Hickman Line Procedure | Print |
Written by James Ilari   
Thursday, 12 March 2009 09:43

I have decided to write this article for all of those who may undergo the insertion of a central intravenous catheter (Hickman line) and for those who are generally interested in the procedure from the point of view of a patient who has lived the operation first hand. What helped me through my procedure was reading a personal story of a man explaining his experience during the surgery. I thought I would do the same and hopefully give that calming feeling to the next person about to undergo this procedure.



What is a Hickman Line?

A Hickman line is a long-term intravenous catheter. The Hickman line catheter is a hollow flexible tube made of soft rubber-like material, which is inserted into your chest prior to beginning treatment. It is a special intravenous device that can be used for drawing blood, infusing chemotherapy, antibiotics, blood products and other medications. You will have your Hickman line in place for several weeks during your treatment and recovery periods. If needed, it can be kept for many months.




The Insertion Procedure

Before I get into the actual procedure I will address what everyone's first question seems to be... Was it painful?  That was my first Google search once I learned I would be receiving the line, so I will start by saying on a pain scale of 1 - 10 it ranks around a 3.5.  It really is not a painful procedure, but an uncomfortable one due to the local anesthetic needles which will pinch and burn when inserted.  Other than these needles, you should only feel pressure and slight tugging when fitting the line into the vein and stitching up the entrance and exit site. 


One thing I will stress is to speak with the doctor prior to the procedure and ask him or her to walk through the steps as they are happening.  My doctor was amazing at this and I was never surprised by a needle, a tug on the skin, pressure, etc... It really made me feel comfortable. You may not want to know what is happening during the procedure, but I found it to be a great help.


Once you are lying on the operating table the doctor will drape you with sterile sheets across your chest and neck, leaving only the right side of your chest and neck exposed.  They will use an ultrasound to determine the placement of the line and to ensure the correct vein has been selected for insertion.  Once this is complete you will be swabbed with antiseptic 4 times across your chest and neck where the incisions and needle pokes will occur.  The first local anesthetic needle will be placed in your neck just above your collar bone.  From there it will penetrate deeper until you are frozen up to the wall of the vein.  This is the most discomfort you should feel during the procedure.  An incision will be made above your collar bone and the vein opened for insertion.  At this point you will receive 4 more local anesthetic needles up the chest leading to the first incision.  Each of these will sting and burn for a few seconds, but will be less painful than the one before.  The doctor will then make an incision in your chest almost directly in the centre of your right peck.  A tunnel will be created under the skin leading the tube up your chest and over the collar bone.  It only took about 10 seconds to make the tunnel and pressure is all I felt at this point.  The tube is then led over the collar bone (slightly painful) and down the vein.  When it's all said and done the catheter should be sitting just above a valve in the heart.  When the tube is being inserted in the vein you may feel a pop and the doctor may ask you to hum... it freaked me out a little, but was short lived.  Throughout the procedure you will be x-ray`d a number of times to ensure the proper placement of the line.  No big deal, but it's just important to stay still.  The procedure took approximately 30 - 40 min... However, most of it was preparation time.  The actual insertion of the line was 10 - 15 min at most.



Following the Procedure

After the procedure you will feel sore around the chest, neck, and shoulder.  This lasted for a good week and I developed a severe knot in my shoulder which made it extremely difficult to sleep and move around without stiffness.  Tylenol 3 and sleeping pills became my friend for the first couple of days Wink... They also recommend you remove the neck bandage after 3 days, but I just changed mine and kept it on for almost two weeks (cleaning around it with alcohol swabs every time).  At that point I was already admitted to Princess Margaret Hospital and they removed the neck stitches for me. 


Showering was a pain for the first week... try to not get the dressing wet or dirty.  I found using a sandwich bag, extra thick plastic wrap, and plastic water-proof tape did the trick.  After two weeks, I didn't wrap it as carefully when showering, but always made sure the site was cleaned and the dressing changed immediately after.  The nurses should show you how to properly clean the site and change the dressing the day of the procedure.  Also, one thing that helped me tremendously was securing the line to my shirt.  I found that if you wrap tape around the point of where both connections become one tube, you can use this as an anchor point to pin to your shirt.  Simply make a stress loop (loop the line so it does not hang straight down) and pin it comfortably to your shirt with a safety pin.  This will keep the line from feeling like it is constantly pulling on your skin and will act as a safety measure in the event the line is tugged on for any reason.  I found that using tape to secure it to my skin was unreliable, created a tugging sensation, and was painful when changing.


If you will be undergoing this procedure and have any questions please don`t hestitate to contact me.  I will be happy to answer any questions as best I can.