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How Drugs Are Administered
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Resources | Ports:
A Patient Discussion
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?
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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.
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| IntraVenous
(IV) administration is administered directly into the blood by
a trained provider.
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| Less
common administration of chemotherapy:
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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):
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Condition
and availability of veins
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Patient
history and medical conditions, prior treatments
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Duration
of treatment
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Types
of drugs (irritant? vesicant?)
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| A temporary IV
(or peripheral
IV)
Risks:
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:
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Access to veins
(easily to locate and in good condition?)
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Edema (swelling)
of extremities
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Sensations
in extremities, such as numbness |
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History of:
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obstruction (blood
or lymphatic blockage) |
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phlebitis (inflammation
of veins) |
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radiotherapy to
the upper torso |
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lymph node biopsy
in the region |
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mastectomy
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Temporary IV: Injection Site Reactions
Drug characteristics that may determine best
administration route:
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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
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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.
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Access port,
or central venous catheters:
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"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:
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TCVC
(Tunneled Central Venous Catheter)
(Hickman, Broviac, Groshong) |
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Peripherally inserted central catheter
(PICC
line)"
(Per-Q-Cath, Groshong PICC) |
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Midline
catheter ((Per-Q-Cath Midline, Groshong Midline) |
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Implantable
Venous Access Port
(Port-A-Cath, BardPort, PassPort, Medi-port) |
Adapted
from: http://www.cancer.org
Risks and
complications:
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Infection
may occur, at or below the insertion point of the line |
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Clots
can form in the catheter |
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The
catheter might leak or break
Topic Search: Web |
When to call your doctor or nurse:
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You
cannot flush the catheter |
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You experience
itching, rash, hives, wheezing, trouble breathing, or chest pain after receiving chemotherapy |
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Temperature of 101.0°F or higher |
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Redness, pain, or swelling at or near the catheter site |
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Drainage from the skin around the catheter |
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The catheter
comes out or breaks
! Contact your doctor and nurse for specific
notification guidance. |
Resources and References
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
More on WebMagic: Port
or No Port?
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