Ports in Infants: Is There Any Choice?

We have recently had a couple members who have had to or are about to, start transfusing infants. At least one of these people have been told that it will be necessary to implant a port for transfusions because it is so hard to find the small veins in a baby.

I would like to ask the parents here who have had to go through the transfusing of their children at a young age what they did. Was a port necessary or did they manage to find the veins of the child? If you did have a port implanted, were there problems encountered afterwards. Did the port get infected? Did it have to be replaced at any point? Should it be treated as a necessity to get one or should it be looked on as a last resort?

Any input would be greatly appreciated, for as you know, this is a hard decision for a parent to make.

Hi all
      Andy i don't have any information because we me and mu wife start blood transfiusion for my son when he was two and half years old but ... i remembar the spicialist NURSE fro I.C.U who taking care for the infants or just new born baby she take blood sample from him when he was two weeks old .. what i mean in this any child whio have deficult to find a port there is spicialist team for this jop ... hope i answer ..
                          khalifa
                       state of kuwait

THANKS SO MUCH ANDY FOR STARTING THIS TOPIC!
I REALLY HOPE WE CAN GET SOME ADVICE AND OPINIONS BEFORE LAURYNS MD APPT! MY HUSBAND AND I ARE SO CONFUSED. ESPECIALLY IF WE DO HAVE A CHOICE. WE WANT TO BE SURE WE ARE DOING THE RIGHT THING.(PORT OR NO PORT).

 :hug
CHRISTINE

The topic of ports in adults has come up several times in the past, but I don't recall it in reference to infants before. There must be more than a few people here that can give some advice on whether a port is necessary for infants. Who has had this done on their child? Who hasn't? If you didn't, was there a constant problem finding veins for transfusions?

I am also curious if this is becoming a standard recommendation. Bostonian, has this been advised for your child?

Hi
I think I had posted a reply to Christine about ports.. its advantages and disadvanges to one of her querries..
It is not a common practice in India to put ports in small kids.. yes veins can be at times difficult to find.. but there are methods which can make the vein prominent.. I have read here that babies should use EMLA type creams.. but the use of any anesthetic cream would deflate the vein and not make it prominent.

Hot compress on the site is a better option. EMLA cream is good for Desferal sites.

Ports can reduce the pain that babies feel everytime they are pricked.. but at the same time, we have to remember that ports are prone to infections.. the surgical proceedure of inserting a port is quite simple though.

Now with the use of the cath, needle pricking is not that painful.. and honestly babies feel very little, if the vein can be found at one go...
I am not too sure if ports can be later taken out after the baby is 3-4 years old and the veins become easier.
Transfuions can also  be given on the leg veins in babies, if the hand becomes too cumbersome..
.
But please use a a cream on the site of the transfusion to reduce the veins becoming thrombossed after each transfusion right from the start. With repeated transfuions, some veins will definetly get thrombossed .. in India I think the name of the cream is Thromoforb.. but I am really not sure as it was many years ago..

Hope this helps..
Shikha

Hi Guys,

Our daughter has gone through two transfusions till now (and her next one is scheduled in another 2-3 weeks) and both the time the NP were able to get to a vein (the first time they had to poke her twice and the second time it needed only one prick). As Shikha has correctly pointed out, the NP at Boston Children's Hospital used a hot pack on the site before inserting the IV. I asked her about this and she indicated that for infants this helps a lot in accessing the veins.

I had a discussion with her regarding ports and she has suggested that as long as the NP are able to access the veins without any issues using hot packs and compresses, we should not have to consider inserting a port. Also, since inserting a port is a surgical process with anesthesia, she did not want to go down that path for our daughter, since she is so young, unless it became absolutely necessary. However, she suggested that we keep that as a possibility in case getting to our daughter's veins become an issue in the future as it eliminates the pain of multiple pricks to access a vein. We have not made any decision as yet regarding this. If the NP are able to get to our daughter's veins with only one prick, I do not think we will have to consider inserting the port, but then again, only time will tell.

Hope I have been able to address Christine's question. I had replied to her pm regarding this.

Regards,

Bostonian

This was recommended to me by my pediatrician who had seen children with ports at CHOPS. She said that their experience was positive.

The NP at our hospital have been struggling with finding my daughter's veins. It takes multiple pricks to get anything and is painful to watch. We are exploring the pros and cons of a port for her.

Thanks Syeda for finding this post as I had never come across this.  How old is your daughter and just for our info after how many transfusion the doctor is now struggling to find her veins . We are very worried of our 4 mths old son getting multiple pricks regularly sometime for checking his HB which is before and after transfusion and pricks at time of transfusion.
My son has already had 3 transfusions & we did not find the doctor struggling to find his veins at least they have not yet informed us. Here in India I have met few more doctors who also have not suggested use of any port as of today.

The multiple pricks do worry us and the only care we take is to use different hand each time for transfusion. We are trying to find better ways to manage his pricks on hands and as Bostonian family suggested will try using hot packs before the transfusion or CBC checks. Is there any other way like using cream which is available in India please let us know.

Ports are almost always strictly for the convenience of the hospital. Children grow and veins become easier to find. I have never favored ports, as they require surgery and pose an infection risk. In some cases, they may be necessary, but usually it is just the hospital wanting to make things more convenient for themselves.

My baby's transfusions start when he was only 3 months old .....though it was difficult to find veins ....but if u can manage ...always try to contact senior doc as their exp helps alot ....and thus succession in 1-2 pricks is possible.....
about ports ...not recommeneded in india and is also a point of infection....so if possible...plz avoid it 

Hi Mukta- she is 7 months now and has is on her 8th transfusion. We tried the hot packs but still had trouble. I am hoping  to be able to avoid the port.

Thanks for your feedback, Andy. I definitely feel the same but am confused based on the way the past few blood draws have gone...

Hospitals have neonatal nurses (trained) for babies. If they are using regular nurses/doctors it will create problem finding veins. We have always asked them to page specialist nurse when my daughter was baby. Worked much better with them.

Some hospitals use EMLA cream (local anesthetic) before the prick.

Few points to ponder.