Display Patient Information Leaflets

Date issued: October 2024 

Review date: October 2026

Ref: C-591/SF/Vascular/Your Hickman Line

PDF: Your Hickman Line.pdf [pdf] 265KB

Introduction

This article aims to provide support information about your Hickman Line procedure and how to care for it once it has been inserted.

What is a Hickman line?

A Hickman Line, also called A Tunnelled Line, is a thin flexible tube that is inserted into a large vein in your chest or neck. One end of the tube sits in a vein above the heart and the other end comes out from underneath the skin.

Part of the line lies under the skin between the exit site where it enters the vein, this is called the skin tunnel. The skin tunnel acts as a barrier to infection from the outside and allows your body to heal around the fleecy cuff. Once healed, the cuff will hold your line in place.

Why do I need a Hickman Line?

Your medical team will have recommended that you have a Hickman Line inserted as part of the care you are receiving. This type of device is recommended to patients who have a prolonged intravenous course of treatment. This makes it possible for you to have treatment without having needles frequently inserted into your veins, as well as gaining and taking blood products.

You can go home with a Hickman Line and carry on your treatment.

What are the benefits of a Hickman Line?

A Hickman Line can make treatment more comfortable for you:

• They are suitable for regular, long-term intravenous treatment such as chemotherapy, Total Parenteral Nutrition (TPN)

• Allowing you to have the medication given directly into your veins

• Reducing the irritation that certain drugs can cause to smaller veins

• Preventing the need for multiple needle punctures

• Preserving the long-term health of your veins

How do I prepare for the procedure?

As a patient you need to do very little to prepare for the insertion of the Hickman Line. When you arrive your doctor or nurse will discuss with you the insertion procedure, alternatives and potential problems. You will be offered an opportunity to discuss any issues and ask any questions with the clinician performing the procedure. You will normally be asked to provide consent for this procedure. Please inform your doctor or nurse of any allergies that you may have. It is important to tell the doctor or nurse before you attend for your procedure if you are taking any medication that thins your blood, you may need to stop taking this prior to your Hickman Line procedure. Your team will advise you if it is necessary and when to stop.

Screening for MRSA and MSSA will be required for all patients prior to line insertion. This will be arranged by your medical team in the days leading up to your procedure. You may be asked to use a special body wash prior to your procedure depending upon the results of these tests.

You can eat and drink as normal.

What happens when I have the Hickman Line inserted?

An outpatient appointment at the hospital will be offered to you for the Hickman Line insertion. Your line will be inserted in a procedure room. It is not an operation but the clinician inserting your line will treat it as a sterile procedure. They will use an ultrasound scanner to be able to find the best vein for the insertion. They will wear a gown and sterile gloves and will use sterile equipment. Your skin will be cleaned with an antiseptic, after sterile drapes will be placed over your neck and chest. Local anaesthetic is used to numb a small area of your neck and chest skin before the Hickman Line is inserted.

The catheter can be placed in different veins, the most common being the jugular vein which is located at the base of your neck. The line will be secured with a couple of stitches and a dressing.

You will have an echo done to see where the line sits, or an x-ray can be required instead. The procedure usually takes under an hour.

You can go home after your outpatient appointment and your Hickman Line is ready to be used.

If you have any concerns or questions, please ask the Vascular Access Team. They will be able to clarify your concerns and questions.

Caring for your Hickman Line

Your line has an entry site and exit site, both will be covered with dressings. The small dressing in your neck needs to be in place for 3 days, the big dressing in your chest that covers the exit site needs to be changed in the next 7 days after the line insertion. You will have a couple of stitches holding the line in place, they need to be removed in 21 days.

Your line needs to be flushed weekly when not in use and will be flushed pre and post medication given.

If you have treatment at home, many patients have the option to look after the line themselves or have a relative help. If this is the case an appointment will be made for you and your relative at the hospital to learn how to care for the line. Otherwise, a district nurse will come and will look after the line for you.

Potential risks

Insertion:

It can sometimes be difficult to find a suitable vein or to get the Hickman Line into the correct position. If this is the case, we may have to insert the Hickman Line into a different vein or discuss alternative options with you.

Infection through the skin:

It is possible for an infection to develop inside or around the place where the Hickman Line goes into the vein (this is the insertion site). Contact your healthcare team immediately if you experience any of the following symptoms: pain, redness or swelling at the insertion site, discoloured fluid coming out from the insertion site, a fever or chills.

Local bruising or bleeding in the insertion site:

It is common to experience some bruising or bleeding at the insertion site. Please inform us of any blood thinning medication you are taking before we insert the Hickman Line, as this can increase your risk of bleeding.

Stenosis:

If you need the catheter for a long period of time there is a risk that the vein becomes narrowed or stenosis. If this happens then you need the catheter into a different vein.

Lung puncture:

This happens when the lung is accidentally punctured during the procedure. It is very rare to happen, and if so, we will keep you in hospital until the lung is healed.

Extravasation:

This is damage caused by leakage of the medication from the vein to the surrounding tissue during intravenous administration. Extravasation of some chemotherapy drugs from ports can cause tissue necrosis (tissue damage) and may need surgical removal of the port and the affected tissue.

Break or split line:

A break in the catheter or port may lead to extravasation.

Blood clots (thrombosis):

It is possible for a blood clot to develop around the Hickman Line. If a clot does form you may be given medication to break down the clot and your line may need to be removed. Contact your healthcare team immediately if you experience any of the following symptoms: pain, swelling, discomfort in the neck or arm or redness on the side of the insertion site.

Can I bathe or shower?

You can shower with Hickman Line in place. We ask that you try not to soak the dressing. The dressing that covers the insertion sites should be in place when taking a shower, at least while the stitches are in situ. If the dressing is loose after your shower, it should be replaced.

Can I do my normal activities, after the Hickman Line insertion?

You can resume normal activities after the procedure, but you may have some discomfort in your neck, chest. Take pain relief.

You can't go swimming while a Hickman Line is in place.

Hand hygiene

You or any person caring for your Hickman Line, should wash their hands and put on gloves prior to accessing or dressing the line.

Dressing changes

You will have two dressings in place, a small dressing in your neck that should stay for 3 days, and a bigger dressing covering the line in your chest that should be changed 7 days after the insertion of the line. After should be changed weekly until, by your district nurse or at the hospital.

When and how will my Hickman Line be removed?

Hickman Lines are usually removed at the end of treatment. Rarely, they are removed because of problems.

You will be given an outpatient appointment, and the removal of the Hickman Line is like the insertion. A small cut will be done just above the wings to loosen the cuff that keeps the line in place, as soon as the cuff is free the line will be removed, and the small cut will be stitched up and covered with a dressing. The stitches are dissolvable.

Any problems?

To report any irregularities or complications such as swelling in your shoulder or neck, redness, leakage or pain around the Hickman Line insertion site, please contact the team that is caring for you immediately.

Rarely some bleeding can occur from the insertion site. If you notice a lump developing or if you see any bleeding from the skin, apply pressure to the area and contact the team that is caring for you.

If you develop any shortness of breath or have pain in your chest within a few hours of the Hickman Line being inserted, then you should go to the Emergency Department immediately.

Contact details for advice: Derriford Hospital, 01752 202082