Care of a Hickman Line

Table Of Contents

The Hickman Line................................................................................................. 2
Why is a Hickman Line used? .............................................................................. 2
Infections (Signs of, Prevention and What to do)...................................................... 4
Storing Supplies.................................................................................................... 5
Getting Your Supplies........................................................................................... 5
Checking for Blood............................................................................................... 5
Maintaining Positive Pressure.............................................................................. 6
Hickman Catheter Dressing Change.................................................................... 6
Changing Your Adapter and Flushing Your Hickman Line................................... 8
Hickman Catheter Care Checklist....................................................................... 11
Example of Hickman Care Schedule for Triple Lumen....................................... 12
Safety Issues When Caring for a Hickman Line................................................. 13




The Hickman Line

A Hickman Line (catheter) is a special intravenous (IV) that goes into a large vein
near your heart. It is made of silicone.

Your Hickman Line can have 2 or 3 lumens (tubes). These lumens act like 2 or 3
separate IV lines.

Each lumen of your Hickman line is given a different colour red, blue or white.
The red lumen is used for taking blood samples or for giving blood products. The
white and blue lumens are used for giving medications and IV fluids. Medications
and IV fluids can also be given through the red lumen if needed.

Part of the catheter is tunnelled under the skin of your chest. The tip of the
catheter rests in a large vein just above your heart. The end of the catheter
leaves the body from a small incision on your chest. This is called the exit site.
A cuff under the skin helps to keep the Hickman in place. This cuff may feel like
a small bump just under the skin next to the exit site. Even with this cuff, it is
still possible to accidentally pull the catheter out, so handle your Hickman
carefully!

Why is a Hickman Line used?

1. It decreases the number of needle punctures needed for IV medications and
blood taking;

2. It can be used for a much longer time than usual IV lines; and

3. It allows for more freedom of movement.











2
Triple Lumen Hickman Line


3
Infections

One of the most important things about caring for and using your Hickman Line
at home is keeping your Line and supplies as free from germs as possible. This
will reduce your risk of developing an infection. If infection occurs you will
require medical treatment and your Hickman Line may need to be changed
or removed.

Signs of Infection:

Skin around the exit site is hot or warm to touch.
Redness, swelling, drainage, or pain around the exit site or along the area
where the Line is tunnelled.
Fever, chiIIs, shaking, feeling that your heart is beating quickly at rest, or
feeling unwell for an unknown reason.


To Prevent Infection:

1. Always wash your hands well with soap and water before caring for your Line.

2. Always care for your Line by following the instructions youve been given.

3. Keep your sterile supplies free from germs by following your instructions about
what parts that you can or cannot touch.

4. Store supplies as directed.

5. Use only sterile (germ-free) supplies.

6. Use a sterile item, such as a syringe only once. Do not reuse disposable
supplies.

7. Change your dressing if it gets wet or soiled.

8. Wear a mask when caring for your Hickman Line if you or your partner has a
cough or cold.

If you suspect an infection you should:
Please see pages 13 & 14 for further instructions.
4
Storing Supplies

Most of your supplies have been sterilized and placed in paper or plastic
packages to keep them sterile (germ free). It is important to store your supplies in
a clean, dry place where the packaging will not be opened or damaged. A
cupboard or closet out of the reach of children and pets is usually a safe place.

Check all paper and plastic covers before use. If they are wet, ripped, or have a
dried water stain do not use them - throw them away. If solutions are cloudy, do
not use them - return them to pharmacy.

Check the expiry date on flushing solutions. If they are past their expiry date,
return them to the Pharmacy as soon as you can for a replacement.

Do not use out of date supplies.


Getting Your Supplies

If you need supplies call Lawtons Home Health Care, 5991 Spring Garden Road
(423-9356), ask for the Home Health Care Department or Pharmasave at the VG
Hospital mini mall (473-6656).

Hickman supplies at the Pharmasave come in kits containing one weeks worth
of pre-filled saline syringes, adapters, transparent dressings, Soluprep Swabs
and alcohol swabs. Clamps are sold separately. It is a good idea to always have
a spare clamp available. It should be smooth edged to avoid cutting into the
catheter.

Checking for Blood

Checking for blood is done when flushing the catheter to make sure it is still in
the right spot in your vein. To do this pull back gently on the plunger of the saline
syringe. Watch for a small amount of blood drawn into the syringe. When you see
blood, continue along to the next step in the flushing procedure.

If you do not see blood when you draw back the plunger, try changing your
position. Try raising your arms above your head, taking deep breaths and
coughing. Try to draw back on the plunger again.
5

If there is still no blood try flushing with a small amount of the saline in the
syringe. Try to draw back on the plunger again. If there is still no blood, finish
injecting the saline solution. Disconnect the syringe, close clamp on the Line.

Never use force to inject the saline solution.

If you are able to inject the saline solution without difficulty but do not see
blood return, you must still call the Medical Day Unit or your family doctor right
away because the Line may be partially blocked and should be checked.

If you do not get blood return and are also unable to inject the saline solution,
you must contact Medical Day Unit staff, your family doctor, or other identified
resource for further instructions.

Maintaining Positive Pressure

This is a special way of closing the clamps on your Hickman Line. It prevents air
from getting into the Line and stops blood from backing up into the lumen where
it may clot, leaving the lumen unusable.

