The use of totally implantable vascular access devices (TIVAD) has gained acceptance in oncology patients, with lower overall complications and maintenance costs than percutaneous silastic catheters. We inserted 135 TIVAD in 131 selected pediatric oncology patients (mean age 8.9 years) for chemotherapy of 68 solid tumors, 39 leukemias, and 24 lymphomas. Patients were required to have an absolute neutrophil count of 1,000/μl prior to TIVAD insertion. The cumulative duration of access was 45,098 days, with a mean of 334 days per device (range 5 to 981 days). At the time of review, 53 (39%) TIVAD were functioning without complication, 69 (51%) were removed at the end of therapy or were functioning at the time of death, and 13 (9.6%) were removed due to complications. Complications (n = 23) included 12 episodes of septicemia and 4 pocket infections for an infection rate of 11.8% (1 in 2,819 access days). Infections were more common in patients with leukemia compared to all others (P <0.001). Coagulase-negative staphylococci were isolated in 10 of the 16 infections; 7 infections resolved with antibiotic therapy. Mechanical complications were associated with 7 (5.2%) devices (1 in 6,443 access days). These data suggest that in selected non-neutropenic pediatric oncology patients, TIVAD can be utilized with minimal morbidity in the delivery of long-term chemotherapy.