Abstract : Implanted vascular access devices are long-term central venous catheters that are advantageous in pediatric hematology-oncology daily practice, as they allow safe administration of intravenous chemotherapy, supportive measures as well as frequent blood sampling without repeated and painful veni-punctures. Despite their utility, complications related to insertion and maintenance remain a concern. The purpose of this study was to evaluate the safety and possible related complications of port-a-cath insertion in pediatric patients with cancer at South Egypt Cancer Institute (SECI). During the period from December 2020 to March 2024, a prospective observational study was carried out at Pediatric Oncology and Hematological Malignancies Department. During the study period, 57 insertions of port-a-cath were done and the patients followed up for occurrence of complications. All insertions were done under general anesthesia using percutaneous ultrasound guided technique. The mean duration of port-a-cath use was 33 days (range 3–61). Complications reported in (45.6%) of insertions, with catheter related blood stream infection being the most common (21%). Significant risk factors for complications were patient age (p=0.042) and coagulation profile at time of insertion (p=0.006). Blood stream infection specifically was significantly affected by phase of treatment at time of insertion (p=0.035), catheter using duration (p=0.046), adherence to instructions (p=0.045) and history of local skin infection (p=0.027). The median complication-free duration was 52 days. Early removal was done in nine insertions, local infection was the most common cause of early removal (44.4%). Totally implantable venous access devices are valuable and generally safe in pediatric oncology practice, providing reliable vascular access and facilitating treatment delivery. Our prospective study at South Egypt Cancer Institute found that most complications were managed successfully without major treatment delays. Significant risk factors for CRBSIs included insertion during consolidation, local soft tissue infection, and poor adherence to care instructions. These results highlight the importance of individualized timing, strict infection control, and early intervention.