To maintain positive pressure when you are flushing your Hickman Line with
saline, always close the clamp on the lumen after you have flushed and
disconnected the syringe.

Always close the clamp over the reinforced clamping sleeve, as shown by your
nurse.

Hickman Catheter Dressing Change

The dressing is changed once a week to prevent infection. If you or your partner
is changing the dressing, a mask is not needed unless either of you has a cough
or cold.

Chlorhexedine Gluconate 0.5% with Isopropyl Alcohol 70% is the cleaning
solution used. Soluprep is the brand name. Soluprep should not be used on
broken skin. Check with your nurse if this concerns you. Do not use bleach (such
as J avex) on fabrics exposed to Soluprep as it may cause a brown discoloration.

6
Procedure

1. Wash and dry your work area. Wash your hands

2. Gather equipment: Soluprep swabs or Soluprep swab sticks 1 4 x 4
Transparent dressing.

3. Remove old dressing by gently pulling upward toward the exit site. Be careful
not to pull on the catheter. Do not touch the exit site with your hands.

4. Look for signs of infection such as redness, pain, drainage and/or swelling at
the exit site and over the catheter. If any of these are noted, apply a gauze
dressing and call the Medical Day Unit or your family doctor.

5. Using Soluprep swab, clean exit site. Begin at the exit site and move outward
to cover a circle of about 4 inches. Make one pass only with each swab, and then
discard. Repeat this 2 more times with new swabs.

6. Clean catheter using one Soluprep swab. Start at exit site and wipe outward
about 3 inches. Allow to dry. Be sure you have cleaned all sides.

7. Apply the dressing by centering it over the exit site. Try not to cover your
nipple area.

8. Secure the catheter using the Bulldog clamp.

9. Dispose of used dressings and swabs in a plastic garbage bag.

10. Wash your hands.



If your skin gets irritated by the transparent dressing, use a large (4 x 4) gauze
dressing and change it every day.

If your Hickman has been in place for longer than six weeks and the site is well
healed, you may be able to stop using a dressing on your Line. Please discuss
this with your specialist.

Dressing Change Day Will Be:
_______________________________________________

7
Flushing Your Hickman Line

Your Hickman Line must be flushed to keep it working well. If it is not being used
regularly, flush each of the lumens with 10 mls of saline once a week Try to
do this on the same day each week. The adapter (or cap) attached to the end of
each lumen must also be changed once a week.

Remember:

1. Never flush your Hickman with a syringe smaller than 10 ml.

2. Adapters are changed once a week.

3. Always flush your new adapter after changing it.

4. Always close the clamp on the lumen after you have flushed and disconnected
the syringe.



Changing Your Adapter and Flushing Your Hickman Line

1. Getting ready:

a. Wash and dry your work area.
b. Wash your hands well with soap and water.
c. Gather equipment:
3 Pre-filled Saline Syringes
3 CLC 2000 Adapters
Alcohol swabs
Waterproof tape
d. Check sterile packages. They should not be torn or soiled.
e. Check expiry dates on the Saline Syringes.
f. Check syringes. Do not use if saline is discolored or contains particles




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2. Change CLC 2000 Adapter:

a. Open adapter package.
b. Remove tape from lumen of Hickman Line.
c. Check that the clamp on the lumen is closed.
d. Clean area where old adapter and lumen join, with an alcohol swab.
e. While still holding the lumen, remove the old adapter by turning
counterclockwise and discard.
f. Replace with new adapter, turning clockwise till snug. Clean connection
with alcohol swab. Tape. Be careful not to touch the exposed end of the
lumen or the part of the adapter that connects to the lumen.



3. Flush With Pre-Filled Saline Syringe:

a. Open syringe package.
b. Remove the protective cap from saline syringe. Do not touch the tip of
the syringe.
c. Expel air.
d. Clean the white tip of the adapter on the lumen to be flushed with an
alcohol swab.
e. Attach the syringe to the adapter by pushing in on the white tip and
turning the syringe clockwise until secure (about a quarter turn of the
syringe)
f. Open the clamp. Pull back on the plunger of the syringe, check for
blood. *
g. Inject the 10ml of saline. **
h. Remove the syringe from the lumen by turning the syringe counter
clockwise.
i. Close the clamp.
j. Dispose of used items as instructed.


Repeat this procedure for all lines. You may find it easier to remember
which lumens youve already flushed if you flush in this order red, white
and blue.
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* If You Do Not Get Blood When Pulling Back on the Plunger:
Changing your position may help. Try bending over from side to side and
forward, raising your arms, taking a deep breath. Try again to pull back on the
plunger of the syringe. Try flushing with a small amount of the saline in the
syringe. Try to draw back on the plunger again.
If still no blood, inject the saline. Disconnect the syringe, close clamp on the
line.
Call the Medical Day Unit (473-5492) for advice as the lumen may be partially
blocked.



** If you are unable to inject saline:
You must call the Medical Day Unit (473-5492) for instructions because your
lumen is probably blocked.
Never use force to flush your Hickman Line.


























10
Hickman Catheter Care Checklist
































11
Example of Hickman Care Schedule for Triple Lumen Example of Hickman Care Schedule for Triple Lumen































12 12



Safety Issues When Caring for a Hickman Line Safety Issues When Caring for a Hickman Line











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Notes
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