•Horizontal position after intrathecal drug delivery in order to prevent development of headache

19.2.9.4Treatment

•Medication: pain-relieving drugs according to doctor’s prescription

•Alternatives: there are a number of psychological and physical methods for pain relief: distraction, for example, listening to music, drawing, reading; for aching, for example, warm bath, packing, heated cushion, rubbing in cream, massage, minimal mobilization

19.3Central Catheter Care

•When long-term chemotherapy is needed, the placement of a central venous catheter (CVC) such as the Port-a-Cath is useful and sometimes essential for treatment

•CVCs comprise all venous catheters introduced into the vena cava for the purpose of administering infusions and/or drugs. A distinction is to be made between CVCs, introduced into the superior vena cava by puncture of a major vein such as the internal jugular or subclavian veins, completely implanted CVCs (so-called port systems), catheters leading to the superior vena cava via a tunnel under the skin (e.g., Broviac catheter), and CVCs introduced through a peripheral vein (peripherally introduced central catheter, PICC; Holach et al. 1999)

19.3.1Port-a-Cath (PAC, Entirely Implanted Catheter Systems)

Reasons to use a Port-a-Cath

•Hardly accessible peripheral veins

•Use of chemotherapeutic agents which irritate blood vessels

•Frequent blood sampling

•Repeated injections and infusions of chemotherapeutic agents, antiemetics, antibiotics, possibly hypercaloric nutrition, transfusions, etc.

•During infusion time the child has use of both hands

•When PAC is not in use, there are no restrictions on activities of the child

19.3.1.1Complications

•If difficulty in drawing blood, movement exercises, change of position, flushing with saline solution and/or heparin solution, as well as increased flow of i.v. solve the problem

•Blockage of PAC rarely occurs, but if it does occur, with urokinase or TPA, the system can be rendered patent again

•Risk of infection is high (infection of reservoir, at tip of catheter)

•The needle can dislocate out of the grommet, causing the drug or infusion to flow not into the vein, but into the tissue. Toddlers should preferably receive chemotherapy via a port system in a resting position

•Defects of PAC membrane