There are many different ways chemotherapy (the use of drugs to kill cancer cells) and other drugs to treat the cancer and manage the symptoms can be given to a person with cancer. One of the most common ways is intravenously, meaning the drug goes into a vein. Veins used in intravenous (IV) therapy can be in the arms, neck, or chest.

IV treatments are commonly given through a small needle connected to a tube called an intravenous catheter (also called an “IV”), which is inserted in a vein in the forearm or the hand. The IV can be used to give medications before the cancer treatment, such as nausea medications or fluids, and then is used to give the cancer treatment. The IV catheters are usually removed once the treatment for that day is completed. In some instances, it may be left in for two to three days as long as it is still in the vein safely and not causing any pain. This procedure is repeated each time the person receives treatment.

If the treatment is frequent (such as weekly or several days in a row), this process can become uncomfortable, and inserting the needle in a vein can become more difficult. Furthermore, some treatments include drugs that can cause damage to the tissue. In these situations, the smaller veins in the forearm or hand are not good options for this kind of treatment, so the nurse or doctor may use larger catheters that are placed into large veins in the upper arm or neck. These catheters may be placed completely under the skin (called a port or port-a-cath), or they may be tunneled under the skin with a catheter tip exiting through the skin in the arm or chest. The tips of these catheters remain outside the body so it can be used to give treatments. Some of these catheters have two (double-lumen) or three (triple-lumen) tips that allow more treatments to be given at one time, such as for a person receiving a bone marrow and stem cell transplantation. Catheters and ports can also be used to draw blood, provide other medications, or provide liquid nutrition if the person has trouble eating or drinking.

Benefits of catheters and ports

Catheters in the upper arm or tunneled into the veins in the neck can remain in place for several weeks or months and can be used to:

• Reduce the number of times a patient has to have a needle stick (particularly helpful if a patient has small veins or veins damaged by previous treatments)
  
  
• Give blood transfusions or more than one type of cancer treatment or medication at a time
  
  
• Decrease the risk of tissue and muscle damage that can occur if some types of chemotherapy leak outside a vein, which is more likely to occur with a regular IV
  
  
• Allow for frequent blood tests for monitoring treatment without needle sticks in the arm
  
  
• Avoid excessive bruising or bleeding in patients who may have bleeding problems, including low platelet counts.

Ports can remain in place for several weeks, months, or even years, and can be used to:

• Reduce the number of needle sticks in the vein
  
  
• Provide chemotherapy or other treatments that last longer than one day (the needle used to access the port can be left in for several days)
  
  
• Give more than one type of chemotherapy or other treatment at a time (a double port is used rather than a single port)
  
  
• Allow blood testing and treatment on the same day with only one needle stick through the skin in the chest

Inserting catheters

There are several types of catheters. The one that is right for you depends on many factors, including how long you need to receive cancer treatment, the type of treatment you are receiving, ease of care, and cost.

Most types of catheters are inserted and work in a similar way. Catheters may be placed in the arm (peripherally inserted central catheter [PICC]) or in the chest (Hickman catheter). PICC lines may be inserted by a specially trained nurse or by a doctor and do not require surgery. Hickman catheters are placed surgically, usually in a special outpatient clinic. There are usually two incisions, one in the chest and one in the neck. The catheter is inserted through the neck and then tunneled under the skin. The other end of the catheter leaves the body through a separate exit point, usually in the upper chest. Patients receive either local anesthesia (numbing medication to the skin and tissue) or conscious sedation (medications that make you sleepy during the procedure).

Inserting ports

A port, a round metal or plastic disk, is typically about the size of a quarter and covered with a rubber seal. The port is connected to a catheter that is tunneled into a large vein in the chest or neck.

If you and your doctor choose to use a port, the same procedure is used to insert the catheter. This is usually done by a surgeon or radiologist, and you will receive either local anesthesia or conscious sedation. Before each “access” or needle insertion, the skin over the port may be numbed using a cream. When treatment is given, the skin is cleansed and a special needle is inserted through the skin into the rubber seal. This allows blood to be drawn or treatment to be given into the catheter that is connected to the port.

Caring for catheters and ports

Each type of catheter or port has some risks that should be discussed with your doctor when deciding on which type is best for you. The risks may includeinfections, blockage or clots, and other problems that are less common, such as kinks under the skin or a shift in the position of the catheter or port (displacement).

There are special instructions for catheters or ports that reduce the risk of these problems (see below for specific directions). For catheters that have tips that remain outside the body, you must take special care of the tube and the skin surrounding the area where the tube exits in the arm or chest. These catheters also need to be flushed with sterile fluid each day to prevent blockage. This care may be provided by a special IV service in your home or by staff in your doctor’s office or clinic until you are comfortable taking care of this on your own.

Typical instructions, which your doctor or nurse can explain in detail, include:

• Wash your hands before you touch the catheter to help prevent infection
  
  
• Never touch the tip of the catheter when the cap is off
  
  
• Clean the area around the tube and change any bandages as directed
  
  
• Prevent air from getting inside the catheter by making sure the top or clamps are on tightly when the tube is not being used
  
  
• Avoid any breaks or cuts in the catheter
  
  
• Flush a small amount of fluid into the catheter so it doesn’t get blocked, as directed
  
  
• Protect the catheter area from being submerged underwater

Because ports are under the skin, there is less to care for. Ask your doctor or nurse for specific instructions on how to care for the area around the port, and follow these instructions until it heals. You may also need to use fluid to flush out the port so it does not get blocked.

Warning signs

Contact your doctor immediately if:

• The area around the catheter or port becomes red, swollen, painful, bruised, or warm
  
  
• There is excess bleeding from the insertion area
  
  
• You develop a fever
  
  
• Any fluid leaks
  
  
• You have shortness of breath or dizziness
  
  
• The catheter tube outside of your body gets longer
  
  
• The catheter or port cannot be flushed out with liquid; it seems blocked. Fluid should never be forced into the catheter.

Removing catheters and ports

Your doctor or nurse will remove the catheter and/or port when you no longer need it. During removal of a catheter, the doctor or nurse will gently pull the tube until it feels loose, and then remove it. Anesthesia is not normally needed for the removal. Your doctor or radiologist can remove the catheter in your neck or chest, and you may need local anesthesia or conscious sedation for this procedure.

When removing a port, your doctor will make a small cut above the port and take it out. The catheter connected to the port is then pulled out, and the small wound is stitched up. You will usually be given local or general anesthesia for this process.

Questions to ask your doctor

• Why are you recommending a catheter or port?
  
  
• What are the risks of a catheter or port?
  
  
• Are catheters and ports covered by my health insurance?
  
  
• What do I need to do before the catheter or port is placed?
  
  
• Will I feel any pain when the catheter or port is inserted?
  
  
• How long does the procedure take?
  
  
• How long will the catheter or port be left in?
  
  
• How do I care for my catheter or port?
  
  
• Can I see or feel a catheter or port under my skin?
  
  
• Can I wear regular clothes with a catheter or port?
  
  
• Can I bathe and swim with a catheter or port?
  
  
• Can I exercise with a catheter or port?
  
  
• Will a catheter or port interfere with radiation therapy or scans?
  
  
• Who should I contact if I have problems with my catheter or port?

More Information

Part I: Understanding Chemotherapy

Part II: Chemotherapy—Your Personal Experience

Additional Resources

American Cancer Society: What Are the Different Ways to Take Chemotherapy?

Last Updated: February 01, 2010