Support > To Port or Not to Port, and other Drug
Administration Questions

Last update: 01/27/2015

TOPICS
How Drugs Are Administered  | Intravenous > Temporary  / Fixed Port
Drug characteristic (Irritant/Vesicant)
  Resources | To port, or not to Port: A Patient Discussion

Also see What is a Drug?

How Drugs Are Administered

The ideal way to administer drugs can depend on

* The drug characteristics (Irritant / Vesicant)

* The expected length of treatment (long favoring a fixed port IV)

* Patient characteristic, and secondary medical conditions
(such as an active infection, low platelets, or fragile veins)

Sometimes patient or physician preferences. 

Temporary versus Fixed Ports - Tradeoffs

As with many medical procedures, the decisions we make often involve trade-offs - we exchange one kind of risk for another.  For example, using a fixed port to more easily administer drugs decreases the risk of damage to fragile veins on the one hand, but drug administration through an implanted port can increase the risk of blood clots if the port is not properly cared for. 

Overview of administration methods:

Chemotherapy drugs are given in order to achieve systemic effects - delivery of the drug into the blood so that it can reach cancer cells anywhere in the body.  There are many ways to administer drugs to have a systemic effect:

	Oral administration of pills, capsules, or liquids that you swallow.   In drugs that can be administered either orally or by injection, assessment of patient or  caregiver competence is needed to asses the risk of under- or over-dosing.
	Intravenous (IV) administration is administered directly into the blood by a trained provider. Temporary IV (Peripheral IV) see below Access Port (central venous catheters or port) see below
	Less common administration of chemotherapy:  Intraperitoneal (IP) injection into the peritoneal cavity  the area that contains organs such as your intestines, stomach, liver, and ovaries. Intramuscular injection (into muscle) Intratumoral injection (into the tumor) Topical application of a cream that you rub onto your skin. Subcutaneous injection (just below the skin) See also Subcutaneous Injections ~ Tips & Resources See also Treatment Support: About Treatment and What's a Drug?

Drug characteristics (Irritant / Vesicant)
that may determine the best IV administration route - temporary/fixed port

Potential Injection-Site Reactions:

Irritant drug can lead to short-lived and limited irritation to the vein.  Symptoms of irritation are redness and itching at the injection site. Examples of Irritant chemotherapy drugs: Bendamustine, bleomycin, carboplatin, carmustine, cisplatin, dacarbazine, denileukin difitox, dexrazoxane, doxorubicin, doxorubicin liposome, etoposide, ifosfamide, streptozocin, teniposide, thiotepa, vinorelbine

Vesicant drug - can lead to extravasation  (infiltration of drug into tissue) leading to chemical cellulitis. Symptoms of extravasation: redness and itching but can worsen, depending on the amount of vesicant that has leaked under the skin; can cause blistering.  Large amounts can can lead to severe skin damage in a matter of days.  Symptoms may be delayed for up to 6-12 hours   Examples of Vesicant chemotherapy drugs:  Dactinomycin, daunorubicin, doxorubicin, epirubicin, idarubicin, mechlorethamine, mitomycin, mitoxantrone, paclitaxel, streptozocin, tenoposide, vinblastine, vincristine, vinorelbine.

intravenous (IV) administration (Giving drugs into the blood)

IV (intravenous) chemotherapy is administered by a healthcare professional directly into blood.  It can be administered through a vein (a temporary IV), or into a vein through a fixed port. "Sometimes the chemotherapy needs to be given through an IV placed  in the arm or hand, which can often be given at your local doctor’s office or clinic.   ... or through a port, inserted surgically, then removed when the course of treatment is completed." Factors which determine the preferred access type - temporary or fixed port:  Condition and availability of veins  Patient history and medical conditions, prior treatments Duration of treatment Types of drugs (irritant? vesicant?)

