Technology Update

DUE to new aggressive treatment protocols, survival from cancer in children has increased considerably during the last two decades. However, such intensive chemotherapy regimes require safe and prolonged access to the venous system [1]. Peripheral veins may be inadequate from the beginning or may gradually be occluded during the course of treatment. The risk of necrosis of skin due to extravasation of antineoplastic drugs is always there and may be disastrous. Some patients may require repeated blood sampling or transfusion, hyperhydration and parenteral nutrition. Repeated venipuncture causes increasing physical and psychological trauma especially in children. The externalized subcutaneously tunnelled catheter developed in 1973 is a good option for a safe and prolonged access to the venous system, but the high risk of catheter sepsis and interference in the day to day life like clothing, bathing, playing and swimming make them far from ideal for outpatient care [2]. In 1984, the first totally implantable central venous access system (Port-a Cath, Pharmacia) became commercially available and since then a wide variety of similar system have developed. The advantages of these devices as compared to the externalized tunnel catheters are (i) minimal risk of infection (ii) minimal maintenance and (iii) excellent patient comfort. This has resulted in a high level of patient acceptability and makes them the best type of device for outpatient oncology treatment [3]