Hickman catheter
Valeria Dahm is a freelance writer in the medical department. She studied medicine at the Technical University of Munich. It is particularly important to her to give the curious reader an insight into the exciting subject area of medicine and at the same time to maintain the content.
More about the experts All content is checked by medical journalists.The Hickman catheter is a special, partially implanted catheter that, in contrast to the normal central venous catheter, can remain in the vein for a longer period of time. Read all about the Hickman catheter, how it works and the risks it carries.
What is a Hickman catheter?
A Hickman catheter is a thin, mostly double-barreled (internally split, one to three lumen) plastic tube that is pushed over a larger vein to the superior vena cava just before the right atrium of the heart. As with the normal central venous catheter (CVC), the connection is on the skin. However, the Hickman catheter runs between the infusion connection and its entry into the vein within the subcutaneous tissue, which is why it is also one of the so-called partially implanted, tunneled-under catheters. An additional sleeve made of antimicrobial impregnated material sits inside the approximately ten centimeter long “tunnel”. These and the longer course in the subcutaneous tissue protect against infections. Doctors use the Hickman catheter especially on children.
Other examples of tunneled catheters are the Broviac catheter (thin tube with one lumen), Groshong catheters (double-barreled, e.g. smaller lumen, no blood collection due to a valve) or a Demers catheter (for blood washing, usually to bridge a shunt OP has taken place). The names of the tunneled catheters can usually be traced back to their inventors. They are usually registered trademarks.
When do you insert a Hickman catheter?
A Hickman catheter is used when patients need central venous access for long periods of time. Hickman catheters are preferred to other access routes, especially for chemotherapy or stem cell transplants and for larger infusions (artificial nutrition). Blood can also be drawn using the Hickman catheter. In contrast, the Hickman catheter is not suitable for measuring central venous pressure.
How do you insert a Hickman catheter?
Before installing a Hickman catheter, your doctor will explain the benefits and risks to you in person, check your blood values and write an ECG. Under local anesthesia, next to the breastbone below the third or fourth rib, the skin is opened with a small incision. The catheter is usually pushed through this with a long needle under the skin to the large vein under the lateral clavicle (junction of the cephalic vein in the subclavian vein) or to the internal jugular vein at the base of the neck (internal jugular vein) (further alternative: external jugular vein) .
Now the corresponding vein is punctured from the outside as in a normal CVC system and a guide wire is pushed just before the right atrium. The catheter tube can now be “threaded” onto this until it is finally positioned in front of the right heart.
The catheter is now fixed with a small suture and covered with sterile plasters. A final X-ray ensures the correct position and also serves to rule out accidental injuries to the pleura or lungs (risk of pneumothorax).
What are the risks of a Hickman catheter?
The risks of a Hickman catheter are manifold, but can be minimized through professional intervention and consistent hygiene. Possible complications include:
- Infections
- Nerve injuries
- Bleeding and bruising (hematoma)
- Cardiac arrhythmias
- Pneumothorax - air enters the gap between the lungs and the pleura
- Injury to surrounding structures (organs, tissue)
- Air embolism - air enters blood vessels
- Blood clot (thrombus)
- pains
Despite the location and its coating, infections (catheter infection) can only occur over time. Patients with a Hickman catheter usually have a suppressed immune system, which is why the germs (often bacteria, but also fungi) can spread quickly and cause life-threatening blood poisoning (sepsis). Rapid treatment of the infection (antibiotics, antimycotics) is therefore imperative. If in doubt, call an emergency doctor.
Fever with a suppressed immune system (immunosuppression) such as after chemotherapy is an emergency situation and must be treated!
What do I have to consider with a Hickman catheter?
Although the risk of infection with a Hickman catheter is lower than with a normal CVC, strict hygiene and careful care of the catheter and the puncture site (change of plaster) are necessary (by trained specialists). Once a week and after each use, the catheter is flushed with an anticoagulant (heparin). Redness, swelling, and pain are signs of infection. In this case, the Hickman catheter must be removed.
Unless complications arise, a Hickman catheter remains for up to about two years or until it is no longer needed. In contrast to the ZVK, it does not have to be removed when patients leave the hospital. With a waterproof plaster, showering is also no problem. However, experts do not recommend bathing, swimming or using a sauna with a Hickman catheter.
Tags: sports fitness nourishment travel medicine