Temporary IV administration
 

A temporary IV (or peripheral IV)  Risks: Irritation to the vein extravasation  (infiltration of drug into tissue) leading to chemical cellulitis: See Injection Site Reactions above. Veins in the hand may be used, and may be easier to observe in some patients, however, extravasation in this area from some types of drugs can cause severe damage.  One or both arms may be used for temporary IV administration. However, placement of an intravenous device may be contraindicated in some patients depending on physical characteristics or medical history.  Assessment includes:  Access to veins (easily to locate and in good condition?) Edema (swelling) of extremities Sensations in extremities, such as numbness History of: obstruction (blood or lymphatic blockage) phlebitis (inflammation of veins) radiotherapy to the upper torso  lymph node biopsy in the region mastectomy

 
Fixed Port (implanted / fixed catheter)

Access port - also called central venous catheters:

A fixed port allows your health care providers to give medications and fluids on a frequent basis.

"When chemotherapy needs to be given regularly over a period of time - several weeks or months, you may be given a special IV called a central venous catheter a thin tube that is inserted into a large vein with access to your central blood supply.  

An implanted access port might be required when a temporary access cannot be done safely or easily as described above, or when receiving irritant or vesicant drugs (described above) 

Examples of implanted access ports: 
    

	Tunneled Central Venous Catheter (TCVC) (Hickman, Broviac, Groshong)
	Peripherally inserted central catheter (PICC line)"  "A Peripherally Inserted Central Catheter (PICC) is a thin, long, soft plastic tube that functions as an intravenous (IV) line. A PICC allows your nurses and doctors to administer medications and fluids on a frequent basis. A PICC can remain in place for as long as you need IV therapy. Typically the radiologist will insert the PICC into a large vein in your arm and guide the catheter up into the main vein near your heart where there is rapid blood flow. The PICC is secured in place and covered with a sterile dressing. An x-ray is taken to assure that the catheter is in the right location. Inserting the PICC usually takes approximately 20-40 minutes to complete. Most patients feel little or no discomfort during this procedure. A local anesthetic may be used."   Source: utahvalleyimaging.com
	Midline catheter ((Per-Q-Cath Midline, Groshong Midline)
	Implantable Venous Access Port (Port-A-Cath, BardPort, PassPort, Medi-port)

Adapted from: http://www.cancer.org 

Risks and complications for IV lines:
 

	Infection may occur, at or below the insertion point of the line
	Clots can form in the catheter
	The catheter might leak or break
	hypersensitivity reactions
	phlebitis (inflammation of veins)

* When to call your doctor or nurse:
 

	You cannot flush the catheter
	You experience itching, rash, hives, wheezing, trouble breathing, or chest pain after receiving chemotherapy
	Temperature of 101.0°F or higher
	Redness, pain, or swelling at or near the catheter site
	Drainage from the skin around the catheter
	The catheter comes out or breaks Contact your doctor and nurse for specific notification guidance.

In the News:

NYT: Needles or Port? A Cancer Patient Decides “They are tiny and rollers,” the nurse says as his fingertips trace the veins on my arms. My part in a trial has begun, but the only “good” vein in the crook of my left arm looks alarmingly bruised, as do both of my wrists.

Resources and References

	About Ports: radiologyinfo.org | emedicinehealth.com
	Essentials: Complications of peripheral I.V. therapy  http://www.nursingcenter.com/library/JournalArticle.asp?Article_ID=765665  PDF
	Central Venous Catheters wikipedia.org
	IV and Injection site reactions chemocare.com
	Oral Chemotherapy - What do you need to know cancer.org
	What Are the Different Ways To Take Chemotherapy? Cancer.gov
	PICC lines wikipedia.org/
	Port Guidelines BCCancer.bc.ca | ACS
	Preventing and managing peripheral extravasation (infiltration of drug into tissue) findarticles.com
	PAL: Tips for Subcutaneous Injections
	PAL:  Tips for Blood Draws and IVs
	PAL: Tips for Treatment Support: About Treatment
	PAL:  What's a Drug?

