Choosing not to use a catheter

Many physicians automatically schedule surgery for catheter implantation as soon as a child is diagnosed with leukemia. Others do not recommend using implanted catheters in their pediatric patients with leukemia, while some physicians only use catheters in high-risk patients. Ask the physician the reason for his recommendation, and discuss it thoroughly if you are uncomfortable with the options presented.

Stephan (6 years old) has no catheter. Sometimes I wish he had one. It seems like it would be easier We were told he didn't need it. He is running out of usable veins and it is getting harder and harder

Some children and teens prefer IVs to an implanted catheter.

My son had a port for a very short time, and due to frequent fevers (with no evidence of infection) and because he had a blood clot form in his heart, they pulled the port. He had IVs for the remainder of treatment and was much happier with the IVs than with what he called "that foreign object in my chest."

Some physicians recommend trying treatment without a catheter before making a decision.

Our physician gave us the option of using a catheter for our 6-year-old daughter with low-risk ALL, but he recommended against it. He said if she could stand the pokes it was better not to use it due to the chance of infections. She had several sessions with the staff psychologist to teach her visualization and imagery which she used successfully to deal with the two years of IVs.

To help you make the best decision for your particular situation, Table 8-2 outlines the pros and cons for each catheter. There is no right or wrong choice; different options are available because each child, each parent, each family is unique.

Table 8-1. Comparison of Catheters

Things to Consider

External Catheter

Subcutaneous Port

Peripherally Inserted Central Catheter

Infection rate

Higher

Lower

Higher

Maintenance

Daily

Monthly

Daily

Body image

Changes: tube outside body

Minor: lump under skin

Changes: tube outside body

Pain

Dressing changes

Needle poke to access (use EMLA); dressing changes

Needle poke to insert the line; dressing changes

Anxiety

Low to high

Low to high

Low to high

Cost

More due to daily maintenance

Less; monthly maintenance

More due to daily maintenance

Risk of drugs leaking into tissues

Lowest

Low

Low

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