external ports

Since the tubing parts of external ports hang outside the chest, your doctor might (or might not) recommend that your child not go swimming while it is in place. Special care must also be taken while bathing. Special tape, or better yet a stretchy net vest, is available to hold the lines close to the body when not in use. Catheters must be flushed daily and the implant site dressing changed twice a week, either by the parent or by the child if the child is old enough and willing.

External ports must be watched very closely for line infections. Also, ports can cause irritation at the implant site or the implant site may not heal well due to low counts associated with cancer treatment. Catheters can be pulled out during rough play; they also may contribute to a low-body image by the child.

Sammie's Tops sells inexpensive short shirts that hold up central lines.

Picczees sells coverups for PICC lines.

Subcutaneous right atrial catheters

Subcutaneous catheters are called either medi-ports or port-a-caths. Like the external catheters, they can have one or two tubes. In this type of catheter, instead of coming outside the skin, the tube ends in a metal chamber that is implanted under the skin. The part of the chamber just under the skin is rubber. To access the port, the nurse pokes through the skin covering the port and then through the rubber of the port using a special needle called a "Huber". This may sound like a needle poke to be avoided, but the skin covering the port soon becomes quite tough and insensitive; also, Emla works great to further de-sensitize the skin.

Medi-ports only have to be flushed once a month, become infected less often than catheters that are external, and there is no dressing at the implant site to be changed. Since they areNEWS 08/31/1993 FDA Announces New Rule to protect Patients with Critical Medical Implants 


P93-36                               Food and Drug Administration
FOR IMMEDIATE RELEASE                Sharon Snider (301) 443-3285

     The Food and Drug Administration today announced a new rule to
protect patients with critical medical implants and life-supporting
devices if malfunctions arise. 
     The action requires manufacturers of 17 implants and five
devices to keep track of patients who receive them so they can be
contacted if problems develop that would threaten patient health or
life.
     The rule affects critical implants such as heart valves and
pacemakers, and life-supporting devices used at home such as
breathing monitors, ventilators and defibrillators.
     The new requirement was mandated by the Safe Medical Devices
Act of 1990, which requires tracking of medical devices whose
failure could have serious consequences.
      "We need a system that will allow us to communicate quickly
and effectively critical information about the safety and efficacy
of implants and devices,"  said FDA Commissioner David A. Kessler,
M.D.  "Tracking will help save lives by making it possible to get
in touch quickly with people who have faulty devices." 
                             -MORE-


                                        Page 2, P93-36, Tracking
     Manufacturers will be required to have systems to track their
products from the manufacturer through the distribution chain to
the patient so that, if necessary, they can provide FDA with the
names of patients and locations of devices within 10 working days. 
The tracking system will have to be maintained for the useful life
of the device, with the data and function of the system audited
periodically.
     No specific method of tracking is required. Manufacturers can
use different methods to ensure collection of information from
patients or health care facilities, as long as the methods are
adequate.  More than one means of data collection may be necessary
to ensure effective tracking.
     Medical devices to be tracked are:
          vascular graft implants
          ventricular bypass devices
          implantable pacemaker pulse generators
          cardiovascular permanent pacemaker electrodes
          annuloplasty rings
          replacement heart valves
          automatic implantable cardioverter\defibrillators
          tracheal implants
          implanted cerebellar stimulators
          implanted diaphragmatic\phrenic nerve stimulators
          implantable infusion pumps
          breathing frequency monitors
                             -MORE-

                                        Page 3, P93-36, Tracking
          continuous ventilators
          DC-defibrillators and paddles
          silicone inflatable breast implants
          silicone gel-filled breast implants
          silicone gel-filled testicular implants
          silicone gel-filled chin implants
          silicone gel-filled angel chik reflux valves
          electromechanical infusion pumps
          jaw implants
          inflatable penile implants
     Other devices will be subject to tracking in the future, as
necessary to protect the public health.
     The new requirement was published as a final regulation Aug.
16 in the Federal Register; it took effect Aug. 29.
     FDA is one of eight Public Health Service