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Hickman / Permacath Line Insertion

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Hickman lines are a long thin tube made out of silicone. It has a cuff attached to it which acts like an anchor to hold the line in place on the chest wall and act as a barrier to infection from the outside. They can have 1, 2, or 3 internal channels. The type of Hickman line that is to be used will depend on your type of treatment. Each channel is used for different reasons such as withdrawing blood samples and giving intravenous treatment. Each channel will have its own clamp attached and bung/caps which are always used to cover the connector when not in use to help reduce infection. This type of catheter can stay in the body for months.

Permacaths are used for short term dialysis or until a permanent dialysis fistula can be created.  The permacath consists of a soft silicon catheter which has 2 internal channels or lumen, one with a red cap and one with a blue cap. These caps are coloured for easy identification of their uses for dialysis. The red cap line is used to withdraw blood from your vein when connected to the dialysis machine, and the blue cap line is used to return blood back to your vein from the dialysis machine.

Procedure

These lines are inserted in a day surgery unit. Local anaesthetic will be used to numb the areas involved for insertion. Two small incisions will be made one at the entry point to the vein being used and one on exit point on the chest wall. Using ultrasound guidance to locate the vein for insertion of the catheter, a needle is inserted into either the jugular vein at the base of the neck or the subclavian vein below the collar bone. The catheter is inserted into the vein and positioned just above the heart, and position checked by xray. The remaining catheter is then tunnelled from the vein entry point under the skin to the exit point on the chest wall. The catheter will be secured at the exit point on the chest with a stitch and a small stitch is used to close the vein entry point. A clear dressing will be applied to protect the entry site and the lumens will then be left free outside the dressing for access. The catheter will be flushed with a heparin saline solution known as heparin locking and left until accessed for treatment

Post Operatively

  • Discharged home same day
  • Take care not to pull on the lines
  • The entrance stitches will remain in place and then can be removed by your treating physician or nursing staff. Please also follow their instructions for dressing changes and use of the line
  • If you have any pain or discomfort take some pain relief as directed
  • Check the exit sites daily for 7 days for any sign of swelling, redness, pain or discharge. If you develop any of these or a fever please see you GP as soon as possible.

See your personal GP for a referral today!