Chemotherapy Infusion: What to Expect

Receiving chemotherapy through an IV can feel frightening and unfamiliar. Understanding what will happen — before, during, and after your infusion sessions — helps reduce anxiety and helps you take an active role in your own safety.

This guide focuses on the infusion experience and what you need to know at home between sessions. Your oncology team will provide guidance specific to your cancer type, treatment regimen, and individual circumstances.

How Chemotherapy Is Delivered

Chemotherapy drugs can be given in several ways, but IV infusion is the most common for systemic treatment:

Infusion center: An outpatient oncology facility where you receive treatment in a reclining chair or private room, monitored by oncology nurses. Most chemotherapy is given this way.

Hospital inpatient: Some regimens — particularly those with very high toxicity, long infusion times, or those requiring close monitoring — are given during a hospital admission.

Home infusion: Some drugs (e.g., continuous 5-fluorouracil infusions) can be delivered at home via a portable pump connected to your PICC or port over 24–48 hours.

Your vascular access: Most chemotherapy requires a central line — PICC, port, or tunneled catheter — because many chemo drugs are highly irritating to veins and will cause severe damage if they infiltrate (extravasate) outside the vein. An implanted port is the most common long-term access for chemotherapy patients because it requires no maintenance between cycles and allows maximum physical freedom.

Before Your Infusion: Preparation

Lab work before each cycle

Most chemotherapy cycles begin with blood work — a complete blood count (CBC) and sometimes additional labs. Your oncologist reviews these results before approving the treatment. If your counts are too low (particularly white blood cells or platelets), your treatment may be delayed until your counts recover. This is not a setback — it is the right decision for your safety.

Plan ahead: Labs are often drawn 1–2 days before your infusion, or on the morning of. Confirm the timing with your oncology team.

Pre-medications

Most chemotherapy regimens include pre-medications given before the main drug. These are designed to prevent reactions and manage side effects:

Anti-nausea medications (antiemetics): e.g., ondansetron (Zofran), granisetron, dexamethasone, aprepitant — given IV before chemo to prevent vomiting during and after treatment. Some are also prescribed as oral medications to take at home in the days following.
Steroids: Dexamethasone is commonly used both for nausea control and to reduce the risk of hypersensitivity reactions.
Antihistamines: Diphenhydramine (Benadryl) and/or ranitidine may be given before certain chemo drugs (e.g., taxanes like paclitaxel, platinum agents) to reduce hypersensitivity risk. These cause drowsiness — arrange a driver for your infusion appointments if antihistamines are part of your regimen.
IV fluids: Some drugs require significant hydration before and/or after infusion to protect the kidneys (e.g., cisplatin).

Pre-medications are given IV over 20–60 minutes before the main chemotherapy. Budget extra time for this.

What to bring to your infusion appointment

Photo ID and insurance card
Medications list (bring ALL medications, vitamins, and supplements)
Food and snacks — some people find eating light before infusions helpful; others prefer not to eat beforehand. Know what works for you.
Entertainment: books, tablet, headphones, or something to occupy you during a potentially long infusion
A layer of clothing — infusion centers are often cool
A trusted companion if desired — many centers welcome one person to accompany you
Your medication list and any questions written down

During the Infusion

Arrival and check-in

You will be identified (name and date of birth confirmed against your wristband or record) — this happens multiple times and is a safety requirement, not an inconvenience
Vital signs taken (temperature, blood pressure, pulse, weight)
Your port or PICC will be accessed/flushed
Blood may be drawn for pre-treatment labs if not already done

The infusion sequence

Pre-medications (antiemetics, steroids, antihistamines, IV fluids as prescribed) — 20–60 minutes
First chemotherapy agent — rate varies widely by drug (15 minutes to several hours)
Additional agents in the regimen
Post-infusion fluids (if required)
Disconnect, flush catheter
Post-infusion observation period (15–30+ minutes for some regimens)

Total time: Depending on your regimen, plan for anywhere from 2 to 8+ hours. Ask your oncology team at the start: “How long should I expect to be here today?”

