What is a Hickman line?
A Hickman line is a long, hollow tube made from silicone rubber.
The Hickman line is put in (tunnelled) under the skin of your chest and into a nearby vein. One end of the line goes into a large vein just above your heart. The other end comes out from under the skin on your chest.
The line is usually sealed with a special cap or bung. This can be attached to a drip or syringe containing your chemotherapy or medication. Sometimes it divides into two or three lines, which allow you to have different treatments and medications at the same time.
What is Hickman line used for?
A Hickman line can be used for various purposes:
- Chemotherapy
- Blood transfusions
- Antibiotics
- Intravenous (IV) fluids
- Liquid food (TPN) if you’re not able to eat
- To take samples of your blood for testing
How is a Hickman Line inserted?
Hickman lines are inserted in the X-ray department using ultrasound and X-ray. The line is put in through the vein at the bottom of the neck, or the vein below the collarbone.
You will be asked to lie on your back on the X-ray table. You will be connected to monitoring equipment to check your heart tracing, blood pressure, and blood oxygen levels. It is very important to insert Hickman lines under sterile conditions to avoid infection. Hair on the skin at the entrance or exit sites may be removed. The radiologist will put on a sterile gown, theatre cap, and mask, and you may also need to wear a theatre cap.
The skin on your chest and neck is cleaned with antiseptic and then covered with sterile towels. Local anaesthetic is used to numb the skin over the vein (the ‘entrance site’) and a point lower down the front chest wall (the ‘exit site’), as well as the skin in between (which will form the tunnel). A small incision is made at the entrance and exit sites. The tube is then tunnelled under the skin from the exit site to the entrance site. The tip of the line is gently threaded into a large vein towards the heart. The position of the line is adjusted until it is satisfactory. The line is secured at the exit site with a stitch. Another stitch is used to close the small incision at the entry site. A dressing is placed over these. The Hickman line is flushed to ensure there is no clotted blood within it, and it is then clamped off. The line is taped to the chest in a loop.
The procedure takes 30–45 minutes.
Important information
What stops the Hickman line from falling out?
There is a small cuff around the Hickman line. It can be felt under the skin, just above the exit site. The tissue under the skin grows around this cuff in about three weeks and holds the line safely in place.
Until this happens, a stitch will hold the line in place. This usually stays in for about three weeks.
How do I care for my Hickman line?
When the line is not being used, there is a small risk of it becoming blocked. A small amount of fluid is flushed into the line using a syringe once a week to stop this from happening. The caps or bungs at the end of each line should also be changed every week.
The exit site needs to be cleaned once a week to reduce the risk of infection. If you have a dressing on the site, it will also need to be changed weekly. Sometimes a special dressing, such as an antibiotic disc, may be put over the exit site to help reduce the risk of infection.
If you feel able, the nurses at the hospital will teach you how to flush the line and change the dressings. They can also show a relative, partner, or friend how to do this.
At home, it is safe to shower or bathe with your central line in. You can place your line in a plastic bag and tape it to your skin so that it does not get wet. If having a bath, keep the exit site out of the water.
Swimming should usually be avoided because of the risk of infection. It is also best to avoid sports such as golf, tennis, or strenuous gym exercises, as these could dislodge the line.
Can I exercise with a Hickman Line?
Strenuous exercise or heavy lifting should be avoided for three weeks after insertion, until the cuff is secure in place by tissue growth. After that, you may exercise and do most of your normal daily activities.
However, you should avoid:
- Swimming, as it is difficult to prevent the line and dressing from becoming wet
- Activities involving large arm movements such as golf, tennis, or skiing, because of the risk of dislodging the line
If exercise is really important to you, please discuss the option of a Port-a-Cath with Dr Goyal.
Can there be problems with Hickman lines?
The chances of problems are low. However, because Hickman lines are external tubes, some issues can occur.
- Infection: Infection may develop inside the line or in the tunnel under the skin. Contact your hospital doctor or nurse if you have:
- Redness, swelling, or pain in the area
- Discoloured fluid from the area
- A high temperature (fever)
If you get an infection, you will be given antibiotics. If it doesn’t improve, the line may need to be removed.
- Blood clots: A clot may form in the vein at the tip of the line or around the line within the vein. This can make it difficult to draw blood or inject fluids. Regular flushing helps prevent this. If a clot develops, you will be given medication to dissolve it, though sometimes the line must be removed.
- Air in the line: It is important not to allow air into your Hickman line. A cap (or bung) should always be in place at the end of the line (or each lumen, if more than one).
- Line displacement: To prevent accidental removal, the line should always be well secured with tape or covered with a dressing, especially in the first three weeks until the tissue around the cuff has grown. If the dressing becomes loose, please have it replaced promptly.
How is the Hickman line removed?
When you no longer need the line, it will be removed. This is usually done in the outpatient department and takes about 30 minutes.
Once you are lying comfortably, the skin over your chest will be cleaned with antiseptic. The doctor or nurse will numb the area around the cuff with local anaesthetic, make a small cut to release the cuff, and slowly remove the line. This may be uncomfortable, but should not be painful.
A dressing will be placed over the exit site. You may be asked to stay in hospital for a couple of hours to ensure that bleeding has fully stopped before going home.