Intravenous (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 – worn for weeks or months
Chemotherapy given over days, weeks or months is called a continuous infusion. You may also hear it called protracted venous infusion (PVI) or ambulant infusion. Ambulant means walking – so ambulant infusion means you can walk around wearing the chemotherapy 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 means you will be able to have treatment as an outpatient.
When you have your chemotherapy your nurse will wear protective equipment such as gloves, goggles and a plastic apron. These are to protect your nurse from accidental splashes of chemotherapy. The chemotherapy nurses will be very careful to avoid any direct contact with the drugs. This is because many chemotherapy drugs are harmful if they get on their or your skin. The equipment your nurse uses to give your chemotherapy, such as syringes, needles and plastic tubing has to be disposed of carefully. There are special containers in the hospital that are used for disposing of used chemotherapy equipment. 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 this should be dealt with. There is information below on what happens if your drip leaks.
There are several different ways of getting the drugs into your bloodstream either as an injection or a drip or intravenous infusion. You can have them through
Your nurse puts a small tube into a vein in your hand or arm. This can stay in for a few days if needed. If you have had surgery for breast cancer or your lymph nodes removed from under your arm your doctor or nurse will try not to put the cannula in your arm on the side you had surgery. They should also not put a cannula in a vein in your arm if you have lymphoedema in it.
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. The pump gently pushes the chemotherapy into your vein at a carefully controlled rate. Your chemotherapy nurse can set it for the right number of hours so that your chemotherapy can be given to you at exactly the rate needed. You can have chemotherapy without a pump, 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. So using these pumps is really a safety precaution.
Doctors often use central lines for chemotherapy because
- Drips can be temperamental – they can stop and start when you move your arm
- The speed of drips is not as easy to control as it is with a central line connected to a pump
- Some people have very fragile veins in their arms – this can make it difficult for the doctors or nurses to get a cannula in
- There is a potential, serious problem with drips where fluid can leak out into the surrounding tissues instead of going into the vein. The area around the cannula may become hard, slightly swollen and sometimes red. Sometimes, it is possible for the doctor or nurse takes the cannula out and put a new one in. And after a day or so the swollen area is 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 will keep a close eye on the chemotherapy drug to make sure it does not accidentally go into your tissues instead of your vein. Let them know as soon as possible if you notice that the drip stops going or if the area around the needle (cannula) is getting sore. Drug leakage into the tissues is called extravasation. Extravasation literally means out of the vein. Our individual cancer drug pages tell you if a drug is a vesicant, so you can check for yourself if you like.
Remember – we are telling you about a rare, but possible problem. Your nurses and doctors will follow hospital policies and guidelines to prevent this happening. Hospitals also have guidelines on how to deal with this situation, if it does happen.
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.
If there appears to be a problem the chemotherapy nurse will stop the drip and disconnect the tubing. A syringe may be used to draw as much of the drug as possible back through the cannula. The cannula will then be taken out. Depending on the drug being used, a hot or cold pack may be put on your arm. You may also have an antidote put onto the affected area of skin, or it may be injected around it. You would have to go back to the hospital regularly over the next couple of weeks so that your doctor could keep an eye on the area of skin. 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. There are different types.
One type of line goes in through a vein in your neck. This is called an acute central line and is used for short term treatments.
Another type of line goes in through your chest, then it is tunnelled 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.
At the end of the length of line that you can see there are connection ports where your chemotherapy drug is attached. The connection ports are kept closed with caps. This is a picture of a central line in place.
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 can move about normally, it won't come out for example while you are sleeping or dressing This is because there is a small cuff on the line, which is under the skin and holds it in place.
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 treatment such as antibiotics if these are needed.
The video below shows how a tunnelled central line is put in. Click on the arrow to watch it.
A portacath is a small chamber or reservoir that sits under your skin at the end of your central line. The other end of the line sits in a large vein close to your heart. You can feel the chamber of the portacath, but unless you are very thin you cannot usually see it. When you need treatment, your chemotherapy nurse puts a needle into the chamber and gives you injections or attaches a drip. The drugs travel from the chamber to the tubing and into your bloodstream. The portacath stays in place for as long as you need 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 outpatient appointment. The line runs up the vein, inside your arm and ends up in a large vein in your chest. 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 (an anti clotting drug) 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. Occasionally, your doctor may also prescribe treatment with a low dose of the drug warfarin. Warfarin is a commonly used drug.
It is very important to avoid getting an infection in the area where your line goes into your body. Phone the hospital and speak to your chemotherapy nurse or doctor if you notice any
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 okay to have a bath or shower. There are very few restrictions to your everyday life. If you have a PICC line, there are waterproof covers available for your arm. You shouldn't allow your PICC line to go under water in the bath, unless you have a waterproof cover. These covers are good enough to use for swimming, although it is important that you check with your doctor first if you are having chemotherapy. There may be an infection risk from using a public pool.
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 day case unit for advice.
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