Support > How Drugs are Administered (IV and Ports)

Last update: 08/19/2010

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How Drugs Are Administered  | Intravenous > Temporary / Port
  Resources |  Ports: A Patient Discussion

TOPIC SEARCH  General | Ports

How Drugs Are Administered

How drugs are administered can depend on

	the kind of drug,
	the expected length of treatment,
	patient characteristic, and
	sometimes patient or physician preferences.

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.

See also Treatment Support: About Treatment and What's a Drug?

	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

intravenous

IV (intravenous) chemotherapy is administered by a healthcare professional directly into blood. "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 port):   Condition and availability of veins  Patient history and medical conditions, prior treatments Duration of treatment Types of drugs (irritant? vesicant?) temporary   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 below Hand veins 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. The 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  Temporary IV: Injection Site Reactions Drug characteristics that may determine best administration route: 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: 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.

Access port
 

Access port, or central venous catheters:

"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: 
    

	TCVC (Tunneled Central Venous Catheter) (Hickman, Broviac, Groshong)
	Peripherally inserted central catheter (PICC line)"  (Per-Q-Cath, Groshong PICC)
	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:

	Infection may occur, at or below the insertion point of the line
	Clots can form in the catheter
	The catheter might leak or break Topic Search: Web

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.

Resources and References

	About Ports: radiologyinfo.org | emedicinehealth.com |
	Drug Administration Guidelines bccancer.bc.ca
	Central Venous Catheters wikipedia.org
	IV and Injection site reactions chemocare.com
	Oral Chemotherapy - What do you need to know cancer.org
	PICC lines - side effects | wikipedia.org/
	Port Guidelines BCCancer.bc.ca | ACS
	Preventing and managing peripheral extravasation (infiltration of drug into tissue) findarticles.com
	Tips for Subcutaneous Injections
	Tips for Blood Draws and IVs
	Tips for Treatment Support: About Treatment
	What Are the Different Ways To Take Chemotherapy? Cancer.gov
	What's a Drug?

Ports?  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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