Different Ways To Receive IV Chemotherapy: Access Types


Chemotherapy may be given as injections or oral drugs but infusions are the most common method. For chemotherapy infusions, the drugs will be delivered to your bloodstream in one of several ways.

Chemotherapy drugs used for infusion are most often prepared in bags that are hung on an intravenous (IV) stand and connected to tubes called catheters. Using an adjustable valve, the drugs are “dripped” into your bloodstream at a controlled rate via an access point in one of your veins. With some drugs, however, the drug is slowly injected by a nurse from a syringe over a scheduled period of time (termed IV push).

There are several options used for venous access. These range from a simple IV drip, such as you would have to receive fluids after surgery, to ones involving a surgically implanted port. The choice of devices is based on the length of time you will be receiving chemotherapy, the drugs used, and personal preference.

Short-Term IV Catheters


If only a few chemotherapy infusions are needed, a short-term IV catheter is usually the best option. These intravenous lines consist of a needle and a short length of tube that connects to an IV bag. The size of the needle and tube depends largely on the drugs being used. (Thicker solutions, for example, require higher gauge needles.)

A nurse will insert the needle into a vein in your hand or arm, and tape it and the tube into place. When the procedure is over, the needle and catheter are removed.

This method is often used even when eight infusions are needed (such as with breast cancer chemotherapy) to avoid the risk of scarring from a port.

Mid-Term IV Catheters

If you need a catheter in place for one to six weeks, a mid-term catheter such as a peripherally inserted central catheter (PICC) line may be used. Unlike short-term IV catheters, most of the tubing will be situated inside an arm vein with only a short length extending outside of the skin.

Unlike a long-term IV catheter, the lines do not reach all the way to your heart. For this procedure, a doctor, nurse, or technician will insert the catheter line into your arm and secure it in place. Since PICC lines are usually placed in deeper veins, a numbing agent and local anesthetic may be used to reduce pain Ultrasound is often used to guide the catheter placement since the catheter is placed in a vein deeper in your arm that can’t be easily seen or palpated.

Whenever you need infusions, the nurse can access the catheter portal rather than sticking a needle into you with every visit. PICC lines can also be used to draw blood.

Compared to a peripheral IV line, PICC lines are more reliable and durable. They allow for larger amounts of fluid to be delivered and reduce the risk of peripheral IV line extravasation (leakage of the chemotherapy drugs outside of a vein).

PICC lines should not be used for infusions lasting fewer than five days. They are also less commonly used for critically ill patients if the delivery of chemotherapy lasts for fewer than 14 days.

Side effects include localized infection, clogging of the PICC line, and abnormal heartbeats if the end of the catheter is placed too close to the heart.

PICC lines are commonly used when people need to continue IV antibiotic therapy at home following discharge from the hospital.

Long-Term IV Catheters and Ports

If you will be having many chemotherapy infusions, a long-term IV vascular access device (VAD) may be recommended

Similar to mid-term IV catheters, you’ll have a length of tubing placed inside an arm or chest vein. But, this one will go almost all the way to your heart, ending in a large vein. Long-term VADs are either tunneled catheters with external injection caps or implanted vascular access devices (called ports).

Examples of long-term IV devices include:

  • Implanted VADs placed just beneath the skin by a surgeon
  • Central venous catheters (CVC) which have tunneled lines with external injection caps

Ports are often placed at the time of surgery when a tumor is removed and at least eight days prior to the first chemotherapy infusion.

Although VADs are often placed in the subclavian artery of the chest, larger veins (like the jugular vein) are sometimes needed and are usually far easier to place.

With some chemotherapy drugs that are very caustic, a port may be strongly recommended. When these drugs are given in a peripheral IV and extravasate (leak outside of the IV line) they can cause significant damage to the surrounding tissues.

Disadvantages include clogging of the port and infection (that can sometimes be serious given low white blood counts after chemotherapy). A port may also cause a minor restriction of arm movement and will leave a small scar behind.

Whether you are considering a peripheral IV, PICC line, or port of chemotherapy, be sure you discuss all of your options with your oncologist and surgeon. They will be able to give you advice based on your treatment needs and current health. Keep in mind that personal preference is important, and everyone is different when it comes to weighing the advantages and disadvantages of each method.

Remember that these devices won’t be with you forever. Once treatment is completed, you can have them removed.

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