What is a Hickman Line?
A Hickman line is a surgically implanted, tunneled, cuffed central venous catheter made of silicone rubber that provides long-term central venous access, primarily used for patients requiring prolonged intravenous chemotherapy, parenteral nutrition, or frequent blood sampling over months to years. 1
Physical Characteristics and Design
The Hickman catheter is a tunneled silicone rubber catheter approximately 20 cm in length that is inserted into a central vein (typically the subclavian or internal jugular vein) with the tip positioned at the junction of the superior vena cava and right atrium. 1
The catheter features a Dacron felt-like cuff that is placed in the subcutaneous tunnel at least 2.5 cm from the exit site, which stimulates tissue growth around it to seal the catheter tract and inhibit bacterial migration along the external surface. 1
The external portion of the catheter exits through the skin on the chest wall, typically requiring a transparent dressing to cover the exit site. 1
Smaller catheter sizes (6.6 Fr) are preferred as they show lower rates of occlusion and are likely less thrombogenic than larger catheters. 1
Primary Clinical Indications
Long-term home parenteral nutrition (HPN) requiring access for more than 3-6 months is the primary indication, as Hickman catheters can remain functional for many years. 1
Prolonged intravenous chemotherapy for patients with hematological malignancies or solid tumors requiring continuous or frequent infusional treatment. 1, 2
Patients requiring frequent venous access who have difficult peripheral access or need to avoid repeated venipuncture. 3, 2
The catheter is designed for continuous or very frequent use in both hospitalized and home care settings. 1
Advantages Over Other Central Venous Access Devices
Durability: Hickman catheters can remain in place for years (documented cases exceeding 2 years), making them superior to short-term or medium-term catheters. 1, 2
Lower infection risk compared to non-tunneled catheters: The subcutaneous tunnel and Dacron cuff provide a mechanical barrier against bacterial migration from the skin surface. 1
No repeated skin puncture required: Unlike totally implantable ports, the Hickman line does not require needle puncture through skin for each access, making it more practical for daily or frequent use. 1
Repairable: If the external portion becomes damaged, it can be replaced using a repair kit without removing the entire catheter. 1
Key Disadvantages and Considerations
Altered body image: The external portion of the catheter and required dressing coverage can affect patient self-perception and quality of life. 1
Exit site care requirements: The external exit site requires meticulous care and regular dressing changes to prevent infection. 1, 2
Not suitable for short-term use: For access needs less than 3 months, peripherally inserted central catheters (PICCs) or non-tunneled catheters are more appropriate. 1
Optimal Placement Technique
Right-sided insertion is strongly preferred over left-sided approaches, as left-sided catheters are associated with significantly higher rates of venous thrombosis, malfunction, and earlier catheter removal. 1, 4
Tip position at the cavoatrial junction (where the superior vena cava meets the right atrium) is critical to minimize thrombosis risk and ensure optimal function. 1
Internal jugular or subclavian vein access to the upper vena cava should be the first choice for placement. 1
Single-lumen catheters are preferred over multi-lumen designs to minimize infection risk, though multi-lumen options exist when necessary. 1
Complication Rates and Management
Overall complication rates range from 1.25 to 4.03 per 1000 catheter days in published series, with infection being the most common late complication. 3, 5
Exit site infections occur in approximately 22% of catheters, while catheter-related bloodstream infections (septicemia) occur in 7-24.5% depending on the patient population. 4, 5
Venous thrombosis complicates 7-9% of Hickman catheters, with higher rates in left-sided placements, obese patients, and male patients. 4, 5
Catheter migration or dislodgment occurs in approximately 7-10% of cases, with obesity being a significant risk factor. 4, 5
Important Clinical Pitfalls to Avoid
Avoid left-sided placement whenever possible due to substantially higher complication rates including thrombosis and catheter malfunction. 4
Male gender and obesity are associated with increased complication rates, requiring heightened vigilance in catheter care and monitoring. 4
Meticulous adherence to catheter care protocols supervised by trained personnel is essential to maintain the low infection rates achievable with Hickman catheters. 2
Tip placement in the high superior vena cava (rather than low SVC or right atrium) results in earlier loss of function and should be avoided. 4