Venous access devices have been in use since 1973 and have made a tremendous impact on care of children with malignancies to facilitate the delivery of complex medical care and minimize the trauma associated with cancer therapy. During the past 20 years the variety and complexity of available devices has resulted in an increased demand for technical knowledge and expertise to prevent complications and assure safe use. This article reviews the various devices, complications and implications for nursing practice, and recommendations for pediatric nursing regarding patient/parent self-care and developmental safety issues.