Hickman Line and PICC

Interventional Radiology and Fluoroscopy

What is a Hickman line?

A Hickman line is a long, hollow tube made from silicone rubber that is inserted into one of your veins in the neck or under the collar bone. The space in the middle of the tube is called the lumen. Sometimes the tube has two lumens to allow different treatments to be given at the same time.

Part of the tube remains outside of the body. At the end of the tube outside the body each lumen has a special cap to which a drip line or syringe can be attached. There is also a clamp to keep the tube closed when it is not being used.

You might hear a Hickman line referred to as a ‘line’, ‘central line’ or ‘tunnelled line’.

What is a PICC?

PICC stands for Peripherally Inserted Central Catheter. It’s a type of central line. The line goes into a vein in your arm, under local anaesthetic. A health care professional can put it in during an outpatient appointment. The line runs up the vein inside your arm and ends up in a large vein in your chest.

PICCs can be left in for several months and used in a similar way to other central lines.

What are benefits of having a Hickman line or PICC?

A Hickman line or PICC is a reliable way for nurses and doctors to give you intravenous (IV) medicines (medicines that need to go directly into a vein), IV feeds, or to take blood samples. It means you can avoid a needle puncture every time you have treatment, which can be difficult, uncomfortable, and stressful.

Hickman lines or PICCs are designed to last for many months if necessary. Some medications (particularly chemotherapy and IV feeds) need to be given into a large vein rather the small veins in the hand or arm.

Are there any risks?

Serious risks and complications of having a Hickman Line or PICCs inserted are very rare. However, as with any procedure, some risks or complications may occur.

For example:

• Bruising. This is quite common and will normally settle a few days after the procedure.
• Infection. The insertion procedure will be carried out in a sterile condition to eliminate or reduce any sources of infection. However, infection may still occur (either local infection of the skin or within the bloodstream) at any time while your line is in place. Infections can usually be treated with antibiotics. However in rare cases we may have to remove the line.
• Lung puncture (Hickman line). This happens when the lung is accidentally punctured during the procedure. This is a very rare complication and happens in fewer than one in every 1000 patients. If this occurred, we may have to keep you in hospital for a few days until the lung has healed.
• Line blockage. Regular flushing helps to prevent this. If it becomes blocked sometimes it is possible to unblock it.

If the line is in place for a long time, breaks and damages can occur, although this is rare. The line may need to be replaced for these reasons.

Thrombosis and clots in the veins are very rare. They can cause arm swelling or prevent blood being taken from the line.

What do I need to do to prepare for the procedure?

You can come into hospital, have a Hickman line or PICCs inserted and go home the same day.

• You will usually need to have a blood test to measure full blood count and clotting before the procedure. Your Doctor or Clinic nurse specialist will tell you how to arrange it when they recommend a Hickman or PICC line.
• Please let us know if you are taking any medicines that thin the blood (for example Warfarin, Rivaroxaban, Dabigatran, Apixaban), as these may need to be withheld temporarily before the procedure. Call the Radiology Day Unit Sister for advice as soon as you get your appointment letter on 01642 854332.

You do not have to stop eating before the procedure, but you will be lying flat, so you should not have a large meal. You may drink water up to the procedure.

What happens before the Hickman line or PICC insertion?

After you have arrived at the radiology day unit, you will be examined and assessed by a radiology nurse and given a hospital gown to wear.

You will be seen by a radiologist or radiographer (a health care professional who uses imaging machines to diagnose and treat illnesses) who will discuss the procedure with you. You will be given the opportunity to ask any questions you have.

Giving my consent (permission)

The staff caring for you will ask your permission to perform the procedure. If you decide to go ahead, you will be asked to sign a consent form that says you have agreed to the procedure and that you understand the benefits, risks and alternatives. If there is anything you don’t understand or you need more time to think about it, please tell the staff caring for you.

How is the Hickman line or PICC inserted?

Hickman line

Your neck will be checked for a suitable vein using a small ultrasound machine. We usually use the right side of your neck or chest. The area where the line is to be inserted is cleaned with an antiseptic fluid and you will be covered with a sterile drape.

The radiologist or radiographer will inject some local anaesthetic into your skin on your chest and neck to numb the area. This may sting a little as it goes in and then go numb. After this you should only feel pressure not pain.

Throughout the procedure a nurse will be with you to monitor your pulse and blood pressure. A small cut is made in the skin near your collarbone (the entry or insertion site) and a second small cut is made on the chest wall (the exit site). The line is threaded under the skin from the exit site to the entry or insertion site, passed into a large vein at the entry or insertion site and the tip advanced through the large veins to lie just above the heart.

There is a small ‘cuff’ around the Hickman line which can be felt under the skin just above the exit site that prevents it from falling out. The tissue under the skin grows around this cuff over a period of about three weeks and holds the line safely in place. Until this has happened you will have a stitch holding the line in place.

