Central Venous Access in Children
For a child facing months of chemotherapy, intravenous antibiotics or feeding, the cannula is often the part they come to dread most. A central line removes that: one device, placed once under anaesthetic, through which treatment is given and blood is taken without another needle. Placing it under ultrasound and X-ray guidance means the vein is seen rather than searched for, the tip is positioned correctly the first time, and the veins a child may need for decades are preserved rather than used up.
Dr. Mohamed El Ghobashy · Consultant Interventional Radiologist
What it treats
- •Chemotherapy for childhood cancer, given through a totally implanted port or a tunnelled line
- •Long courses of intravenous antibiotics or antifungals, including at home
- •Intravenous feeding, from the neonatal unit through to children with intestinal failure
- •Repeated blood sampling and transfusion in children with difficult veins or a bleeding disorder
- •Tunnelled catheters for haemodialysis, plasma exchange and stem cell collection
- •Replacing a line that has failed, become infected, or been outgrown
Who is a candidate?
- Children starting a treatment course expected to run for weeks or months
- Children whose peripheral veins are exhausted, or in whom cannulation has become distressing and repeatedly unsuccessful
- Children receiving drugs that damage small veins if given peripherally
- Neonates and infants needing reliable access, where the vessels are millimetres across and ultrasound is not optional
- Referral usually comes from paediatric oncology, haematology, nutrition, nephrology or the neonatal team
How the procedure works
- 1
Choosing the device
Port, tunnelled line or PICC is decided by what the treatment needs and how long it will last, alongside the child's size, previous lines, and what daily life should look like. Clotting and any infection are checked and settled first.
- 2
Anaesthesia
Children have a general anaesthetic. The device and the side are confirmed with you before the child goes to sleep.
- 3
Puncture under ultrasound
The vein is punctured under direct ultrasound vision. In a small child this is the difference between one clean pass and repeated attempts on a vessel a few millimetres wide.
- 4
Placement and tunnelling
A port is placed in a small pocket under the skin of the chest and the catheter tunnelled to the vein; a tunnelled line exits the skin below the entry point; a PICC is advanced from an arm vein. X-ray confirms the tip position, which matters more in children because they grow.
- 5
Check and first use
The line is flushed and its position documented, and a port can usually be used the same day or the next. The ward team is given the flushing and dressing plan.
Recovery
The site is tender for a few days and the small wound is kept dry until it heals. Once healed, a port sits entirely under the skin — children can shower, swim and play normally — and it is flushed periodically when not in use. A tunnelled line or PICC has an external portion that needs a dressing and a routine that the ward team teaches you before discharge. Because children grow, the tip position is rechecked from time to time. Report fever, redness or discharge at the site promptly; a line infection is treatable, and treated early it usually does not mean losing the line.
Discuss this procedure
Private consultations and procedures are at Andalusia Hospitals, Maadi. Kasr Al-Ainy is Dr. El Ghobashy's academic post at Cairo University and does not take private cases.
Frequently asked questions
Port or tunnelled line — which is better for my child?
A port is entirely under the skin, has nothing to catch or dress, and suits long treatment where the child is well between cycles — school and swimming carry on. A tunnelled line or PICC is quicker to place and remove, gives larger-volume access, and suits shorter courses or treatment needing frequent access. The decision is made against the actual treatment plan.
How long can it stay in?
A port can stay for years while treatment continues, as long as it is flushed on schedule and stays free of infection. PICCs and tunnelled lines are shorter-term. All are removed once they are no longer needed — the port through a small procedure, usually as a day case.
Will it hurt every time it is used?
A port is accessed through the skin with a needle, and numbing cream applied beforehand makes that comfortable for most children. A tunnelled line and a PICC are connected externally with no needle at all. Either way it replaces repeated cannula attempts, which is what most children find hardest.
What about school and sport?
With a healed port, normal school, showering and swimming are fine, and most sport is too — contact sports are discussed individually. With an external line the dressing must stay dry and swimming is out, which is one of the reasons a port is often preferred for long treatment.
Other procedures
This page is general information, not medical advice for an individual. Whether a procedure suits you depends on your imaging, your history and an in-person assessment.