To Port or Not to Port?  A Patient Discussion

I'll be starting chemo pretty soon, so I'm trying to figure out whether to have a port installed. I'm interested in hearing the  pro's/con's from people who have been through this. 

Dan

I have a port and I wouldn't do it any other way. Of course my veins are hard to access so a port was the only option. It goes in your upper chest and after the initial surgery and recovery I've had no trouble with it. I've had mine since October of 2008. If you are not getting chemotherapy you have to have it flushed once a month but that takes only about a half hour. You do that so that it doesn't clog up. Mine is plastic. As I said I haven't had any trouble with it.

Good luck, Joyce

I think it's a call based on your body. The younger you are and the better shape you're in enable the person administering the drug to find a vein. I donated many pints of blood, and was an aphaeresis donor, so I knew nobody ever had problems finding a vein to poke. I never got a port, but did get a central line catheter for my stem cell transplant chemo. The port, as I understand, is implanted under the skin, so it's really easy for someone to stick a needle into it, and it doesn't require all the cleaning that a catheter does. I guess the drawback is whether you can see and feel them (I think so) and it's another surgery. 

Mark

It depends on the chemo you have. I had CVP, mostly in pill form. The Vincristine was administered by IV on the first day of treatment each three weeks - took about twenty minutes. This was before Rituxan and maybe a port is necessary for that tho I have heard others on this list say they had oral chemo also. It was a breeze. 

Sally 

Dan, I went 8 rounds CVP without a port. It really depends how good your veins are. At your age they are probably okay. Every three weeks we alternated arms. A port comes with a lot of maintenance. It must be continually cleaned to keep from infection. Ned

Hello Dan,

I did 6 weeks of Rituxan IV in 2005, and just finished 4 weeks of a clinical  trial of a newer "humanized" version of Rituxan. Each infusion took approx.  5-6 hours. Never had a port. Hope this helps some. ps:  this is a journey,  keep your chin up, ask questions, get multiple opinions from qualified  hematologist oncologist, and do basic research. In the end, it is still your decision  what to do. No one knows your body better than yourself.  "Keep The Faith"....post as often as you need, we are all here to help, or 
at the very least , support,.....

God Bless, Roger 

I have had a port since September 2008 also due to poor vein access. I have had no problem with it. I am about to begin Rituxan maintenance for 2 years and wonder if anyone has info on keeping the port in for another 2 years. I know I will have to have the port flushed every 4 to 6 weeks when not receiving the Rituxan, but I am a little worried about effects of having the double port in for so long. Any thoughts or experience with this? 

Thanks, Nadine

Dan,  I have a Power Port, which I was told allows them to infuse the chemo drugs faster than they would through an IV. Accessing the port is still a poke, so it's no less pain.  I didn't like the idea of having something implanted into my body initially, but as chemo weakened me, I decided that the port was a reliable way to access veins that might be hard to find if one was sick.  Now that my chemo is done, the port doesn't bother me much at all. I have it flushed every 2-3 months when I see the doctor anyway. If I had it to do over again, I would still get the port.

Jonni

Anna, you will get better as you become active again and work out. I did, and I definitely improved, but I never got back to the level I had before. Of course, each year takes its toll regardless of whether we're taking chemo or whatever, so I can't say how much I lost. I can say the adria messed up my heart slightly, so besides having the damage from the Cytoxan (scarring my vessels), my heart is slightly impaired too. I was also at least a dozen pounds heavier when I completed my ten rounds of chemo, but I lost some before and after my stem cell transplant. I've always been on the thin-side, so having extra pounds may have contributed to my huffing and puffing. But now I'm back below my weight of twenty three years ago, and I'm still not in what I call good shape. Still, life is good. My lumbar discs are the focus of my attention right now, as my lover back has been much more troublesome than my nhl recently. Nice to be able to write that.

Mark

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