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Introduction: Long term disease treatment in children is a very special medical problem due to a necessity of maintaining an efficient venous access for many months and even years. Vascular ports applied in those children improved the conditions of treatment and a quality of life, additionally, made the job of personnel taking care of them easier., Material and Methods: The study presents own experience in long-term venous access into the central veins system, so called vascular ports, gathered for 15 years of using them in children with hemato-oncogical diseases. The analysis of 309 of implanted vascular ports was done taking into consideration the maintenance and complications. Ports were implanted in 300 children with oncological diseases. The received results are presented in numbers and percentage., Results: Mean time of port insertion has decreased in comparison to earlier studies by 35 days and now is 722 days, median 658 days, however, minimal and maximal time of port insertion has changed respectively 7 and 2099 days. The total time of port insertion in this period was 232 536 days. The observation showed 31 (10.03%) cases of complications, out of which the most common were set infection (16 - 5.18%), catheter occlusion by a clot (7 - 2.27%) and "spontaneous" catheter move out of vessel lumen (3 - 0.97%), migration of a torn-off catheter into the right heart ventricle (2 - 0.65%)., Conclusions: 1. Application of vascular ports enabled a long-term and intensive chemotherapy in children with oncological and hematological diseases. 2. Application of vascular ports bears a minor risk of complications, the most dangerous observed complication was a replacement of a torn-off catheter into the right heart ventricle.

During past 10 years 234 central venous access ports (CVAP) were implanted in 225 patients at the Department of Pediatric Hematology and Oncology in Zabrze. Mean exposure time was 745 days and total implantation time reached 173,768 days. Complications were encountered in 17 patients (7.6%). This mainly concerned central venous line infection, which led to removal of 10 CVAP (4.4%). The remaining complications necessitating removal of the CVAP consisted mainly of mechanical problems (catheter fracture, occlusion, and erroneous implantation to artery). In the opinion of the authors, subcutaneously implanted CVAP are a safe and effective option for high-dose chemotherapy deliverance in childhood cancer patients.

Occasionally unexpected technical difficulties occur during Port-A-Cath implantation and the central venous catheterization. We described a case of superior vena cava developmental anomaly diagnosed during Port-A-Cath implantation.

Unlabelled: The application of central venous lines in children has been widely accepted in the case of pediatric cancer treatment. This is of particular importance when the treatment must be continued during the long period of time. The indication to long-term application of central venous lines became significantly frequent within last years. They are necessary in the treatment of chronic pediatric patients, in whom the central venous line allows continuous access for medication, parenteral rehydration, nutrition and frequent blood sampling., Material and Methods: In the current study authors present their experience in subcutaneous port devices application in children with kidney disease. The case history data obtained from 8 children were retrospectively analysed. In these children subcutaneous port devices were applied for mean 26.7 months (totally 9 port devices). The mean age at the time of implantation was 2.2 years, and the mean body weight--10.6 kg., Results: Peripheral venous access in all children was bad. In one child during the time of implantation the hematoma of coli and chest was present. Infectious complications connected with implanted port device were not detected. Thrombotic complications were present in 6 children with chronic renal failure--in 5 the lumen of port device has been successfully recanalysed, in 3 cases even several times. In 1 child the thrombus on the tip of central venous line was detected. In 2 children the removal of port device was necessary because of breakage of venous line and in the second case because of port device thrombosis. Two children died with functioning port device. The cause of death was not connected with implanted port device., Conclusions: The application of subcutaneous port devices definitely improved the comfort of treatment but was significantly associated with thrombotic complications. Infectious complications were not detected as compared to hematological group of patients.

The aim of the work was to evaluate the safety of Vascuport catheter long-term application in children treated for acute lymphoblastic leukemia (ALL). 21 children treated in the Department of Pediatric and Hematology in Zabrze were enrolled in the study. Echocardiography and ultrasonography were performed to examine Vascuport catheter in the central vein. Coagulation parameters were estimated too. None of the children presented symptoms of pulmonary embolism or venous thrombosis. Thrombotic material was found on the course of Vascuport catheter in 5 (23%) children. Changes in the hemostatic system: increased d-dimmer levels in 2 (9%), increased fibrinogen level in 7 (33%), decreased value of APC-R in 7 (33%) and protein C in 8 (38%) children were observed. Changes of hemostatic system and presence of thrombotic material on the course of Vascuport catheter in 23% of the patients with ALL imply the necessity of rigorous monitoring of haemostatic system as well as Vascuport catheter in the central vein. In case the risk factors of thrombotic events or their clinical symptoms are present anticoagulant therapy should be introduced.

In the study we analyzed the methods and results of implantation of 100 ports. Children age ranged between 0.5 and 16 years. All children received chemotherapy during neoplasm treatment. In conclusion, ultrasound detector, radiological control and subclavian venous access are safe and less traumatic than external jugular vein.