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About Hickman lines
A Hickman line is a long-term tube which goes into your blood stream. Once we have inserted it, it allows you to have multiple blood tests, intravenous medicines and blood transfusions without the need for any more needle pricks.
We insert the tube in your skin just below your collar bone. It then ‘tunnels’ under your skin for a few centimetres before entering a large ‘central’ vein at the base of your neck.
If you need a blood test, we simply connect a syringe to a valve on the outer end of the tube under sterile conditions, open the tap and withdraw blood. We then remove the syringe, flush the tube through with sterile saline and close the tap.
We can also give you intravenous infusions (drips) without having to insert a needle in your arm.
Why you need a Hickman line
If you are likely to need multiple blood tests, or medicines and transfusions given over the course of several weeks or months, then we generally recommend a Hickman line.
This usually applies to patients who:
- are undergoing chemotherapy
- need recurrent transfusions for blood disorders
- need long term intravenous feeding.
Your consultant and your interventional radiologist feel that this is the best option for you. They will discuss their recommendation with you and they will take your opinion into account. You will have the chance to ask questions. If, after discussion with your doctors, you do not want us to carry out the procedure, you can decide against it.
We will only go ahead with this procedure after you have given us your written consent.
If you only need a few blood tests then it is best for you to have these tests in the usual way, with a syringe and needle.
If you only need a few days of intravenous medicine or short-term infusions, then it is best for you to have these via a standard ‘intravenous’ cannula (thin flexible tube with a needle on the end) placed into a vein on your arm.
Who performs the procedure and where it takes place
A consultant interventional radiologist will carry out the procedure. This is a doctor who specialises in performing percutaneous (through the skin) procedures under imaging guidance. They use ultrasound and X ray images on screen to guide the procedure and move the Hickman line into position.
They will perform the procedure in the Interventional Screening Room which is part of the Kingston Hospital Radiology Department.
Preparing for your procedure
You need to be an inpatient in the hospital, even if it is only for the day.
To prepare for the procedure, do the following.
- You can take sips of water up to 2 hours before the procedure.
- You can take your normal medicines up until the procedure.
- When you receive your appointment letter, tell the Interventional Radiology Unit if you have previously had allergies to foods, medicines or intravenous contrast medium (the dye used for kidney X rays and CT scans).
- When you receive your appointment letter, tell the Interventional Radiology Unit if you have been on blood thinning tablets such as warfarin, aspirin or clopidogrel.
We will have given you some blood tests, and on this basis, some patients may need a top up transfusion of platelets to minimise the risk of bleeding [Amanda: when/where does this happen?]. Platelets are the cells that help our blood to clot.
You can expect the following during the procedure.
- We will ask you to lie on your back on the X ray table.
- We will wrap a cuff around your arm to monitor your blood pressure, and put a clip on your finger to measure your pulse and breathing.
- The radiologist will check the veins in your neck with an ultrasound scan.
- We will clean the skin over your neck and upper chest with antiseptic solution and cover it with a sterile towel.
- We will inject you with some local anaesthetic to make everything go numb and make two small incisions (cuts), one just above the collar bone, the other just below.
- We will move the Hickman line into position through these two incisions, using the X ray images on screen. Once in place, we will use one or two stitches to close the skin, secure the tube and apply a dressing.
How long it takes
Every patient’s situation is different, but you can expect to be in the room for approximately 1 hour. Most of this time is taken up with preparation. It only takes about 20 minutes to insert the Hickman line.
Pain
When we anaesthetise your skin and deeper tissues with local anaesthetic, this will sting for a few seconds, after which the area will go numb. Most patients only experience minor discomfort.
A nurse or another member of clinical staff will stand next to you and look after you. If the procedure does become uncomfortable, they will arrange for you to have painkillers through a needle in your arm, directly into your blood stream.
After the procedure
We will transfer you back to your ward [Amanda: or the Radiology Recovery Ward?].
It is important that you remain comfortable and lie quietly in bed for a few hours until you have recovered. Your nurse will keep a close eye on your pulse, blood pressure and breathing, to ensure you are recovering as expected.
Some patients may be discharged the same day, but most remain in hospital so they can start using the tube straight away. It is also important that we have time to show them how to look after the Hickman line properly.
For a few days after the procedure, you may experience a little discomfort around the insertion site, but a mild painkiller such as paracetamol usually helps with this.
Risks
Hickman line insertion is usually a safe procedure, but risks and complications can arise. These include:
- bleeding from the arteries or veins
- collapse of the lung
- misplacement of the tube.
We minimise these risks by using a radiologist to perform the procedure using imaging equipment.
If you have concerns or questions about this procedure, you can discuss these with your medical team and your interventional radiologist at any time.
Looking after your Hickman line
This tube will play an important part in your treatment and assist your recovery
After we have inserted the tube, it is important to remember that it is always there, to prevent it from being pulled out accidentally.
For the first 3 weeks, the tube is kept in place by the stitches. After this, a small cuff on the shaft of the tube becomes incorporated into your skin tissue, and this acts as a permanent anchor.
- Keep the tube clean to prevent it from becoming infected. If the tube becomes infected, we will probably have to remove it.
- The tube can only be handled by people who have been trained and who use strict technique free from contamination and wear sterile gloves.
We will encourage and support you to challenge anyone who does not appear to be following these strict rules
How long the Hickman line stays in place
The amount of time it stays in place depends on your individual circumstances, and when you complete your treatment.
Most Hickman lines stay in place for weeks or months.
When it is time for us to remove your Hickman line, you will need a simple operation to release the anchor cuff, allowing us to withdraw the tube with ease.
Contact information
Interventional Radiology Unit
Interventional Radiology Unit Charge Nurse​​​​​​​
Telephone:
Interventional Radiology Unit: 020 8934 6206
Interventional Radiology Unit Charge Nurse: 020 8934 2758