SACT may be administered via a peripheral cannula or a central venous access device (CVAD). A peripheral cannula is used for bolus injections and short or intermittent infusions of both vesicant and non‐vesicant drugs (Box 23.4). However, this device is associated with phlebitis and increased risk of extravasation (Gabriel [80], INS [111], Scales [219]). A central venous catheter is useful for patients with poor venous access, those at high risk of extravasation and those undergoing long‐term, high‐dose or continuous infusional chemotherapy (Gabriel [80], Weinstein and Hagle [265], Wilkes [268]). These devices are associated with infection and thrombosis (Dougherty [57]).

For the peripheral route, a cannula may be used. The insertion site of choice should be the large veins of the forearm (cephalic or basilic) as these are easier to access, reduce the risk of chemical phlebitis and result in fewer problems if extravasation should occur (Weinstein and Hagle [265]). The next area of choice would be the dorsum of the hand, then the wrist. The antecubital fossa should only be used as the last resort as it can limit movement and is associated with problems if extravasation occurs in this area (Gabriel [80], Weinstein and Hagle [265]). The general rule is to start distally and proceed proximally where possible and also to alternate the arms (Weinstein and Hagle [265]) to ensure that the same veins are not being used and damaged by chemical and mechanical irritation (Dougherty [59], RCN [201]).

When using the peripheral intravenous route, the following principles should be adhered to.

In addition, where possible, a new site should be used for vesicants, to ensure the vein is healthy and patent, although this may not always be possible. There are some controversial issues related to peripheral intravenous cytotoxic drug administration (Box 23.5).

Central venous access devices have the advantage of providing a more reliable form of vascular access (Table 23.1). This is because the problems associated with peripheral devices, such as phlebitis, venous irritation and pain, are eliminated as central venous access enables rapid dilution and circulation of the drug. However, extravasation can still occur because of catheter tip malposition, catheter malfunction, a damaged catheter, port needle dislodgement or fibrin sheath formation along the length of the catheter, faulty equipment, human error and system problems (Dougherty [57], Mayo [150]).

Vascular access devices are often inserted without an assessment of the suitability of the vein for the patient‐intended therapy, which can result in repeated attempts at cannulation as well as device failure during treatment (Moureau et al. [159]). Complications related to poor choice of device and vein suitability such as occlusion, chemical phlebitis and infection can lead to a delay in the patient's treatment as well as causing unnecessary discomfort and pain for the patient. A vessel health preservation (VHP) framework was developed from the US version in the UK (Jackson et al. [115]); this focuses upon vein assessment, drug assessment, best vascular access device and regular evaluation of the device and therapy required (Hallam et al. [93]) (Figure 23.3). The use of the tool was positively evaluated by nurses who stated that it assisted in making vein assessments in clinical practice (Hallam et al. [93]). The tool has demonstrated improved success of insertion, improved patient outcomes as well as time saved through efficiency (Moureau and Carr [158]).