Overview

This information is about having a tube called a Hickman^® line put into a vein in your chest. We can use the long, thin and flexible tube to give you medicines or take blood samples.

The aim of the information is to help answer some of your questions about having a Hickman line. It explains:

• what a Hickman line is
• the benefits of having a Hickman line
• the risks of having a Hickman line
• what to expect when you come to hospital
• what happens after the procedure
• how to care for your Hickman line

If you have any more questions or concerns, please contact the interventional radiology (IR) department.

About a Hickman line

A Hickman line is a long, flexible plastic tube that we put under the skin of your chest wall. The tube then goes into a large vein just above the heart. 

Hickman® is a brand name. It is a type of central line (tube into a central blood vessel of the chest) tunnelled under the skin.

Part of the Hickman line stays outside of the skin. The nurses can then use the line to give you medicines or take blood samples. Usually, your clothes hide the outside part of the line. This means that people do not know you have a line in place.

Outside your body, the Hickman line divides into 1, 2 or 3 smaller tubes called lumens. Each tube is usually sealed with a special cap or plastic bung.

If your Hickman line has 2 or 3 lumens, you can have different treatments at the same time. Your specialist called an interventional radiologist or IR doctor decides how many lumens your line needs.

Benefits of having a Hickman line

A Hickman line is a reliable way for us to:

• give you medicines directly into a vein (intravenously)
• give you liquid food through a vein (if you have all of your food in this way, it is called total parenteral nutrition)
• take blood samples for testing

A Hickman line allows you to avoid a new needle puncture every time that you need treatment or a blood test. The Hickman line can stay in place for a long time (months to years). This means that we can use it throughout your treatment.

Your doctor may recommend a Hickman line if:

• you regularly have chemotherapy (a cancer treatment where medicine is used to kill cancer cells)
• you need long-term antibiotics
• you cannot use your digestive system and need liquid food (total parenteral nutrition)
• it is difficult to take blood samples through your veins

Some medicines can irritate body tissues. To prevent irritation, we need to give these medicines directly into a large vein rather than a small vein in the hand or arm.

Risks of having a Hickman line

It is very rare to have any serious complications after we put in a Hickman line. However, as with any procedure, you need to be aware of some risks and possible side effects. 

We explain the risks before asking for your permission (consent) to do the procedure. Please ask us if you have any concerns or would like more information.

The most common risks are listed in this section.

Infection

We do the procedure to insert a Hickman line in a clean (sterile) environment that is free from germs.

It is important to keep the Hickman line clean. Otherwise, any infection can get directly into the bloodstream. This needs to be treated with antibiotics and we often remove the line to prevent the infection from getting worse.

Lumen blockage

Your Hickman line needs regular care to keep it working properly. If it is not looked after well, one or more of the lumens (smaller tubes) can become blocked and stop working.

If the line gets blocked, or breaks and does not work, it will need to be replaced.

Scarring

When we put in a Hickman line, we need to make at least 2 small cuts in the skin. These heal as small scars.

Radiation risks

During the procedure, you are exposed to X-rays. They are a type of radiation called ionising radiation. This may cause cancer many years or decades after you are exposed to it.

You might have some skin redness after the procedure that feels like sunburn. We do not expect this to be permanent. The redness might be harder to notice on brown and black skin.

Interventional radiology (IR) is when we use medical imaging guidance to do minimally invasive procedures. The amount (dose) of radiation from these procedures is generally low. More complex procedures might involve a medium (moderate) dose of radiation.

The IR doctor and radiographer (health professional who specialises in medical imaging) make sure that:

• your radiation dose is kept as low as possible
• the benefits of having X-rays during your procedure are greater than the radiation risks

Radiation and pregnancy

Radiation can be harmful for an unborn baby. If you are or think that you might be pregnant, it is important to tell a member of your medical team before the procedure. We cannot do any procedure that involves radiation if you are pregnant.
 
If you can become pregnant from sex, you need to use protection (contraception) from the first day of your period until your appointment. This means that you will not be pregnant when you have the procedure.

If the first day of your period has already passed, please contact the interventional radiology (IR) department. We can then give you another appointment within the first 10 days of your period. 

We ask you to sign a pregnancy declaration form before the procedure.

Other treatment options

Having a Hickman line put in is a voluntary procedure. Another option is for us to put in a temporary line every time that you have your treatment. We then need to place a new line whenever you come to hospital and remove it before you go home.

Having new lines put in can be painful and take time. Also, temporary lines:

• might not be suitable for some medicines
• are not practical if you need medicine to be given directly into a vein (infusions) over a long time

One other option is to have a PICC (peripherally inserted central catheter) line. We usually put this tube (catheter) in the arm, but it is smaller in size and may not be suitable for all medicines. A PICC line can get blocked more easily than a Hickman line and might cause the vein in your arm to clot.

Please talk to your doctor or nurses if you like more information about these other treatment options.