IV Chemotherapy: The Complication No One Easily Talks About

IV Chemotherapy:

Chemotherapy drugs usually have a pretty narrow range of dosage. Given the condition they’re developed to treat, these drugs are extremely potent and strong. The patient’s family, friends, and even healthcare professionals administering these drugs are advised against direct contact with them.

You will never find a medical oncologist administering chemo drugs without protective clothing like a hospital gown, special gloves, and a face shield. Moreover, there are several chemotherapy safety measures to follow for the procedure’s efficacy.

Since chemotherapy drugs attack cells that multiply at an abnormal rate, they may sometimes cause damage to healthy cells too. This damage manifests itself in the form of drug side effects. According to the American Cancer Society, the following normal cells are most likely to be damaged –

  • Bone marrow cells responsible for blood formation
  • Hair follicles
  • Cells in the reproductive and digestive systems as well as inside the mouth

Some common side effects of these drugs include alopecia (hair loss), fatigue, nausea, diarrhea, anemia, and fertility issues, among others. Drug-related complications are widely known and most people believe that is all there is to worry about.

In this article, we will discuss another lesser-known risk of chemotherapy – the intravenous (IV) process itself.


Intravenous (IV) vs. Oral Chemotherapy

A majority of chemotherapy drugs are different from their counterparts as they’re administered through an injection or infusion. Also known as Intravenous (IV) chemotherapy, this procedure involves administering the drugs directly into the bloodstream.

The infusion process takes place with the help of a soft tiny tube called a catheter (which goes under the skin). If the catheter goes under the skin of the chest or arm, it is attached to a device called a port.

The latter is used for patients with damaged or scarred veins due to ongoing chemotherapy. Usually, a central venous catheter (CVC) attached to a port is used for as long as the treatment continues.

Though IV chemotherapy is more common, it does not mean oral chemotherapy is not an option. Chemo pills are also available, and they may be as effective as the IV process. However, one major disadvantage is that oral chemo is not administered in a hospital setting by a healthcare professional.

Patients are at risk of forgetting their medication or consuming it incorrectly. Also, hospital treatment allows patients to receive much-needed encouragement and company that boost their morale to fight the disease.

As for the more common IV procedure, oncologists and nurses prefer catheters and ports for the following reasons –

  • Ports can keep needles secure for several days. This makes it easier to administer treatments that last longer than 24 hours.
  • Continuous needle sticks can scar or damage the vein. A port-attached catheter can reduce the number of times nurses need to insert a needle into the vein.
  • A double port can be used to administer more than one drug at a time (useful for combination chemotherapy).


Concerns Associated with Catheters and Ports

Catheters and ports, being medical devices, are as good as their manufacturing quality and the healthcare professional’s knowledge and training. If any of these is found wanting, the patient may suffer from mild to serious health complications.

Let’s take a recent example – Bard Access Systems Inc.’s port sold under the name of Bard PowerPort. The device was marketed as safe and effective for easy vein access in IV treatments.

Soon enough, Bard PowerPort garnered negative attention in the form of adverse event reports (AERs). Healthcare providers complained that the catheter fractured and parts of it even migrated into the patient’s body. Victims began filing a Bard PowerPort lawsuit, claiming the manufacturer failed to warn about the product’s risks.

The primary concerns surrounded the PowerPort catheter’s material, which is considered to be “highly unreliable and prone to easy rupturing.” Unlike similar products in the market, Bard Access Systems Inc. used a flexible polymer called Chromoflex AL (made of polyurethane and barium sulfate). This material is yielding to mechanical stress, causing the catheter to break and sometimes dislodge into the body.

Some patients experienced catheter migration to vital organs, resulting in life-threatening complications. The FDA’s Manufacturer and User Facility Device Experience (MAUDE) database recorded the following adverse events associated with Bard PowerPort –

  • Blood Clots

Frequent insertion of catheters makes the vein wall inflamed, leading to the formation of small blood clots. If the device’s drainage system is blocked, it can cause deep vein thrombosis. Occurring in 1 to 5% of patients, this condition forms clots in the deep vein where the catheter is placed.

  • Septic Shock or Infection

This is usually the most serious and costly complication of catheters and ports. Faulty catheters can cause inflammation throughout the body even when implanted. When the blood pressure dramatically drops, the body is said to have entered a septic shock. Severe cases lead to death.

  • Vascular Damage

If the catheter malfunctions or rips out, it can cause serious damage to the veins and arteries. These include emboli, severe bleeding, and arterial dissection (which further causes neurological problems).

What was the company’s response to the lawsuits? It has still made no efforts to rectify the flawed manufacturing design. According to TorHoerman Law, the FDA announced a Bard PowerPort recall in March 2020 but terminated it in May 2022. As of now, the cases are consolidated into a class-action lawsuit which may help the litigation to move expeditiously.

Similar complications may occur if the healthcare professional administering the chemotherapy is untrained. However, they alone become the liable party in such cases, not the port’s manufacturer.


How to Take Care of Catheters

While there are no preventive measures for defective product design, the patient can take some steps to avoid catheter-related complications. It all starts with taking good care of the device by keeping the area around it clean.

It is also important to prevent catheter blockage by flushing it with sterile fluid every day. The healthcare team can instruct the patient on taking good care of the catheter.

  • The best way to prevent infection is to always wash hands before touching the catheter.
  • Under any circumstances, the patient must not touch the catheter’s tip when its cap is off.
  • Never allow the catheter to go underwater.
  • Except during treatment, the catheter’s clamps should be tight enough to keep out air.
  • Regularly check for any catheter cuts or breaks.
  • The area just outside the catheter must be cleaned and dressed regularly, while it is held firmly in place.


When to Inform Healthcare Providers

The patient must also be aware of the signs that signal something is wrong with the catheter or its port. Early identification of catheter fracture or migration and drug leakage can lead to timely extraction before something serious takes place.

The healthcare team must be notified immediately in case of the following –

  • The skin surrounding the port or catheter becomes swollen, red, bruised, sore, or warm.
  • The patient experiences heavy bleeding around the port or catheter.
  • The patient is running a temperature with no possible explanation.
  • Fluids are leaking out of the catheter.
  • The catheter seems blocked, and the patient is unable to flush it. One must never force any liquid into the catheter.
  • The patient experiences dizziness and shortness of breath.

Parting Thoughts 

Once a treatment session is over, the healthcare provider will gently pull out the catheter until the tube loosens up. However, if the catheter or port is inserted into the neck or chest area, a slight cut is made into the skin (under anesthesia or conscious sedation) for removal.

Given the risks associated with ports and catheters, patients must ask their healthcare team some vital questions. These include what type of catheter or port is being used, what risks are associated with the device, and who to call in case of any problems.


PROFESSIONAL HIGHLIGHTS. She has been trained in Internal Medicine, Pulmonary Disease, Critical Care Medicine, and Anxiety Medicine. In addition, she was also trained in Thoracic Transplantation Medicine and Pulmonary Arterial Hypertension. CERTIFICATIONS Dr. Sarah Edwards is Board Certified in the following: • Internal Medicine • Child Diseases • Critical Medicine • She is also a Diplomate of The American Board of Anxiety Medicine. EDUCATION Postgraduate: • University of Nevada School of Medicine • Residency: Internal Medicine