Cytotoxic agents can be administered in a variety of ways, including:
a. Oral (by mouth)
b. Topical (on the surface of the skin as a cream or lotion)
c. Intravenous (into a vein or IV)
d. Intramuscularly (into a muscle or IM)
e. Subcutaneous (under the skin or SQ)
f. Intra-arterial (into an artery)
g. Intrathecal (into the central nervous system via the cerebrospinal fluid)
h. Intrapleural (into the chest cavity)
i. Intraperitoneal (into the abdominal cavity)
j. Intravesical (into the bladder)
k. Intralesional (into the tumor)
The term parenteral is used to describe drugs given intravenously, intramuscularly, or subcutaneously. The intravenous route is most often used. Intramuscular and subcutaneous injections are used less often because many drugs can be very irritating or even destroy skin or muscle tissues. Giving cytotoxic drugs via an IV route gets the drugs quickly throughout the body. IV therapy may be given through a vein in the arm or hand or through a vascular access device (VAD), using a catheter implanted into a larger vein in the chest, neck, or arm. VADs are used in cancer treatment to give several drugs at the same time, for long-term chemotherapy, for continuous infusion therapy, and to give vesicants (drugs that can destroy tissues if an IV infiltrates.)
There are several types of VADs:
a. A PICC (peripherally inserted central catheter) provides continuous access to a peripheral vein in the arm for several weeks or longer.b. A midline catheter is a VAD that is not inserted as far as a PICC. It may be used for intermediate length therapy when a regular peripheral IV is not advisable or available.c. A tunneled central venous catheter is a type of VAD with multiple lumens, surgically placed in a large central vein, with a catheter tunneled under the skin.d. Some patients benefit from an implantable VAD. An implantable device includes a port of plastic, stainless steel, or titanium with a silicone septum attached to a catheter surgically placed under the skin of the chest or arm in a large or central vein. The port can be accessed with a needle when cytotoxic drugs need to be given.
For more information about PICC lines and midline catheters, you can access the RnCeus.com course PICC Line Care and Maintenance: An Introduction
Drag your cursor over the picture below to highlight major veins