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Chemotherapy may be given in different ways, depending on the type of cancer you have and the chemotherapy drugs| used.
It’s standard for nurses to wear gloves and a plastic apron when they give you chemotherapy. This is just a precaution to protect themselves from any spillage of the drugs.
Chemotherapy can be given:
Chemotherapy given into a vein (intravenous) goes directly into your blood and is carried to all areas of your body.
It can be given through:
When your cannula, line or port is in place the chemotherapy drugs can be given into it by injection, as a drip on its own or through a pump.
Your nurse will check that the cannula, line or port is working properly before giving you the chemotherapy.
Having a cannula put in can be a bit uncomfortable or painful, but it shouldn’t take long and any pain soon wears off. Your nurse might put anaesthetic cream or spray onto the skin to numb the area first.
The cannula is put into a vein in the back of your hand or lower arm. Your nurse will place a see-through dressing over it to make sure it stays in place. The cannula is removed before you go home.
If you feel any discomfort, or notice redness or swelling around the cannula or along your arm, during or after chemotherapy, let your nurse or doctor know immediately.
These are used to take blood as well as to give you chemotherapy and are designed to stay in until your course of chemotherapy is over. This means you won’t need a cannula or needles put into the veins in your arm every time you have chemotherapy. You can also have antibiotics, fluids or a blood transfusion through your line or port.
Your specialist nurse will explain how the line or port will be put in. Once it’s in place the nurses will show you how to look after your line or port.
When your course of treatment is over the line or port will be taken out. A doctor or nurse will do this for you, usually in the outpatients department.
Many people won’t need to have a line or a port - it depends on the chemotherapy treatment you’re having. They can also be used if there are problems with the veins in your arm, or if you’re very anxious about having needles put in.
A central line is a long, thin, hollow tube that is inserted into a vein in your chest. They’re sometimes called skin-tunnelled central venous catheters. But you may hear them called by the brand names of commonly used central lines, such as Hickman® or Groshong® lines.
Your central line will be put in at the hospital by a doctor or specially trained nurse. You’ll usually have it done under a local anaesthetic, but sometimes a general anaesthetic is used. Before the procedure, you’ll have your neck checked for a suitable vein using a small ultrasound machine.
Your doctor makes a small cut in the skin near your collarbone and gently threads the tip of the line into a large vein just above your heart.
The other end of the line is tunnelled under the skin to reach the site where it comes out of your body (exit site). You’ll have a chest x-ray to make sure it’s in the right position.
Around the central line there’s a small ‘cuff’ you can feel just under the skin. The tissue under your skin grows around this cuff over about three weeks and holds the line safely in place. Until this happens you’ll have a stitch holding the line in place.
A central line
View a large version of the image of a central line|
A PICC line is a long, thin, hollow tube that your doctor puts into a vein near the bend in your elbow. You’ll be given a local anaesthetic to numb the area before the line is put in.
The doctor gently threads it along the vein until the tip sits in a large vein in your chest. The end of the line comes out just below the crook of your elbow. Once it’s in place, the PICC line is taped firmly to your arm to prevent it being pulled out of the vein.
A PICC line
View a large version of the image of a PICC line|
The end of the PICC line comes out just below the crook of your elbow
View a large version of this image|
An implantable port is a thin, soft plastic tube with a rubber disc (port) at the end. It can be put in under a general or local anaesthetic. The tube is inserted into a vein until its tip sits just above your heart and the port lies under the skin on your upper chest. Once it’s in place you can feel and see the port as a small bump underneath the skin of your chest, but nothing shows on the outside of your body.
An implantable port
View a large version of the image of an implantable port|
To use the portacath, a needle is passed through your skin into the port to give medicines into the vein or take blood. The skin over the port can be numbed with an anaesthetic cream first so you don’t feel any discomfort.
Before you go home, the nurses will show you how to look after your line or port. If you find this difficult, your nurse will arrange a district nurse to do it or they will show a relative or friend how to do it for you.
The main things to do are to:
Most people won’t have any serious problems with their central line or port, but possible problems can include blockage and infection. We have more information about caring for lines and ports|, which you might find helpful. Your nurse will go over this with you.
Contact the hospital for advice straight away if you have:
Chemotherapy drugs given into a vein (intravenously) can be delivered in different ways.
The chemotherapy drugs are injected directly into a vein through your cannula or central line over a few minutes. Sometimes a bag of clear fluid is attached to plastic tubing and connected to the cannula or line in your vein first (called a drip or infusion). The drug is injected into a connection or tap on the plastic tubing and flushed into your vein with fluid from the bag.
