IV chemotherapy
This page is about the ways you can have chemotherapy into a vein. There is information about
Intravenous chemotherapy can be given over different amounts of time, depending on the drug and the type of cancer it is treating. For instance, the drugs for each course of chemotherapy may be given as
- An injection into a vein, over a few minutes
- Through a drip (intravenous infusion) over anything from 30 minutes to a few hours
- Through a drip or pump over 2 or more days
- Through a pump that you wear for weeks or months
Chemotherapy given over weeks or months is called a 'continuous infusion'. You may also hear it called 'protracted venous infusion' (PVI) or 'ambulant infusion' (this just means you can walk around wearing the pump).
If your treatment only lasts a few hours, you may have the drugs as a day patient at the hospital. In some areas of the country, some types of chemotherapy may be given in your home by specially trained nurses. If the treatment takes longer than a few hours, you may need to be admitted to a ward at the hospital. Using a pump may allow even these treatments to be given to you as an outpatient.
When you have your chemotherapy your nurse will wear gloves and possibly a plastic apron. They will be very careful to avoid any direct contact with the drugs. This is because many chemotherapy drugs are harmful if they get on your skin. The equipment your nurse uses to give your chemotherapy, such as syringes, needles and plastic tubing has to be carefully disposed of. There are special containers in the hospital that they will use. This may seem like a lot of fuss and even a bit scary. But it is important to be as safe as possible. If the staff do spill any of the drugs or get some on their or your skin, your hospital will have guidelines on how to deal with it. There is information below on what happens if your drip leaks.
There are several different ways of getting the drugs into your blood stream either as an injection or a drip or intravenous infusion. You can have them through
- A small tube put into a vein in your hand or arm (a cannula)
- A central line
- A PICC line
- A portacath
Your nurse puts a small tube into a vein in your hand or arm. This can stay in for a few days if needed.
Sometimes the drugs are injected into a drip bag to dilute them, so that they can be given into a vein in your arm. This is known as an intravenous infusion. Your nurse connects a set of plastic tubing to your cannula. The plastic bag containing your treatment attaches to the top of this plastic tubing and the drug solution drips into your vein slowly over a set period of time.
These days, chemotherapy through a drip is almost always run through a pump. This doesn't pump the chemotherapy into your vein. It very carefully controls the rate that the fluid goes into your vein. Your nurse can set it for the right number of hours so that your chemotherapy can be given to you as slowly as necessary. Using these pumps is really a safety precaution. You can have chemotherapy without one, but your nurse will have to keep a much closer eye on the drip rate to make sure it is going in at the right speed. Even moving your arm can affect the rate of a drip.
Doctors often use central lines for chemotherapy because drips can be temperamental. They can stop and start when you move your arm. And the speed of the drips is not as easy to control as it is with a central line connected to a pump. Sometimes, people have very fragile veins in their arm, which it is difficult for the doctors or nurses to get a cannula into. But the most serious potential problem with a drip is fluid leaking out into the surrounding tissues instead of going into the vein. Nurses usually call this 'tissue-ing'. Generally, this will cause the area around the cannula to become hard, slightly swollen and sometimes red. Often these problems are very minor. The doctor or nurse takes the cannula out and puts a new one in. After a day or so the swollen area has usually completely recovered.
But some chemotherapy drugs can cause damage to the tissues if they leak. These are called vesicants. Your doctor and nurse will be aware if the drug you are having is a vesicant. They may ask you to keep a close eye on it and let them know as soon as possible if the drip stops going, or if the area around the needle (cannula) is getting sore. Our individual cancer drug pages tell you if a drug is a vesicant, so you can check for yourself if you like. Doctors and nurses sometimes call drug leakage 'extravasation'. This just means 'out of the vein'.
Remember - we are telling you about a possible problem. Your own nurses and doctors will take all the steps they can to make sure that this doesn't happen to you.
If you are treated with a vesicant drug that leaks, it can cause pain and ulceration to the body tissues. This doesn't necessarily happen straight away. There may not seem to be much harm done. But the area can become more swollen and painful over the next few days. Ulcers (sore and broken areas of skin) may develop within 2 weeks. This type of damage can take quite a long time to heal.
