Hospitals differ in their approach to removing a central venous catheter once chemotherapy ends.
There is no universal agreement on the best time to remove the line. The plan for your child will depend largely on the thoughts of the individual doctor or hospital.
When a child received chemotherapy after enucleation due to high risk pathology, some doctors remove the catheter immediately after the last treatment. Most wait several months, and some more than a year.
When a child received eye salvage treatment, most doctors wait for several clear EUAs before considering line removal. Some don’t remove the line until the child has had no cancer activity for at least a year. Most doctors also leave the line in place for at least a year after treatment for trilateral or extraocular retinoblastoma.
Discuss the plan with your child’s oncologist. If either you or your child have very strong opinions on whether the line should be removed or stay in place, discuss them fully with the oncologist. Doctors are usually understanding, and there is often room for negotiation.
Surgery
Implanted catheters are removed during a short surgery under general anaesthetic. A small incision is made just above the port. The stitches attaching the port to the muscle are removed, and the port is lifted out, together with all tubing. The surgery site is then cleaned, stitched and sealed with a sterile dressing.
External catheters are usually removed in an outpatient clinic. Your child will be given a short acting sedative before the oncologist or another doctor pulls out the catheter by hand. Very young children, may have the line removed under general anaesthetic, usually during a scheduled EUA.
Closure
Many children look forward to the day of catheter removal as the true end of major treatment. Children with an external line especially celebrate this day. Some children can feel lost without their “wiggly” or “tubies” with which they have lived for so long. They may take a little time to adjust to this change.
Ask the surgeon if you can keep the port or external line once it has been removed. Many children find great satisfaction and power from “hurting it back”.
A child life specialist can be especially valuable at this time. Engaging your child in healthy medical play willt help her turn the page on this chapter in her life.
