Having chemotherapy into a vein (intravenous chemotherapy)
Chemotherapy given into a vein (intravenous) goes directly into your blood and is carried to all areas of your body.
This video provides a brief overview of intravenous chemotherapy (chemotherapy into a vein), what to expect and possible side effects.
The information in this video was correct as of 1 May 2013.
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Intravenous chemotherapy can be given through:
a cannula - a short thin tube put into a vein in your arm or the back of your hand
a central line put in through the skin of your chest or neck into a vein in the chest
a PICC (peripherally inserted central venous catheter) line put into a vein in the arm and threaded through to a vein in the chest
an implantable port (portacath) put into a vein and has an opening (port) under the skin on your chest or arm.
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.
Central lines, PICC lines and implantable ports
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.
How it’s put in
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.
PICC (peripherally inserted central venous catheter) 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.
Implantable port (portacath)
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.
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.
Looking after your line or port
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:
flush the line or port with a small amount of fluid using a syringe to keep it working and stop it from getting blocked
clean the area around the line to reduce the risk of infection
keep the area dry when you have a shower or bath – your nurse will give you waterproof covers
recognise if there’s a problem with your line or port and to contact your nurse or doctor at the hospital for advice.
What to look out for
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:
soreness, redness or darkening of the skin around the line or port
fluid leaking from the skin around the line or port
swelling of your arm, chest, neck or shoulder
pain in your chest, arm or neck
feeling ‘shivery’ or unwell after your line or port has been flushed
a high temperature. Most hospitals say that a temperature above 38°C (100.4°F) is high, but some use a lower or higher temperature. The cancer doctors and nurses at your hospital will advise you on this.
Having intravenous chemotherapy
Chemotherapy drugs given into a vein (intravenously) can be delivered in different ways.
As an injection
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.
A drip through a pump
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.
A drip on its own
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.
Through a small pump
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 chemotherapy drug leaks
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.