Some treatments can be performed at home rather than in a hospital setting.

Some treatments can be performed at home rather than in a hospital setting. While this may be a bit daunting for both patients and caregivers, patients often have the final say in what will be done at home. Talk with your doctor about it and express your concerns.

Intravenous (IV) medicines (including chemotherapy), subcutaneous injections (shots given under the skin, also known as "sub-Q" injections), intramuscular injections (shots given into a muscle, also called "IM" injections), and other treatments may be given at home.

Most likely, a home health or infusion nurse will bring the necessary supplies and equipment to the patient’s home, and either administer the treatments or teach the patient and/or caregiver how to do so. “Written instructions, videos, and a lot of practice will be offered to make sure you are comfortable performing treatments at home,” says Kimberly A. Stump-Sutliff, MSN, RN, AOCNS, associate medical editor with the American Cancer Society in Atlanta.

Intravenous Medications

The needles and catheters used to give chemotherapy and other drugs as part of cancer treatment can scar or weaken veins. “Instead of having a needle put in every time you need treatment, your doctor or nurse may talk to you about getting a central venous catheter (CVC),” says Stump-Sutliff. The CVC is a bigger catheter that is placed into a large vein in the chest or upper arm. It stays in place throughout treatment so that IV medicines can be given more easily and will cause less wear and tear on veins when you are undergoing frequent or continuous treatments. Blood can also be drawn from CVCs. Many people talk about CVC options with their doctor even before starting treatment. A discussion with a doctor can help determine whether a CVC is needed based on many factors, including the type of drug being given, how long you will be getting treatments, and how long it takes to infuse each dose.

Many different kinds of CVCs are available. Some are soft tubes that stick out of the skin and require no needles after they are put in. Examples of this type are PICC (peripherally inserted central catheter) lines, Hickman catheters, and triple lumen catheters. These may be placed in the doctor’s office, an outpatient clinic, or during surgery, depending on which type you are getting. For instance, PICC lines are inserted through the arm into a central vein and do not require surgery, whereas Hickman catheters are tunneled deep beneath the skin into a central vein and must be surgically placed.

Another type of CVC is a port, such as a Port-a-Cath, InfusaPort, PasPort, or subclavian port, Stump-Sutliff says, which is a small plastic or metal disc, about the size of a quarter, covered with a rubber seal with a thin tube coming out of it. The thin tube that is attached to the port is threaded into a nearby large vein. “Ports are permanently placed under the skin of the chest or arm during surgery,” she added. “Special needles are then stuck through the skin into the top of the port to use it.”

In many cases, these implanted devices are easier to manage because there is nothing sticking out of the skin when they are not in use. The devices can usually be felt and seen, but they do not hurt, and the only special treatment is to not injure the area around them, says Stump-Sutliff.

Important Precautions

Anything that goes in the CVC must be sterile in order to avoid spreading germs into the bloodstream and causing infections. Because IV equipment is used only once, it must be handled carefully to keep germs out of the body. After use, the materials are thrown out and replaced with new, sterile equipment fresh out of the package.

Stump-Sutliff compiled a checklist of things you need to know if you have a port that has a needle in it or any other type of permanent CVC:

• Keep extra clamps handy at all times. If a tube breaks and you notice blood leaking out, clamp the tube between your body and the leak and call your doctor right away.
• If the catheter or needle comes out or the site begins to bleed, call your doctor or nurse right away.
• Keep the catheter site clean and dry. Shower facing away from the showerhead. Try to keep the dressing dry, but change it or call the nurse if it gets wet.
• Use a calendar to record when you change injection caps and dressings and to note supply delivery dates. Your doctor or nurse will tell you what things you need to keep track of.
• Wash your hands well with soap and water before touching the catheters.
• Avoid activities that may pull the CVC or rub on the dressing.
• Check the IV site daily to be sure the tape is holding the IV in place and the dressing is clean and dry.
• Look for any tenderness, pain, redness, burning, swelling, warmth, or drainage (bloody, yellowish, or clear) at the IV site. Any of these might mean the site is getting infected.
• Take your temperature each day to see if you have a fever.
• If you notice any of the above symptoms, take off the dressing, look at the IV site, and tell your doctor or home health nurse what you found.