# Peripheral cannula for anticancer treatment: vein choice, siting and checks, including vesicants

Source: https://onco.cc/protocols/peripheral-cannula-for-anticancer-therapy/  
OnCo record `peripheral-cannula-for-anticancer-therapy` (Protocol). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

If your chemotherapy goes in through a small tube (cannula) in a vein in your arm, the nurse should choose a good vein in the forearm, avoid joints and the back of the hand, put in a fresh cannula, check it works before and during the drip, and ask you to say at once if it stings, burns or swells.

## Summary

Most guidance on peripheral cannulas comes from infection prevention, and much of the chemotherapy-specific detail from extravasation guidelines. The most recent graded guideline on the subject, the Japanese JSCN/JSMO/JASPO extravasation guideline (2024, GRADE), weakly recommends a central venous device rather than peripheral veins for people starting anticancer drugs (certainty B), recommends siting a peripheral cannula upstream (closer to the heart) of any previous puncture (weak, C), recommends against routine timed replacement of a peripheral cannula during anticancer treatment (weak, C), and, unless strict rate control is needed, weakly recommends against an infusion pump for peripheral anticancer infusions (C).

CDC/HICPAC (2011, updated 2017) asks for an upper-limb site in adults (Category II), never a steel needle for anything that can cause necrosis if it leaks (IA), and a midline or PICC rather than a short cannula when therapy will likely exceed six days (II); it finds no need to replace peripheral catheters more often than every 72 to 96 hours (IB) and makes no recommendation on replacing only when clinically indicated. epic3 asks for 2% chlorhexidine in 70% alcohol, allowed to dry, before insertion (Class D/GPP). Practice detail comes from UK network guidance (West Midlands, 2017): avoid joints, the antecubital fossa and the back of the hand; prefer large forearm veins; use a new cannula, the smallest gauge in the largest vein; repeat attempts above the previous site; check for blood return before and throughout; give vesicants first; consider central access for long vesicant infusions or after a previous extravasation.

## Fields

- Kind: Protocol
- Last checked: 2026-11-11
- Also known as: peripheral IV for chemotherapy; cannulation for chemotherapy; peripheral venous catheter for chemotherapy; PIVC for vesicants; short peripheral catheter chemotherapy; venflon for chemo

## Connected records

- protocols: [Anticancer treatment administration checks at the chair: assessment, independent double checks and line tracing](https://onco.cc/protocols/sact-administration-checks-at-the-chair/), [Choosing a venous access device for anticancer treatment: port, PICC, tunnelled line or cannula](https://onco.cc/protocols/venous-access-device-selection-for-anticancer-therapy/), [Management of chemotherapy extravasation by drug class](https://onco.cc/protocols/chemotherapy-extravasation-management/), [Midline catheters in cancer care: when to use one, insertion, care and limits](https://onco.cc/protocols/midline-catheters-for-anticancer-therapy/)
- technologies: [Infusion pumps, ports, and ambulatory chemotherapy devices](https://onco.cc/technologies/infusion-devices-vascular-access/), [Smart infusion pumps with drug libraries (Novum IQ, Plum, Infusomat Space, Agilia, Ivenix)](https://onco.cc/technologies/smart-infusion-pumps/)
- terms: [Infusion reactions, hypersensitivity and extravasation](https://onco.cc/terms/extravasation-infusion-reaction/)

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