A Hickman line is a

central venous catheter A central venous catheter (CVC), also known as a central line(c-line), central venous line, or central venous access catheter, is a catheter placed into a large vein. It is a form of venous access. Placement of larger catheters in more centra ...

most often used for the administration of

chemotherapy Chemotherapy (often abbreviated to chemo and sometimes CTX or CTx) is a type of cancer treatment that uses one or more anti-cancer drugs ( chemotherapeutic agents or alkylating agents) as part of a standardized chemotherapy regimen. Chemothe ...

or other medications, as well as for the withdrawal of blood for analysis. Some types are used mainly for the purpose of

apheresis Apheresis ( ἀφαίρεσις (''aphairesis'', "a taking away")) is a medical technology in which the blood of a person is passed through an apparatus that separates out one particular constituent and returns the remainder to the circulation ...

or dialysis. They have also been used in

total parenteral nutrition Parenteral nutrition (PN) is the feeding of nutritional products to a person intravenously, bypassing the usual process of eating and digestion. The products are made by pharmaceutical compounding companies. The person receives a nutritional mix ...

(TPN). Hickman lines may remain in place for extended periods and are used when long-term intravenous access is required. Long-term venous catheters became available in 1968, and the design was improved by Dr. John W. Broviac (b. 1942), a

nephrologist Nephrology (from Greek'' nephros'' "kidney", combined with the suffix ''-logy'', "the study of") is a specialty of adult internal medicine and pediatric medicine that concerns the study of the kidneys, specifically normal kidney function ( ...

based in

East Lansing, Michigan East Lansing is a city in the U.S. state of Michigan. Most of the city lies within Ingham County with a smaller portion extending north into Clinton County. At the 2020 Census the population was 47,741. Located directly east of the state capital ...

, in 1973. Robert O. Hickman, after whom the system is named, further modified the principles in 1979 with subcutaneous tunneling and a

Dacron Polyethylene terephthalate (or poly(ethylene terephthalate), PET, PETE, or the obsolete PETP or PET-P), is the most common thermoplastic polymer resin of the polyester family and is used in fibres for clothing, containers for liquids and foo ...

cuff that formed an infection barrier. Dr. Robert O. Hickman (1927-2019) was a

pediatric Pediatrics ( also spelled ''paediatrics'' or ''pædiatrics'') is the branch of medicine that involves the medical care of infants, children, adolescents, and young adults. In the United Kingdom, paediatrics covers many of their youth until the ...

at the Seattle Children's Hospital.

Insertion

Hickman lines are inserted under

local anaesthetic A local anesthetic (LA) is a medication that causes absence of pain sensation. In the context of surgery, a local anesthetic creates an absence of pain in a specific location of the body without a loss of consciousness, as opposed to a general ...

with or without sedation by a

, by an

interventional radiologist Interventional radiology (IR) is a medical specialty that performs various minimally-invasive procedures using medical imaging guidance, such as x-ray fluoroscopy, computed tomography, magnetic resonance imaging, or ultrasound. IR performs bo ...

, or surgeon. The insertion involves two incisions, one at the

jugular vein The jugular veins are veins that take deoxygenated blood from the head back to the heart via the superior vena cava. The internal jugular vein descends next to the internal carotid artery and continues posteriorly to the sternocleidomastoid mu ...

or another nearby vein or groove, and one on the thoracic wall. At the former incision site, a tunnel is created from there through to the latter incision site, and the catheter is pushed through this tunnel until it "exits" the latter incision. The exit area is where the lumen (single, double or multiple) comes out of the thoracic wall. The catheter at the entrance is then inserted back through the entrance site and advanced into the

superior vena cava The superior vena cava (SVC) is the superior of the two venae cavae, the great venous trunks that return deoxygenated blood from the systemic circulation to the right atrium of the heart. It is a large-diameter (24 mm) short length vein th ...

, preferably near the junction of it and the right atrium of the heart. The entrance incision is sutured. The catheter at the exit is secured by means of a "cuff" just under the skin, and the lumen/lumina held in place otherwise by a sterile gauze centered on the exit incision, which also serves the purpose of preventing potential contamination. Throughout the procedure,

ultrasound Ultrasound is sound waves with frequencies higher than the upper audible limit of human hearing. Ultrasound is not different from "normal" (audible) sound in its physical properties, except that humans cannot hear it. This limit varies ...

and

X-ray An X-ray, or, much less commonly, X-radiation, is a penetrating form of high-energy electromagnetic radiation. Most X-rays have a wavelength ranging from 10 picometers to 10 nanometers, corresponding to frequencies in the range 30&nb ...

s are used to ascertain the positioning of the catheter. Potential complications of placement of such a line include

hemorrhage Bleeding, hemorrhage, haemorrhage or blood loss, is blood escaping from the circulatory system from damaged blood vessels. Bleeding can occur internally, or externally either through a natural opening such as the mouth, nose, ear, urethra, v ...

and

pneumothorax A pneumothorax is an abnormal collection of air in the pleural space between the lung and the chest wall. Symptoms typically include sudden onset of sharp, one-sided chest pain and shortness of breath. In a minority of cases, a one-way valve i ...

during insertion and

thrombosis Thrombosis (from Ancient Greek "clotting") is the formation of a blood clot inside a blood vessel, obstructing the flow of blood through the circulatory system. When a blood vessel (a vein or an artery) is injured, the body uses platelets (t ...

infection An infection is the invasion of tissues by pathogens, their multiplication, and the reaction of host tissues to the infectious agent and the toxins they produce. An infectious disease, also known as a transmissible disease or communicable dis ...

at later stages. Patients with a Hickman line therefore require regular flushes of the catheter with normal saline, in order to prevent the line becoming blocked by blood clots. Preventing contamination at the exit site and ensuring that the lumen is flushed frequently is especially important for

oncology Oncology is a branch of medicine that deals with the study, treatment, diagnosis and prevention of cancer. A medical professional who practices oncology is an ''oncologist''. The name's etymological origin is the Greek word ὄγκος (''� ...

patients, as they may have become

immunocompromised Immunodeficiency, also known as immunocompromisation, is a state in which the immune system's ability to fight infectious diseases and cancer is compromised or entirely absent. Most cases are acquired ("secondary") due to extrinsic factors that a ...

as a result of cytotoxic

Pyrexia Fever, also referred to as pyrexia, is defined as having a temperature above the normal range due to an increase in the body's temperature set point. There is not a single agreed-upon upper limit for normal temperature with sources using val ...

(fever) is one of the symptoms of contamination. This symptom and others, including the observance of swelling or bleeding at the exit area, indicate the patient should seek medical attention as soon as possible. Permacath

References

Citations

General references

* Bard Access Systems, ''Hickman, Leonard and Broviac Central Venous Catheters'' instruction manual. * *

External links

Video from the Royal College of Surgeons of Edinburgh showing the insertion of a Hickman line
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* ttps://lavascular.com/hickman-catheter/ An overview of the Hickman Line Catheters

Insertion

See also

References

Citations

General references

External links