Hickman Catheter: Insertion, Care, Complications, and Patient Education

A Hickman line is a tunneled, cuffed central venous catheter (CVC) inserted percutaneously into the subclavian or internal jugular vein, advanced to the superior vena cava (SVC), with the cuff embedded in the subcutaneous tunnel to anchor and reduce infection.

Indications

• Long-term IV therapy: chemotherapy, TPN, prolonged antibiotics, stem cell transplant.
• Frequent blood sampling.
• Poor peripheral access.

Insertion Overview

1. Ultrasound-guided venous puncture (IJ or subclavian).
2. Guidewire → peel-away sheath → catheter threaded to SVC/RA junction.
3. Tunnel created from venotomy to exit site (chest wall); cuff positioned in tunnel.
4. Secure with suture; sterile dressing; chest X-ray confirms tip position.

Key Care Points

• Sterile dressing change q7d (or per protocol); chlorhexidine prep.
• Flush each lumen daily with heparin (100 U/mL) or saline per policy.
• Cap changes q7d; clamp sequence: clamp → flush → clamp.
• Monitor for infection (exit site, tunnel, bloodstream), thrombosis, catheter fracture, migration.

Complications

• CRBSI (central line–associated bloodstream infection)
• Thrombosis (SVC syndrome)
• Catheter malposition, pinch-off syndrome (subclavian)
• Air embolism (if open to air)

Patient education: shower with waterproof cover, no submersion, report redness/pain/fever immediately.