Different Ways to Receive IV Chemotherapy

Needles, PICCs, and Ports

Chemotherapy for breast cancer may be given as shots, pills, and infusions, but infusions are the most common method following surgery. For chemotherapy infusions, the drugs will be given through your bloodstream.

Fluid chemotherapy drugs are prepared in bags that are hung on an IV pole and connected to catheters. The term catheter can be confusing as many people think of the catheters used to drain urine when someone is ill. But a catheter in this setting simply refers to a system of tubes that allows the chemotherapy to drip into your bloodstream at a controlled rate. To receive IV chemotherapy, you will need some device that gives access to one of your veins.

There are several different options available for accessing your veins. These range from a simple short-term IV, such as you would have to receive fluids after surgery, to catheters and ports. Some devices are preferable depending on the length of time you will be receiving chemotherapy. There are also some chemotherapy drugs that are too caustic to be given in a traditional IV in a peripheral vein and require a port. Let's look at these choices, their advantages and disadvantages, and how you and your doctor can make the best decision for your care.

Short-Term IV Catheters

Simple IV Line in Hand
There are different ways in which you can receive IV chemotherapy. Art © Pam Stephan

When you're having surgery or only a few chemotherapy infusions a short-term IV catheter is often the best option. (Some chemotherapy agents, however, cannot be given in this way).

These intravenous lines, the kind most people are familiar with, consist of a needle and a short length of tube that ends in an injection portal. The size of your needle and tube depends on what type of procedure you will need as well as the condition of your veins. A nurse will insert the needle in a vein in your hand or arm, and tape it and the tube into place. When your procedure is over, the catheter is removed.

Many people are concerned about a needle in their arm, but most often a needle is used to insert the catheter and then removed, leaving only the soft and flexible catheter in place.

Mid-Term IV Catheters:

PICC Line - Peripherally Inserted Central Catheter
A PICC Line (Peripherally Inserted Central Catheter). Art © Pam Stephan

If you need a catheter in place for one to six weeks, a mid-term catheter such as a PICC line (peripherally inserted central catheter) may work for you. Like short-term IV catheters, you'll have a length of tubing, but most of it will be inside an arm vein, with a short line of tubing outside your skin that ends with a cap. 

Unlike a long-term IV catheter, these lines do not reach all the way to your heart. A nurse will insert the catheter line into your arm and secure it in place. Since PICC lines are usually placed in deeper veins in your arm, she may numb the insertion site with a local anesthetic before inserting the needle. Ultrasound if often used to help locate these deeper veins and guide the needle into place.

When you need injections and infusions, your nurse can access the catheter portal instead of sticking a needle into your skin. This is particularly helpful if you are a "hard stick" and finding a peripheral vein is difficult. PICC lines can also be used to draw blood.

Compared to a peripheral IV line, PICC lines are more reliable and more durable. They also allow for larger amounts of fluid to be given. With a peripheral IV line extravasation (leakage of the chemotherapy agent into tissue surrounding the access site) can sometimes be a problem, and having a PICC line reduces the likelihood that this will happen.

Side effects include the risk of infection, clogging of the PICC line, and abnormal heart rhythms if the end of the catheter is too close to your heart (an x-ray will be done to see where the end of the catheter lies to avoid this complication).

Long-term IV Catheters and Ports:

Portacaths For Chemotherapy
Portacaths or "Ports" For Chemotherapy. Art © Pam Stephan

If you will be having several chemotherapy infusions, for example, four or more infusions, a long-term IV vascular access device (VAD) may be the best option.

Similar to mid-term IV catheters, you'll have a line of tubing 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, also called ports. Your nurse will be able to use either device to administer treatments.

Examples of long-term IV devices are:

  • Implanted port (IVAD): Portacath, PassPort, InfusaPort, Medi-Port, which include a durable infusion port located beneath your skin.
  • Central venous catheter (CVC): Broviac, Groshong, or Hickman Catheters, which are tunneled lines with external injection caps.

Ports are commonly used for chemotherapy with breast cancer and are often placed in a surgical procedure at the time of breast cancer surgery. It's optimal if the port is placed at least eight days prior to your first infusion. Disadvantages include the chance that your port will become clogged (thrombosis) or an infection will develop. A port can cause some minor limitations with movement of your arm and will leave a small scar behind.

In addition to giving chemotherapy, a port can be used to draw blood or to give infusions of red blood cells or platelets.

Making Decisions About Catheters and Ports

Whether you are considering a peripheral IV, PICC line, or port for chemotherapy, be sure you discuss all of your options with your oncologist and surgeon. They will be able to give you professional advice based on your specific treatment needs and personal preferences. 

Take a moment to learn about and compare the use of a port versus an IV, including the benefits and risks of each method.

Remember that these devices won't be with you forever, and once treatment has ended, you can have them removed.

Sources:

American Society of Clinical Oncology. Catheters and Ports in Cancer Treament. Updated 09/16. https://www.cancer.net/navigating-cancer-care/how-cancer-treated/chemotherapy/catheters-and-ports-cancer-treatment

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