Hickman Line vs Port: Infection Rates and Daily Life

A Hickman line and an implantable port (often called a Port-a-Cath) both serve the same basic purpose: they give medical teams reliable access to a large vein so they can deliver chemotherapy, nutrition, blood products, or other treatments without repeatedly sticking you with a needle. The fundamental difference is that a Hickman line has an external catheter tube that hangs outside your chest, while a port sits entirely beneath your skin, accessed only when needed through a special needle. That single design distinction ripples outward into nearly every practical concern you might have, from infection risk and daily care routines to what you can do in the shower and how long the device can stay in place.

What Each Device Actually Looks Like

Both devices are tunneled central venous catheters, meaning a surgeon threads a flexible tube through a vein (usually in the chest) until the tip rests near the heart. The tube is “tunneled” under the skin for a short stretch before entering the vein, which helps anchor it and reduces infection risk. Where they diverge is what happens at the other end of the tube.

A Hickman line exits the skin on the chest wall, leaving one, two, or three external lumens (separate channels) capped and clamped when not in use. Those lumens dangle outside the body, typically secured with a dressing. A port, by contrast, terminates in a small reservoir or “chamber” implanted under the skin, usually below the collarbone. The reservoir has a self-sealing silicone membrane on top. To use the port, a nurse pushes a non-coring (Huber) needle through the skin and into that membrane. When treatment is finished, the needle comes out and there is nothing visible except a small bump under the skin.

In a study of patients with blood cancers, Hickman catheters were typically double- or triple-lumen devices, while chemoports had a single-lumen reservoir.¹ That lumen count matters clinically: if your treatment plan requires running two infusions simultaneously, or drawing blood from one channel while infusing through another, a multi-lumen Hickman line makes that straightforward. A single-lumen port can’t do both at once without stopping one task to start the other. Double-lumen ports do exist but are less commonly used.

When Doctors Recommend One Over the Other

The choice between a Hickman line and a port usually comes down to how intensively and how frequently the device needs to be used, and for how long. A Hickman line is the go-to for situations that demand constant or near-constant access: bone marrow transplants, intensive induction chemotherapy for leukemia, and long stretches of total parenteral nutrition where the line may be connected for many hours a day. Children undergoing bone marrow transplant, for example, typically need a double-lumen Hickman line because the treatment involves simultaneous infusions that a single-lumen port cannot handle.²

Ports tend to be preferred when treatment is intermittent and will stretch over months or years. A patient receiving chemotherapy every two or three weeks for a solid tumor, for instance, only needs access on infusion days. Between cycles the port sits quietly under the skin, requiring no dressing changes and little maintenance. That makes ports especially popular in outpatient oncology, where people want to get back to their daily routines between treatments.

Patients on long-term home parenteral nutrition (tube-free intravenous feeding) often end up with Hickman lines because they connect to their infusion bags nightly and need easy, repeated access. A study following patients with intestinal failure found that Hickman catheters had a mean dwell time of about 325 days compared with roughly 127 days for another type of central line (PICCs), and the Hickman lines had significantly lower bloodstream infection rates than the alternative in that context.³ So the “best” device depends heavily on what it is being asked to do.

Infection Rates Compared

Infection is the complication people worry about most with any central line, and the data here consistently favor ports. In a study of patients with solid tumors receiving chemotherapy, the infection rate for Hickman lines was about 2.5 per 1,000 catheter days compared with roughly 0.9 per 1,000 catheter days for ports.⁴ An earlier study in adult solid-tumor patients found the gap was even wider: about 1.8 infections per 1,000 catheter days for Hickman catheters versus 0.4 per 1,000 catheter days for ports.⁵

The reason is intuitive. A Hickman line creates a permanent opening in the skin where the catheter exits. Even with careful dressing changes and good hygiene, that exit site is a doorway for bacteria. A port, once the Huber needle is removed after each treatment, is sealed beneath intact skin. The only time bacteria get an opportunity is during an access event, and a trained nurse using sterile technique can minimize that window.

In pediatric oncology, the pattern holds. One study reported bloodstream infection rates of roughly 4.7 per 1,000 catheter days for Hickman catheters versus about 1.5 per 1,000 catheter days for implantable ports, and the average time to first infection was about 52 days for Hickman lines compared with about 109 days for ports.⁶ Across populations, the infection advantage of ports is one of the most consistently replicated findings in the central venous access literature.