PICC line

Your arm will be checked for a suitable vein using a small ultrasound machine. The area where the line is to be inserted is cleaned with an antiseptic fluid and you will be covered with a sterile drape.

As the line is being put in you will have occasional images taken using the x-ray machine to make sure it is in the right place. There is a small ‘clip’ around the PICC line which can be felt under the skin just above the exit site that prevents it from falling out. A waterproof dressing will also be placed over the line.

Will I feel any pain?

As you are given a local anaesthetic, you should not feel any pain during the procedure. You may however feel some discomfort after the procedure when the local anaesthetic wears off. You may want to take paracetamol tablets for the pain. You may also have a little bruising.

What happens after the Hickman line or PICC insertion?

After the line placement you will go to the radiology day unit for about 20 minutes. You will be offered a cup of tea or coffee. The line insertion should be no worse than having a ‘filling’ at the dentist. You may drive yourself home, but some patients prefer to be driven. We are happy for you to use public transport if that is convenient to you.

Taking care of your dialysis line at home

• Showering
  Use a waterproof dressing over the exit site as this will keep it dry during a shower. We will provide some dressing and advice how to use them after you leave hospital. You will generally need a dressing for the first two or three weeks after the insertion. Afterwards, you only need one when showering to keep it dry

• Having a bath
  Bathwater is not as clean as shower water so if you have a bath please make sure that you keep the exit site out of the water for example, by sitting in a shallow bath

• Sports
  Most sports are fine after the first few days. Once it has settled in going to the gym is fine. We advise you to avoid contact sports. Gardening, cleaning, cooking, decorating etc. should not be problem

• Swimming
  You can’t swim with a Hickman line in place

• When in a car, wear your seat belt in the conventional way

• Air travel is not a problem

Keeping your Hickman line working

The Hickman line can be used as soon as it is inserted. If your line is not being used, the plastic clamp must stay closed. Remember to check it is closed every day and that the stopper on the end is securely attached.

We recommend your line is flushed once a week to prevent it becoming blocked. This will be done in the ward or day unit when you get your treatment, but it is also done by district or practice nurses between treatments. Many patients or their carers learn how to flush the lines themselves.

How will I know if something is wrong with my Hickman line or PICC?

If you experience a cold and shivery attack during or after flushing your line, contact the doctor or nurse caring for you immediately. This could be due to an infection in the line. The line is in a large vein close to your heart, so it is important to treat any infection as soon as possible.

How is the Hickman line or PICC removed?

When you no longer need the line it will be taken out. A doctor or nurse specialist delivering your treatment will usually do this for you. The nurse or doctor performing the procedure will give you all the information you need, and if any preparation is required.

It is usually a quick procedure. You will be asked to lie on a bed. The area around the cuff is cleaned with antiseptic fluid and numbed with local anaesthetic. A small cut is made to gently release the cuff and the line is then removed. Sometimes stitches are required. This can feel uncomfortable, but it should not be painful. Patients don’t usually need sedation.

A dressing will be put over the exit site and you will be asked to remain lying down (for about 10 minutes) until it is certain that there is no bleeding. When you feel ready you will be asked to sit up and get dressed. You will be returned to your ward if you are an inpatient (staying in hospital overnight) or you will be able go home if you came in as an outpatient (leaving the hospital the same day you have the procedure).

Useful websites

• https://en.wikipedia.org/wiki/Hickman_line
• https://www.macmillan.org.uk/cancer-information-and-support/treatment/types-of-treatment/chemotherapy/central-lines
• https://www.macmillan.org.uk/cancer-information-and-support/treatment/types-of-treatment/chemotherapy/picc-lines

Radiation dose and risk

X-rays use ionising radiation which can cause cell damage that may, after many years or decades, turn cancerous. The risk of this happening is very small compared to the normal lifetime risk of developing cancer which is 1 in 2.

We are also all exposed to background radiation every day. The risk of long-term effects is considered when the healthcare team decide whether someone needs an x-ray examination and radiation doses are kept as low as possible.

For this examination radiation dose levels are typically equivalent to around 1-2 years of background radiation. The associated risk is less than 1 in 1000 – Low.

Is there anything I should tell the staff?

For patients who have ovaries and are between the ages of 12 and 55, the x-ray department has a legal responsibility to ensure that this examination is performed within TEN DAYS of the first day of your menstrual period.

Patient experience

South Tees Hospitals NHS Foundation Trust would like your feedback. If you wish to share your experience about your care and treatment or on behalf of a patient, please contact The Patient Experience Department who will advise you on how best to do this.

This service is based at The James Cook University Hospital but also covers the Friarage Hospital in Northallerton, our community hospitals and community health services.

To ensure we meet your communication needs please inform the Patient Experience Department of any special requirements, for example; braille or large print.

T: 01642 835964
E: [email protected]

The James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW.
Telephone: 01642 850850

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