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 those children who require this access and which access device (external vs. totally implanted) is best suited to that child is important to minimize complications and obtain optimal results. Although most of these devices can be expected to last the duration of the treatment protocol or the patient's life, complications (infection, occlusion, dislodgment) occur with higher than desired frequency, infection being the most common. No measures are clearly beneficial in preventing infection, but most infections can be treated successfully without device removal. Premature removal or dislodgement occurs more frequently with external catheters and may be minimized by techniques used at insertion. Occlusion, detected early, can be successfully managed by clot lysis in most children.