Portacath Vs Broviac

chelsealush

Zoe is 5 months old, DX Osteogenesis Imperfecta type 3. She has infusions for a medicine called Pamidronate every 7 weeks for 5 hours at a time. While I know this isnt as often as some children, we are looking into getting her a port. She has a very hard time getting an IV stick, let alone having it last for 5 hours. We can only use scalp veins because her bones are very deformed and brittle so moving her arm/leg or holding it down to get a IV is impossible. We went and had a consultation with a ped surgeon but he suggested we get a Broviac. I just wanted to know your experience with either of them. Thanks

Meg4583

Lurking, but I'm a pedi nurse and hope you don't mind me answering.

When we have parents who have a choice between a port and a broviac,  I think a port is the best option. 

A broviac is a long term central line, but you'll be required to do weekly dressing changes, keep the area clean and dry, no baths, etc. Its a bigger risk for infection with a child since its so hard to keep it clean. It is possible though and I've had patients go years with a broviac.

however, a portacath is implanted under the skin.  It can be access and deaccessed when you are finished with the pamidronate session. It is accessed by a small needle that goes directly into the port, and secured. It is still considered a central line and when accessed, is done under sterile technique and secured under a sterile dressing.  However, unlike the broviac, when she is done with the infusion and access is no longer needed, the needle is removed and there is no outward dressing/lines/etc. She can bath with a port in and not worry about getting a line wet/dirty/etc. 

Ports do need to be "packed" once a month, with a large amount of heparin ( a blood thinner medication), to keep them from clotting off.  

So for an active child who has potential for pulling out lines, my vote is for the port. If she pulls the port while accessed, the needle will be pulled out of the skin, but there should be no damage to the port. If she has the broviac and pulls that out, immediate pressure must be applied and she'll require surgery for another one. 

I hope that helps you

On a side note, how is the pamidronate therapy working for her? I've seen many kids on it and they seem to do quite well and break less with it. 

not_finished

Grant has had several PICC lines as well as several Broviacs.  He does not have enough body fat to have a Port.  Our surgeon requires kids to be at least 10 Kilos to try a Port.  Did they not mention using a PICC?  They have a lower risk of infection than Broviacs do.  It would be located in her upper arm, so I'm not sure if that is an option or not.   

Grant has Mito, so he is very prone to very serious line infections.  We were literally in the hospital more than we were out during the time of his lines.  Line infections can quickly become septic, which is something you definitely do not want.  Like I said though, he was more prone.  Just to be safe, before considering a line I would ask for an Immunologist's opinion, just to rule out an underlying immunology condition that could complicate things. 

Do you have any specific questions? 

babyhubbardinme

My son has a genetic disorder, and while he was getting treatment we have become used to both a port and a central line (broviac).  I highly reccomend the port.  The big thing for me was there was a span of over a year where he couldn't even have a bath and that is SUCH a pain.  Especially when they get sick (or get into the hamburger grease when you're not looking) and need to be seriously bathed.  Plus, you have to constantly run things through the broviacs to keep them clean, and you have to clean around them.  With the port, once the site heals there is no up-keep.  Plus, if your child is curious they will pull on the broviac.  While they have to pull VERY hard to get them out it will turn your stomach to see them yank on them.  I have NEVER fainted in my life, but when my son yanked hard on his once, even though we had them pinned to his shirt, I about fainted then!  Honestly, from my experience, go with the port.

chelsealush

Pamindronate is working AMAZINGLY. Oh my word I can not imagine where Zoe would be without it. After every infusion she hits a milestone. Its incredible. She sleeps better, eats more, its just... really really cool.

 

Also, we have Port surgery on the 25th of this month. We were told the pediatric surgeon would try for a port and if he couldnt place it do a broviac. we told him to try for the port and if he couldnt get it... dont even bother with the broviac. its way too much of a risk for us.