A Hickman line is an intravenous catheter which is intended for long-term use. Once a patient is fitted with a Hickman line, health care providers have convenient venous access which they can use to draw blood, deliver medications, and perform other tasks related to patient care. It is not necessary to be hospitalized to receive a Hickman line. Patients can care for their long-term intravenous catheters at home with a little bit of training from a nurse or doctor and some supplies provided by a hospital or clinic.
The line consists of a plastic tube which is inserted into a vein in or near the neck, and which exits the chest wall. The precise placement of the line varies depending on the anatomy of the patient. Several medical imaging studies of the neck are usually performed in order to select a good spot for the entrance point, and the positioning of the exit point may be discussed with the patient to find a place which will be accessible and comfortable.
Patients are sedated or anesthetized for the placement of a Hickman line. Two small incisions are made, one in the chest wall and one in the neck, for the purpose of introducing the flexible tube, tunneling it under the skin, and making sure that it is placed properly in the vein. X-rays or ultrasound are used to confirm that the line is placed properly and then it is stitched in place. Some pain and soreness may be experienced after the surgery.
The Hickman line has a small cuff under the skin which is designed to help the line resist infection while anchoring it in place. Two to three lumens, usually color-coded, are attached to the line at the chest wall. Care providers can use these lumens to deliver chemotherapy, perform dialysis or apheresis, or take blood for analysis. The Hickman line allows medical personnel to provide treatment without having to place needles every time.
Caring for the line requires periodic flushing with anticoagulants to ensure that blood clots do not block the line. The area around the exit also needs to be kept clean to reduce the risk of infection. When there is no longer a need for the Hickman line, as when a patient’s chemotherapy is finished, the line is removed. Small stitches may be used to close the incision, and then it will be bandaged so that the patient can heal.