Mechanical Complications and Blood Clots

Infection is not the only thing that can go wrong. Catheters can fracture, migrate out of position, become blocked, or get accidentally pulled out. Here, too, ports generally fare better, though neither device is problem-free. In one study of solid-tumor patients, Hickman lines had a 26% rate of leakage or displacement; ports had zero such events.⁷ In a pediatric study looking at all types of mechanical complications, Hickman lines had problems in about 26% of cases compared with about 13% for ports.⁸ Younger children and those with lower body weight were at the highest risk of mechanical issues regardless of device type.

Ports can develop their own specific problems. The subcutaneous reservoir can occasionally flip or rotate (“twiddler’s syndrome”), making it impossible to access. Skin over the port can thin with repeated needle sticks, and in rare cases the port erodes through the skin entirely. These complications are uncommon but essentially don’t exist with Hickman lines because there is no implanted hardware to shift around.

Blood clots are another concern with any central line. A meta-analysis looking at clot risk in cancer patients found that ports were associated with a substantially lower risk of blood clots compared with PICCs, and showed a trend toward lower risk compared with Hickman catheters, though the difference between ports and Hickman lines specifically did not reach statistical significance.⁹ In practice, both devices can trigger clot formation around the catheter tip, and anticoagulant flushes are standard maintenance for both.

Overall Complication Rates and Early Removal

When you combine infections, mechanical failures, clots, and everything else, a randomized trial comparing the two devices in chemotherapy patients found that about 54% of Hickman-line patients experienced at least one complication, compared with 38% of port patients. Perhaps more telling, 28% of Hickman devices had to be removed early because of a complication, versus just 4% of ports. The odds of experiencing one or more complications were roughly twice as high with a Hickman catheter.¹⁰ That early-removal gap matters practically: having a device pulled out mid-treatment means another procedure to place a new one, more downtime, and potential delays in your chemotherapy schedule.

What Daily Life Looks Like With Each Device

For many patients, the day-to-day experience of living with the device weighs as heavily as the complication statistics. A Hickman line requires regular attention even on days when you are not receiving treatment. The exit site needs dressing changes, usually every few days, and the lumens need to be flushed with saline or heparin to prevent clotting. Evidence-based reviews suggest daily flushing for Hickman catheters that are not in active use.¹¹ Swimming is generally off-limits because keeping the exit site dry is critical. Showering requires waterproof dressings or careful wrapping. The external tubes need to be secured to avoid snagging on clothing, seat belts, or curious toddlers.

A port, when it is not being accessed, requires almost no daily maintenance. It sits invisible under the skin, covered by intact skin that you can wash normally. Swimming is usually permitted between treatment cycles once the initial surgical site has healed. The port does still need periodic flushing to keep it patent, typically once every four to six weeks if it is not being used. That flushing visit requires a needle stick through the skin, which some patients find uncomfortable, but it takes only a few minutes and happens far less frequently than Hickman line maintenance.

On infusion days, the experience flips slightly. A Hickman line can be connected to an IV bag in seconds: the nurse uncaps a lumen, attaches the tubing, and the infusion starts. Accessing a port involves cleaning the skin, pushing a Huber needle through the skin and into the reservoir, confirming placement, and then starting the infusion. That needle stick is a brief moment of discomfort (numbing cream can help), but it adds a step that Hickman-line users never have to think about.

How Patients Feel About Each Device

A qualitative study explored how chemotherapy patients perceived their central line. Patients with Hickman lines generally viewed the device positively and compared it favorably against the alternative of repeated peripheral IV cannulation in the arm. But patients with ports went further: they consistently compared their device favorably not just against peripheral IVs but against Hickman lines and PICCs. Ports were seen as offering a greater sense of freedom, less intrusion in personal relationships and intimacy, and unique psychological benefits related to having nothing visible on the body between treatments.¹²

That psychological dimension should not be dismissed. Cancer treatment is already an assault on a person’s sense of normalcy. For some patients, having a tube dangling from their chest is a constant visual reminder of illness, something that has to be hidden under clothing and explained to partners. A port, by contrast, is invisible. After healing, other people cannot tell it’s there unless they know to look for the bump. For patients who value body image, this distinction can be significant.