Monitoring for reactions

For some chemotherapy drugs — particularly taxanes (paclitaxel, docetaxel), platinum agents (oxaliplatin, carboplatin, cisplatin), and monoclonal antibodies — severe hypersensitivity reactions can occur during the first infusion. Your nurse monitors you closely, particularly in the first 15–30 minutes:

The infusion starts slowly (low rate)
Your nurse checks on you frequently
Emergency medications (epinephrine, steroids, antihistamines) are immediately accessible

Tell your nurse immediately if you develop:

Flushing, rash, or hives
Shortness of breath, wheeze, or chest tightness
Back pain, particularly if sudden and severe (a reaction to some agents)
Throat tightening or difficulty swallowing
Dizziness or lightheadedness
A feeling that “something is wrong” — trust your instincts

Most reactions are manageable if caught and treated quickly. Reactions are more common on the first or second infusion of a new drug; subsequent cycles are usually well-tolerated.

Extravasation: the most important catheter safety issue in chemotherapy

If chemotherapy leaks out of the catheter into surrounding tissue — called extravasation — it can cause severe, permanent tissue damage. This is why central access (PICC, port) is strongly preferred for chemo.

Signs of possible extravasation:

Pain, burning, or stinging at the infusion site during the infusion
Swelling or puffiness around the access site
The infusion slowing down or stopping unexpectedly
Redness or discoloration developing around the site

Tell your nurse immediately if you notice any of these during a chemotherapy infusion. Do not wait for the nurse to come by. Some extravasation injuries require urgent antidote treatment within minutes to hours.

After the Infusion: The First 24–48 Hours

Acute side effects vary widely by regimen but commonly include:

Nausea and vomiting: Can begin within hours or be delayed 1–2 days. Your oncology team prescribes antiemetic medications for home use — take them as scheduled, not just when you feel nauseous. It is much easier to prevent nausea than to treat established vomiting.

Fatigue: Often peaks 2–3 days after treatment and gradually improves before the next cycle.

Changes in appetite and taste: Food may taste metallic, bitter, or simply wrong for several days. Small, frequent meals and cold foods (which have less smell) are often better tolerated.

Hair loss (for some regimens): Typically begins 2–3 weeks after the first treatment. Not all chemotherapy causes hair loss — ask your oncology team what to expect with your specific regimen.

Bowel changes: Some drugs cause diarrhea; others cause constipation. Your team will advise on preventive management.

Safe handling of bodily waste

For 48–72 hours after chemotherapy, your urine, stool, vomit, and other bodily fluids may contain traces of chemotherapy drugs. These can be hazardous to others:

Use the toilet normally. Flush twice with the lid closed.
If you are incontinent or cannot manage the toilet independently, caregivers handling your bodily waste should wear disposable gloves.
Wash any clothing or bedding that comes into contact with body fluids separately from household laundry, with two wash cycles.
Pregnant women and children should minimize exposure to these waste products during the first 48–72 hours.

Your oncology nurse will provide specific guidance for your regimen.

Understanding the Nadir

The nadir is the point in your treatment cycle when your blood cell counts are at their lowest — typically 7–14 days after chemotherapy (the timing varies by drug and regimen). During the nadir:

Your white blood cells (particularly neutrophils — the infection-fighting cells) are at their lowest
Your risk of infection is at its highest
Your platelet count may also be low, increasing bleeding risk
You may feel most fatigued during this period

Your oncology team will tell you the expected nadir timing for your regimen. During the nadir, fever is an emergency.

Neutropenic Precautions

When your white blood cell count (specifically your absolute neutrophil count, or ANC) falls below a safe threshold, you are neutropenic — meaning your body cannot effectively fight infection. Precautions during this period:

Fever = Emergency

If you develop a temperature ≥38°C / 100.4°F (some teams use ≥38.3°C as their threshold) during the nadir or at any point when your counts are known to be low:

Call your oncology team or go to the ER immediately — do not wait until morning. This is called febrile neutropenia and is a medical emergency. IV antibiotics must be started within hours to prevent life-threatening sepsis.

