ABSTRACTIntravenous (iv) bisphosphonates are widely used to treat the skeletal manifestations of osteogenesis imperfecta (OI). Obtaining peripheral iv access in pediatric patients with OI is often difficult and traumatic. Although this may be mitigated with surgically placed iv ports (port‐a‐caths), surgeons may be hesitant to perform this procedure on these children because of the lack of safety data. This study aims to gain better insight into the safety and efficacy of port‐a‐cath use in this population and identify risk factors for port‐a‐cath complications. In the present study, we conducted a retrospective cohort analysis of patient characteristics and the incidence of port‐a‐cath‐related complications in children with OI. Fifty‐three port‐a‐caths were placed in 29 children (21 males and 8 females). Of the 29 patients, most are OI type III (n= 18), followed by type I (n= 4), type IV (n= 4), and type V (n= 3). At the time of initial port‐a‐cath placement, the median age was 52 months (10–191 months), and the median weight was 7.9 kg (5.1–41.1 kg). Most patients (n= 20) weighed less than 10 kg during initial placement. Weight correlated significantly with OI type (p= 0.048), sex (p= 0.03), and vessel used (p= 0.02). Median initial port‐a‐cath longevity was 43 months (1–113 months), and we found no significant difference in port‐a‐cath longevity between sexes, OI types, or vessels used. Most patients (n= 19) required multiple port‐a‐cath placements. There is a significant difference (p= 0.02) between the number of placements and OI type, with type IV having more than type III. Port‐a‐cath removal was almost always due to mechanical complications (n= 19) but also for infection (n= 1) and malposition (n= 1). Eight patients still had their initial port‐a‐caths in place at the conclusion of this study. These findings indicate that complications associated with port‐a‐cath placement are mild and can be used to safely deliver iv bisphosphonates to pediatric OI patients. © 2023 The Authors.JBMR Pluspublished by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.