Chemotherapy being given by injection into a cannula
The chemotherapy drugs are dissolved in a bag of fluid and given to you as a drip that runs through an infusion pump.
The nurses set the pump to give you a controlled amount of chemotherapy over a fixed time. This can be from 20 minutes to several hours depending on the chemotherapy you’re having.
Sometimes chemotherapy is given through a drip without a pump. The nurses set the rate and check it regularly to make sure it’s at the right speed.
Some types of chemotherapy are given over a few days and are set up at the hospital so you can go home with it. A nurse puts the chemotherapy into a small pump and connects it to your central or PICC line. The pump is small enough to fit into a pocket, or can be carried in a bag or belt holster.
You, and sometimes a relative or friend, will be taught how to look after it. Some pumps are battery-operated so you need to be careful not to get them wet when you’re washing. There are also disposable pumps that are operated by a balloon mechanism or spring control.
Your nurse or pharmacist will explain how to look after the pump and who to contact if you have any problems.
When the infusion is finished there may some fluid left in the pump. Some pumps need to be overfilled to get the correct dose so this may be normal. Your nurse or pharmacist can tell you if you should expect this.
If a drug leaks into the area around the vein while being given, it’s called extravasation. This is uncommon but can happen if a cannula dislodges so that it isn’t correctly positioned in the vein. It rarely happens with a central line.
Your nurse will be very careful to prevent extravasation when giving your chemotherapy. If you notice any swelling, pain, stinging or redness during your treatment session tell them immediately. Or, if any of these problems develop after you get home, contact the hospital straight away.
Some chemotherapy drugs can damage the tissues, and it’s important that extravasation is dealt with straight away.
Some chemotherapy drugs are taken as tablets or capsules. This is just as effective as other types of chemotherapy.
The drug is absorbed into your blood and carried around your body just like intravenous chemotherapy.
You’ll be told when to take your chemotherapy tablets or capsules and given other instructions, such as whether or not to take them with food.
It’s very important to:
Chemotherapy by mouth can cause side effects, just like chemotherapy into a vein, and it’s important to know what they are. You also need to know how to store your drugs safely. You can read more about having chemotherapy at home below.
Some chemotherapy drugs are given by injection into a muscle (intramuscular) of the leg or buttock. This might feel a bit painful or uncomfortable for a short time.
Some drugs are given by injection under the skin (subcutaneous) using a very fine needle.
In some leukaemias|, lymphomas| or some brain tumours cancer cells can pass into the fluid surrounding the brain and spinal cord (cerebrospinal fluid or CSF).
Intrathecal chemotherapy can be used to destroy these cancer cells or to try and prevent this from happening. Chemotherapy into a vein or by mouth can’t reach these cancer cells.
Your cancer doctor and nurse will explain it all so you know what to expect. They’ll make sure you’re comfortable, and you can have a relative or friend with you.
The doctor numbs an area of skin over your spine with local anaesthetic. After a few minutes they will gently insert a needle between two of the spinal bones into the CSF (called a lumbar puncture|). Your doctor then injects the chemotherapy through the needle into the CSF.
The most common side effect of a lumbar puncture is a headache. To help prevent this, you need to lie flat for a few hours afterwards and drink plenty of fluids.
Chemotherapy drugs can be given into a space (cavity) in the body, such as the bladder. This can cause irritation or inflammation in the area the drugs are given but it doesn’t usually cause side effects in other parts of the body.
A fine tube (catheter) is usually inserted into the body cavity and chemotherapy is put in through this tube. It may be drained out again after a set period of time.
This may be done to treat early bladder cancer. Liquid chemotherapy drugs are given directly into the bladder through a catheter, which is removed when it’s over. Our section on early (superficial) bladder cancer| has more information.
This is very occasionally used to treat ovarian cancer and there’s more information in our section on cancer of the ovary|. It may also be used to treat mesothelioma| in the abdomen (peritoneal mesothelioma).
Chemotherapy is sometimes put in between the two layers of the pleura to treat cancer cells that have spread there.
Chemotherapy is very occasionally given directly into the blood vessels in a limb. This is to treat a skin cancer called melanoma that has come back.
Chemotherapy creams are used to treat some types of skin cancer. You put the cream on the affected skin in a thin layer and cover the area with a dressing. Your specialist nurse or pharmacist will show you how to do this and will explain how often you need to apply the cream. Although the cream can irritate the skin in the area or make it sore, it won’t cause side effects in other parts of the body.
If you’re having chemotherapy at home as tablets or through a pump, there are certain things to remember:
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Content last reviewed: 1 October 2012
Next planned review: 2014
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© Macmillan Cancer Support 2013
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