Do not give acetaminophen (Tylenol) to reduce the fever before calling — this can mask the fever and delay critical treatment. Follow your oncology team’s specific fever management instructions.

Everyday precautions during neutropenia

Hand hygiene — yours and everyone around you. This is the single most effective prevention.
Avoid people who are sick. If household members have colds, flu, or gastrointestinal illness, keep your distance.
Avoid large crowds in enclosed spaces during the nadir period if possible.
Food safety: During periods of severe neutropenia, your team may recommend dietary modifications:
- Avoid raw or undercooked meat, fish, poultry, and eggs
- Avoid raw sprouts, unwashed fruits and vegetables
- Avoid unpasteurized dairy or juice
- Wash all produce thoroughly
- Avoid buffets and cafeteria-style food with poor temperature control
Avoid live vaccines during chemotherapy. Consult your oncology team before any vaccination.
Dental work: Defer non-emergency dental procedures until your counts recover; some procedures require antibiotic prophylaxis — coordinate between your dentist and oncologist.
Pets: Avoid cleaning litter boxes, fish tanks, or bird cages. Avoid contact with animal feces. Wash hands after handling pets.
Gardening: Soil contains fungal spores — wear gloves and wash hands thoroughly.

Growth factor injections (G-CSF)

Your oncologist may prescribe filgrastim (Neupogen), pegfilgrastim (Neulasta), or similar growth factor medications to stimulate white blood cell production and reduce the depth or duration of the nadir. These are injected under the skin — either by a nurse or by you or a caregiver at home. Follow the prescribed schedule carefully.

Managing Side Effects Between Cycles

Mouth sores (mucositis)

Some regimens cause painful sores in the mouth and throat. Prevention and management:

Gentle oral rinses (salt water or sodium bicarbonate rinse) several times daily
Soft toothbrush or foam swabs
Avoid alcohol-based mouthwashes, spicy or acidic foods
Oral mucositis medications if prescribed (e.g., magic mouthwash)
Severe mucositis affecting eating or drinking requires prompt reporting to your oncology team

Peripheral neuropathy (numbness/tingling in hands and feet)

Common with platinum-based agents (oxaliplatin, cisplatin) and taxanes (paclitaxel, docetaxel). Can range from mild tingling to significant numbness, pain, and coordination problems. Report any new or worsening symptoms at each visit.

Fatigue management

Rest when you need to rest — do not push through exhaustion
Light activity (short walks) can actually help with chemotherapy-related fatigue
Protect sleep
Save your energy for what matters most to you on a given day

When to Seek Urgent Help

Go to the Emergency Room immediately (or call 911) for:

Fever (≥38°C / 100.4°F) at any time during chemotherapy treatment — especially in the nadir window; this is febrile neutropenia until proven otherwise
Difficulty breathing, chest pain, or persistent cough — could indicate pulmonary toxicity, pulmonary embolism, or infection
Severe or uncontrolled vomiting (unable to keep down fluids for 24 hours, signs of dehydration)
Confusion or change in mental status (chemotherapy can rarely cause neurological effects; infection can cause confusion in neutropenic patients)
Unusual or significant bleeding — nosebleed that won’t stop, blood in stool or urine, unexplained bruising
Signs of extravasation during or after infusion
Port or PICC problems: catheter falls out, swelling, chest pain

Call your oncology team (during hours) for:

Nausea/vomiting that is not controlled by your prescribed medications
New or worsening pain
Diarrhea (more than 4 loose stools per day)
Rash developing between cycles
Concern about a treatment side effect
Any question about your medications or treatment plan

This guide is for educational purposes. Chemotherapy protocols vary enormously by cancer type, stage, and individual patient factors. Always follow the specific instructions of your oncologist and oncology nursing team.