How common is chemo through peripheral IV?

Double-Helix, BSN, RN · Oct 22, 2016

What is your facility's policy regarding administration of chemotherapy? Many hospitals only allow nurses who have received special education/training in chemotherapy to administer those drugs. That education may help you feel more comfortable.

Typically, chemotherapy is given through a central line, because all chemo meds are either irritants or vesicants, and safety of delivery is increased through a central line. However, it can be given through a PIV in some circumstances, such as early in diagnosis when central line access hasn't been established, or when long term infusions aren't needed. The IV should either be newly placed, or you should be certain of placement within the vessel evidenced by rapid blood return before, during, and after administration. In my experience (which I'll admit is limited), the only chemo agents I've given through a PIV are those given IV push, when blood return can be checked throughout administration. I haven't given infusions through a peripheral line.

globalRN · Dec 13, 2016

Still fairly common if the chemotx has a finite # of cycles or is every 3 wks or longer.

If the patient has good peripheral veins or the patient declines to have a port or a PICC

KelRN215, BSN, RN · Dec 14, 2016

In pediatrics, I've never seen chemo given via peripheral IV. I have had parents of pediatric oncology patients who were cancer survivors themselves and told me that they never had any sort of central access during their treatment.

la_chica_suerte85, BSN, RN · Dec 17, 2016

It depends. I'm work in pediatric hemonc and we do sometimes do chemo through PIV (it's done much more frequently in the infusion center than on the floor). It is almost exclusively done on the big kids (with big, wonderful veins) who are in for some kind of germ cell tumor or osteosarcoma (so, they get cisplatin, etoposide, bleomycin, etc.) and, for whatever reason (i.e. body image, being squicked out about CVCs, not reliable to care for a CVC properly, etc.) prefer to have a new PIV placed every time they're inpatient. Of course, just like with a CVC, blood return must be verified before administration. If extravasation occurs, the intervention depends on the type of chemo - some you don't want spreading, so you must apply cold packs. Some carry a risk of permanent damage so a central line is mandatory. At any given time, we have probably 3 or 4 patients who are getting peripheral IV chemo. Very infrequently will there be an issue with infiltration and it usually happens with the hydration fluids being run during the day.

At the end of the day, it would be nice if everyone had a nice and easy CVC to deal with but, I guess if I was a teenage boy with testicular cancer, I would take the PIV over a CVC. The whole thing is a lot to take in and I think I would rather leave inpatient treatment without any vestige of treatment (and another responsibility and restriction on things I can do in my life) in between cycles, if that makes sense. The only time it kind of freaks me out if I struggle to get blood return out of a PIV that has been in for a little while but that doesn't happen too often.

Certifiable, BSN, RN · Mar 10, 2017

Very common.