Children usually cannot wait for the catheter to be removed, as it symbolizes that treatment has truly ended. Physicians differ a great deal on when is the best time to remove the catheter. Some recommend removal when the child starts maintenance. Others remove it when the child is sedated for the last bone marrow aspiration, while some doctors advise waiting several weeks or months after treatment ends. Ask the doctor for her reasons for her recommendation, and discuss it fully if you or your child have strong feelings about the timing.
Removal of the external catheter (Hickman or Broviac) is usually an outpatient procedure, although it may also be done under general anesthesia by the surgeon or radiologist who inserted it. The child is given a mild sedative, then the oncologist pulls the catheter out of the childs body by hand.
Kristin's Broviac removal wasn't too bad. They gave her Fentanyl ahead of time, so she was fairly relaxed. I wished that they had offered me a sedative as well. One of the nurses had her hand on Kristin's shoulder and quietly talked to her to try to keep her focused elsewhere. I held her legs, and my wife held her hand. The doctor put one hand on her chest, and pulled on the tubing with the other. It only took about two seconds to come out. There was little blood; they just put a Band-Aid on the site and sent us home.
Implanted catheters such as the Port-a-cath are removed surgically in the operating room. Children are usually given general anesthesia, and the operation takes less than half an hour. Only one incision is made, usually just above the port at the same place as the scar from the implantation surgery. The sutures holding the port to the underlying muscle are cut, and the port with tubing is pulled out. The small incision is then stitched and bandaged. When the child begins to awaken, he is brought out to the parent(s). The family then waits until the surgeon has approved their departure. Often, the wait is short, for as soon as the child is awake enough to take a small drink or eat a popsicle, he is released. If your child becomes nauseated from the anesthesia, the wait can be several hours until he is feeling better.
Brent had a very easy time with his port-removal surgery. We scheduled him to be the first patient early in the morning, so there was no delay getting in. Then the anesthesiologist asked him what flavor gas he wanted, which he liked. They brought him out to us while he was still groggy, and he woke up feeling goofy and happy. We went home soon thereafter. It felt more like the ending then than on the last day of treatment.
I remember when Andrew had his port out. As he was coming out of his anesthesia fog I leaned over to him and said rather tearfully, "Andrew, you did it, you're all done." He took his small hand and placed it at the site where that port sat for two years, felt its absence and smiled. It was one of the best moments of my life.
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