On the other hand, some patients with Hickman lines appreciate the lack of needle sticks. People who have needle phobia, or who simply dread that moment of skin puncture, may prefer the trade-off of daily maintenance in exchange for pain-free connections. Personal preference is a legitimate part of the decision.

Cost and Resource Use

The economic comparison tends to favor ports, though the picture depends on your healthcare system. A UK-based randomized trial with an economic evaluation found that Hickman catheters were associated with substantially greater average costs over a year (about £2,500 versus about £700 for ports), driven largely by more frequent nursing visits for maintenance, more complication-related hospital admissions, and more device replacements. Quality of life, measured by a standard health metric, was essentially identical between the two groups. The researchers concluded that ports were the dominant strategy: less expensive and marginally better outcomes.¹³

The upfront cost of placing a port is typically higher than placing a Hickman line, because the port involves implanting hardware under the skin. Removing a port also requires a minor surgical procedure, whereas a Hickman line can usually be pulled out at the bedside. But those one-time costs are dwarfed by the ongoing savings from fewer dressing changes, fewer nursing visits, and fewer complication-driven hospitalizations. For patients on treatment plans lasting several months, the total cost almost always tilts in the port’s favor.

Pediatric Considerations

Choosing a device for a child adds layers of complexity. Small children are less cooperative with dressing changes and flushing routines, and they are more likely to tug on an external catheter. At the same time, very young children have smaller veins and less subcutaneous tissue, making port implantation technically trickier and raising the risk of mechanical problems. The pediatric study on mechanical complications found that younger age and lower weight were the strongest predictors of trouble, regardless of device type.¹⁴

For long-term use in children with cancer, ports have generally shown better durability. A prospective study found that ports had a significantly longer failure-free duration of use than externalized Hickman or Broviac catheters, and remained infection-free significantly longer. The advantage became particularly clear after 100 days: for long-term catheter use, ports were considered superior.¹⁵ A separate prospective study found broadly similar results, noting that when patients were matched for diagnosis, therapy, and age, ports had lower infection rates than Broviac catheters after 100 days, with the difference growing more significant after 400 days.¹⁶

Still, as noted earlier, bone marrow transplant protocols often mandate a double-lumen Hickman line because the treatment intensity requires simultaneous access. In those cases, the question is not “which is better” but “which meets the clinical requirement.” A port may follow later, once the transplant phase is complete and the child transitions to less intensive maintenance therapy.

When Infections Happen and Why They Are Hard to Treat

Both Hickman lines and ports can develop biofilm on their internal surfaces. Biofilm is a thin layer of bacteria embedded in a slimy matrix that sticks to the catheter material. Once it forms, antibiotics struggle to penetrate it, which is why catheter-related bloodstream infections frequently require removing the device altogether rather than trying to treat through it. For ports, the reservoir’s internal surface is an additional niche where biofilm can take hold, making salvage attempts (treating the infection without pulling the port) particularly hit-or-miss.

With a Hickman line, removal is straightforward. A clinician can pull the catheter at the bedside under local anesthesia, the exit site is dressed, and a new line can be placed elsewhere if needed. Port removal is a minor surgical procedure that requires a fresh incision and some dissection to free the reservoir from the tissue pocket. That extra procedural burden means clinicians sometimes try harder to salvage an infected port with intravenous antibiotics and antibiotic lock therapy (filling the catheter with a high concentration of antibiotic and letting it dwell). Success rates vary, and there is no strong consensus on when salvage is worth attempting versus when it is better to just take the device out. The general rule is that complicated infections, fungal infections, or tunnel-track infections warrant removal regardless of device type.

Power Injection for CT Scans

If you have a central line and need a contrast-enhanced CT scan, the question of whether your device can handle power injection matters. Power injectors push contrast dye at high flow rates that could theoretically rupture a standard catheter. A pediatric study examining power injection through various central lines, including Hickman catheters and ports, found a complication rate of only about 0.4%, suggesting that both device types can tolerate power injection when done carefully.¹⁷ That said, not all ports are rated for power injection. Some manufacturers make “power-injectable” ports with reinforced reservoirs and catheters specifically designed for high-pressure contrast delivery. If you know you will need frequent CT scans with contrast, this is worth discussing with your team before the device is placed, since switching later means another procedure.