You need to tell your nurses straight away if you suspect there is something wrong. Immediate treatment can really help to stop the tissue damage occurring in the first place. The nurse will disconnect the drip tubing and may use a syringe to draw as much of the drug as possible back through the cannula. Then, they will take the cannula out and put hot or cold packs on your arm (depending on the drug). They may also put an antidote onto your skin in the area, or inject one around it. You'll have to come back to the hospital regularly over the next couple of weeks so that your doctor can keep an eye on the damage. To help them do this they may take photographs. If there is damage you may also see a plastic surgeon.
The other way of giving intravenous chemotherapy is through a long, flexible, plastic line called a central line. These are called central lines because they end up in a central blood vessel in your chest, close to your heart. Central lines usually go into your body in the centre of your chest. Then they run up, under your skin, to a large vein by your collarbone. The only bit you can see is the length of line that hangs out of the small entry hole in your chest. This is a picture of a central line in place.
Other central lines you may hear about are PICC lines and Portacaths.
The central line can stay in your vein for many months. So you won't need to have needles into your hand or arm each time you have your chemotherapy treatment.
You have a general or local anaesthetic before the central line is put in. When it's in place, the central line is stitched in place or special dressings may be put over it so that it can't come out. Your doctor may want you to have an X-ray afterwards to make absolutely sure the end of the tube is in the best place. Sometimes the tube is put in using continuous X-rays, so that the doctors can see where the tube is going.
Your doctor and nurse can also take blood from the line for tests. They can also use the line to give you fluids or other treatmnet such as antibiotics if these are needed.
A Portacath is a small chamber or reservoir that sits under your skin at the end of your central line. You can feel it, but unless you are very thin you cannot usually see it. When you need treatment, your nurse puts a needle into the chamber and gives you injections or attaches a drip. This stays in place for as long as you need treatment. Then your nurse will remove it until your next treatment.
The main advantage of a Portacath is that you can't see it on the outside of your body. You don't have to have a tube coming out of your chest as you do with a central line. But some people prefer a central line because they don't like having a needle put in each time they need treatment. If you prefer, you can have the area over the portacath numbed with a local anaesthetic cream before the needle is put in.
PICC stands for Peripherally Inserted Central Catheter. This is a type of central line. It is put into a vein in your arm, under local anaesthetic. It can be put in during an outpatients appointment. The line runs up the vein, inside your arm and ends up in a large vein in your chest (where the central line goes too). PICC lines can be left in for several months and used in a similar way to other central lines.
Sometimes problems occur with the line
- You may get an infection
- The line may get blocked
- A blood clot can develop
- A PICC line may split, but this is very rare
The line is flushed regularly with 'Heparin' or salt water (saline) to prevent clotting. The nurses on the ward can teach you how to do this. Your district nurse can help you at home at first. Your doctor may also prescribe treatment with a low dose of the drug warfarin. Warfarin is a commonly used drug. It helps to prevent blood clots which could block your line.
If you notice any
- Redness
- Swelling
- Soreness
where your line goes into your body, ring the hospital and speak to your chemotherapy nurse or doctor. These could be signs of infection. You will need to have treatment with antibiotics straight away if you do develop an infection. Otherwise, the line may have to be removed and a new one put in.
If you are not having treatment regularly you or a nurse need to clean and flush the line regularly to keep it clear and stop you developing any problems.
You can go home with a central line in place. It is OK to have a bath or shower too. There are very few restrictions to your everyday life. Waterproof covers are available for your arm if you have a PICC line, if that would make you more comfortable. These are even good enough for swimming, although you must check with your doctor first if you are having chemotherapy because there may be an infection risk from using a public pool. You shouldn't go under water with it (in the bath or when swimming) unless you have a waterproof cover.
Before you go home make sure you are confident about looking after your line. Ask the staff on the ward if you are not sure about anything. They can arrange for district nurses to visit you at home to help with the line until you feel confident about looking after it.
If you have problems at home contact the medical staff on the ward or chemotherapy unit for advice.
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