A Hickman catheter is a type of long-term central venous catheter (CVC) designed to provide reliable access to the bloodstream over an extended period. It is used when a patient requires frequent or continuous intravenous treatments that would otherwise damage smaller peripheral veins. The catheter serves as a secure entryway into the body’s central circulation, avoiding the need for repeated needle sticks for medication delivery or blood sampling. Its design helps secure it in place and reduce the risk of infection, making it a preferred option for months or even years of therapy.
Structure and Function
The Hickman catheter is a soft, flexible tube, usually made of silicone, inserted into a large vein near the heart, typically the superior vena cava. A defining feature is that it is “tunneled” beneath the skin of the chest wall before entering the vein. This tunneling creates a physical barrier that helps lower the chance of bacteria traveling from the skin surface into the bloodstream.
Part of the catheter remains outside the body at an “exit site” on the chest, where one or more channels, known as lumens, are accessible. The tubing includes a small Dacron cuff positioned just beneath the skin in the tunnel. Over a few weeks, tissue grows into this cuff, anchoring the catheter and creating an additional seal against infection.
Hickman catheters can have one, two, or three lumens, each functioning as a separate pathway into the central vein. This multi-lumen design allows multiple treatments to be administered simultaneously without mixing, or permits one lumen to be dedicated to a specific function, such as drawing blood. The catheter tip sits in the large central vein, ensuring that medications are rapidly diluted by the high volume of blood flow.
Insertion and Removal Procedures
Placing a Hickman catheter is considered a minor surgical procedure, typically performed in an operating room or an interventional radiology suite. The procedure is generally done with the patient awake under local anesthesia, often combined with light sedation for comfort. The medical team uses imaging guidance, such as ultrasound and fluoroscopy, to ensure precise placement.
The insertion involves making two small incisions: an “insertion site” near a large vein (often in the neck or collarbone) and an “exit site” lower on the chest wall. The catheter is tunneled subcutaneously from the exit site up to the insertion site. From there, the catheter is threaded into the vein and guided until its tip rests in the superior vena cava, just above the right atrium of the heart.
Once the tip position is confirmed by imaging, the insertion site incision is closed with sutures, and the catheter is secured at the exit site. The entire placement process usually takes between 30 and 45 minutes. Following the procedure, an X-ray is routinely taken to confirm the final position and check for potential complications, such as a pneumothorax.
When the catheter is no longer needed, removal is generally simpler than insertion. The patient may receive local anesthesia at the exit site. The healthcare provider makes a small incision to gently free the Dacron cuff from the surrounding tissue, and the catheter is then carefully withdrawn from the tunnel and the vein. The exit site is closed with pressure or a few stitches.
Daily Care and Management
Routine daily care is necessary to maintain the catheter’s function and prevent infection. This regimen involves meticulous hand hygiene before touching the device to maintain a sterile field. The catheter’s external segment must be secured to the chest, often by looping and taping it, to prevent accidental pulling or tension at the exit site.
Flushing protocols are performed regularly to prevent the catheter from becoming blocked by blood clots. This procedure involves injecting a small volume of a sterile solution, typically normal saline, into each lumen. Following the saline flush, a locking solution, such as heparin or a citrate solution, may be instilled to keep the line free of clotted blood when it is not in use.
The sterile dressing over the exit site must be changed periodically, usually at least once a week, or immediately if it becomes wet, soiled, or loose. This change requires a sterile technique, including the use of sterile gloves and antiseptic solutions like chlorhexidine, to thoroughly clean the skin. Patients and caregivers are taught how to perform these changes to ensure the area remains clean and protected.
Patients must make specific lifestyle adjustments to protect the catheter and minimize complications. While showering is generally permitted, the dressing must be kept dry using a waterproof cover or sleeve. Activities that involve vigorous pulling or tugging on the catheter, such as contact sports, are prohibited, and swimming is not advised due to the high risk of waterborne infection.
Preventing and Addressing Complications
The most common complication is infection, which can be localized to the exit site or tunnel, or become a systemic bloodstream infection. Bacteria can enter the body through the catheter’s exit site or by migrating along the external surface. To prevent this, prophylactic measures, such as antimicrobial-coated dressings and antibiotic lock solutions, are sometimes employed.
Another frequent complication is occlusion, or blockage, which occurs when a blood clot or fibrin sheath forms within or around the catheter tip. If the catheter cannot be flushed easily, or if blood cannot be drawn, it may be occluded. Healthcare providers may use a thrombolytic agent, such as alteplase, to dissolve the clot and restore patency to the lumen. Patients should never force a flush against resistance, as this can damage the catheter.
It is important to recognize warning signs that require immediate medical attention. These include fever or chills, which signal a systemic infection. Local signs of infection at the exit site, such as increasing redness, swelling, tenderness, pain, or discharge, also need prompt evaluation. Difficulty flushing the line, or a noticeable change in the catheter’s external length, may indicate a blockage or migration out of position.