Injections and drips
You can have cancer drugs as an injection or drip through a vein, through a central line, PICC line or Portacath. Sometimes you might have it as an injection into a muscle or under the skin.
Injection or a drip into your vein
Drugs given by injection usually work very quickly.
An injection into a vein is called an intravenous injection (IV). You have the injection through a small tube (cannula) put into a vein in one of your arms. This can stay in for a few days if needed.
Your nurse or doctor attaches a syringe to the cannula to inject the drug. The cannula has a rubber bung on it, and they might inject the drug through the rubber bung.
Some cancer drugs are diluted in a bag of fluid, and you have them as a drip.
Your nurse or doctor attaches the drip bag to the cannula, and the drug goes into your vein over 20 minutes or a few hours. Some drugs are given in this way over a few days, and a small electronic pump keeps the dose rate constant.
Injection into your muscle
Some drugs are injected into a muscle (intramuscular injections), usually in your buttocks, upper thigh or upper arm.
You might have stinging or a dull ache for a short time after this type of injection, but they don't usually hurt much.
Injection under your skin
You usually have injections under the skin (subcutaneous injection) into the stomach, thigh or top of your arm.
You might have stinging or a dull ache for a short time after this type of injection, but they don't usually hurt much. The skin in the area may go red and itchy for a while.
The video below shows you how to inject just under your skin (subcutaneously).
Nurse: This is a short film showing you how to give an injection just under your skin. This is called a subcutaneous or sub cut injection. This does not replace what your doctors and nurses tell you, so always follow their advice.
Voiceover: Subcutaneous injections may be part of your cancer treatment. Or, you may need them to prevent side effects of treatment, such as blood clots after surgery. Or to help control cancer symptoms, such as pain or sickness.
Most injections come in prefilled syringes.
Nurse: So, today I am going to show you how to give a subcutaneous injection. I am going to start by giving it into a practice cushion and then you can have a go at giving one yourself. Before you start, you need to get your equipment together. What you are going to need is an alcohol wipe to clean your skin, some cotton wool, a prefilled syringe and a sharps bin. It is important that you wash your hands with soap and water and dry them thoroughly before you start. Check that you have got the correct drug and that it is in date.
You can give the injection into the back of your arm, your tummy, your thigh or the outer part of your bottom. It is important that you vary where you give the injection. So it may be that you give it one day in your tummy and the next in your thigh.
So you start by cleaning the skin with the alcohol wipe and allowing it to air dry. Then you take the cover off the needle and pinch the skin up and hold it a bit like a pen and in an upright position, in a quick dart like motion pop it straight down into the skin. Then you press the plunger right to the end, quickly pull the needle out, dab it with cotton wool, pop the needle into the sharps bin. And then you need to wash your hands again.
So here’s what you are going to need. If you start by checking the drug and the expiry date. And then with the alcohol wipe give your skin a clean. That’s it give it a few seconds for the air to dry it. Ok and then if you want to pick up the syringe and take the cover off the needle. Then pinch your skin up and at a ninety degree angle gently push the needle in...then press the plunger...and then quickly remove it... dab your skin with the cotton wool and put the syringe in the sharps bin.
Central lines (skin tunnelled catheters)
Central lines usually go into your body in the centre of your chest. Then they run under your skin to a large vein by your collarbone. They are also called skin tunnelled catheters.
The only bit you can see is the length of line that hangs out of the small entry hole in the skin on your chest. This is a picture of a central line in place.
The central line can stay in your vein for many months. So you don't need to have needles into your hand or arm each time you have your cancer drug treatment.
You have a general or local anaesthetic before the central line is put in. When it's in, the doctor stitches it in place. Or they might put a dressing over it so it doesn't come out.
Your doctor and nurse can take blood from the line for tests. They can also use the line to give you fluids or other treatments such as antibiotics, if you need them.
How a tunnelled central line is put in
You lie on a tilted bed with your head turned to the left and lower than your feet.
The doctor cleans your skin with antiseptic solution and injects a local anaesthetic into your neck and chest.
They then put a needle through your skin and into a vein and thread a guide wire through the needle into your vein.
Next, they make a small cut in your neck and chest and, using a tunneler put the line through the cut in your chest passing it under your skin and out of the cut in your neck.
Then they remove the tunneler.
Next, they put a covered dilator over the guide wire into your vein.
Then they remove the guide wire and dilator leaving the cover in your vein.
The doctor feeds the line into the cover in your vein and then removes the cover.
Next, they take blood to check it is in the correct place then stitch the cuts in your neck and around the line and put dressings over them.
Finally, you have an X-ray to check the position of the line. The line is then ready to use.
PICC lines
PICC stands for Peripherally Inserted Central Catheter. You have it into a vein in your arm. It can be put in during an outpatient appointment under local anaesthetic.
The line runs up the vein inside your arm and ends in a large vein in your chest.
PICC lines can be left in for several months and are used similarly to central lines.
Portacaths (implanted ports)
A Portacath is a particular type of central line. It has a small chamber or reservoir that sits under your skin. You can feel the chamber but cannot usually see it unless you are very thin. It is also called an implanted port.
When you need treatment, your nurse puts a needle into the chamber and gives you injections or attaches a drip. The needle stays in place for as long as the treatment is given. Then your nurse removes the needle until your next treatment.
The main advantage of a Portacath is that you can't see it on the outside of your body. You don't have to have a tube coming out of your chest as you do with a central line.
But some people prefer a central line because they don't like having a needle put through the skin each time they need treatment.
If you prefer, you can have the area over the Portacath numbed with a local anaesthetic cream before the nurse puts the needle in.
Syringe drivers and syringe pumps
A syringe driver or pump can be:
- battery operated
- plugged into a normal electric wall socket
Some chemotherapy drugs are given using a syringe pump. You can also have a syringe pump or driver if you need a constant dose of a particular drug but find swallowing difficult.
People who are very ill, and might be dying, often have syringe drivers. Drugs given this way can give very good pain and sickness control. It is a very efficient way of having regular medicines at home.
A pharmacist or nurse puts the drug into a syringe. The driver or pump gives the drug from the syringe through a soft plastic tube to a needle that goes under your skin or directly into your vein. Your nurse fixes the needle in place with a see through plastic dressing stuck over the top.
Sometimes you have more than one drug in the syringe. Your nurse sets the pump so that you get exactly the dose you need each hour.
Your nurse might change the syringe every day or so. Some drugs can't be used in syringe drivers because they irritate the skin or don't completely dissolve in water.
