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:

• a cannula – a short thin tube put into a vein in your arm or the back of your hand
• a central line – a long thin tube inserted into a vein in your 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 or through a pump. Your nurse will check that the cannula, line or port is working properly before giving you the chemotherapy.

Cannula

Having a cannula put in can be a bit uncomfortable or painful, but it shouldn’t take long and any pain soon wears off.

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.

Central lines, PICC lines and implantable ports

Lines and ports are used to take blood samples as well as to give you chemotherapy. You can go home with the line or port in and it can be left 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 or blood tests. 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 it.

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 type of cancer you have or 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.

Central line

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 brand names, such as Hickman^® or Groshong^® lines.

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 specialist nurse or 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 special needle called a Huber needle is passed through your skin into the port. Your nurse can 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.

Having intravenous chemotherapy

Chemotherapy drugs given into a vein (intravenously) can be delivered in different ways. Your chemotherapy nurse will wear gloves and a plastic apron while giving you chemotherapy. This is just a precaution to protect them from any spillage of the drugs.

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. The chemotherapy is in a small pump which your nurse connects to your central or PICC line. The pump is small enough to 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 and isn’t in the correct position in the vein. Extravasation rarely happens with a central line.

Your nurse will be very careful to prevent extravasation when giving your chemotherapy. Some chemotherapy drugs can damage the tissues so it’s very important that extravasation is dealt with straight away. If you notice any swelling, pain, stinging or redness during your chemotherapy, tell your nurse immediately. If you develop any of these problems after you go home, contact the hospital straight away.

This section is about other ways you can have chemotherapy (apart from intravenously). Your chemotherapy nurse or cancer doctor will explain more about this.

By mouth (oral chemotherapy)

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:

• read the labels on the boxes before you leave the hospital and if instructions are unclear, ask your nurse, doctor or pharmacist
• take your drugs exactly as prescribed because not taking them at the right times can affect how well treatment works
• contact your nurse or doctor at the hospital immediately for advice if you can’t take your medicines for any reason or are sick after taking them.

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.

Injection into a muscle or skin

Some chemotherapy drugs are given by injection into a muscle of the leg or buttock (intramuscular). 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.

Injection into the spinal fluid (intrathecal)

In some leukaemias, lymphomas or brain tumours, cancer cells can pass into the fluid that surrounds and protects the brain and spinal cord (cerebrospinal fluid or CSF).

Intrathecal chemotherapy can be used to prevent this from happening or to destroy any cancer cells in the CSF. Only certain chemotherapy drugs can be given in this way. Chemotherapy into a vein or by mouth can’t reach these cancer cells.

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. This is called a lumbar puncture. Your doctor then injects intrathecal chemotherapy through the needle into the CSF.

Having a lumbar puncture is not usually painful, although some people may find it uncomfortable. Your cancer doctor and nurse will explain it to you so you will know what to expect. They will make sure you are comfortable and you can have a relative or friend with you.

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.

Into a body space (intracavitary)

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. Chemotherapy can be given:

• Into the bladder (intravesical) – This is used to treat early bladder cancer. Liquid chemotherapy drugs are given directly into the bladder through a catheter, which is removed when it’s over.
• Into the abdominal cavity (intraperitoneal chemotherapy) – This is very occasionally used to treat ovarian cancer or mesothelioma in the abdomen (peritoneal mesothelioma).
• Between the two layers of the pleura (tissue that covers the outside of the lungs) – Chemotherapy is sometimes put in between the two layers of the pleura to treat cancer cells that have spread there.
• Into a limb (isolated limb perfusion) – 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

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:

• Chemotherapy tablets, capsules or injections may need to be stored in a particular way, such as in the fridge. Always follow the instructions given by your nurse or pharmacist.
• Other people in your household should avoid direct contact with your chemotherapy drugs and avoid picking them up with bare hands.
• All drugs must be stored out of the reach of children as they could cause serious harm if taken by accident.
• If you’re having intravenous chemotherapy by pump and you notice the drug leaking from the pump or tube, you should close the clamps on the pump, wrap it in a plastic bag and wash your hands. Some hospitals provide a ‘spill’ or ‘leakage’ kit, which includes instructions on what to do if your pump leaks. You should then contact the nurse or doctor at the hospital immediately.
• If you feel unwell at any time of the day or night, use the contact numbers you’ve been given to get advice.