06 Hickman line
Updated: Sep 26, 2021
Just wanted to open this post up straight into some info on the Hickman line, the link just below is similar to the sort of posters we'd walk past on the ward and glance over, never really absorbing anything until......"your son will need an operation to install a Hickman line".
Link Hickman line
A Hickman line is a long, flexible plastic tube that is inserted underneath the chest wall skin, and into the large vein draining into the heart. A Hickman line is a type of tunnelled central line. The space in the middle of the tube is called the lumen. Hickman lines can have one, two, or three lumens. These allow different medications to be given at the same time, although the external line diameter is the same. Part of the Hickman line tube remains outside of the skin so that nurses can use the line to give medications or take blood samples.
It is a reliable way to give intravenous (directly into a vein) medicines, nutrients such as total parenteral nutrition (TPN), or to take blood samples. Having a Hickman line means you avoid having a new needle puncture every time you need treatment or a blood test. The Hickman line is meant to remain in place for a long time (months to years) so it can be used throughout your treatment. Doctors recommend a Hickman line for patients who regularly have chemotherapy, long-term antibiotics, TPN, or difficulty with venous access.
First thoughts of Mason sporting a Hickman line just reinforced that not only was he an ill kid but he was going to look ill too. Tubes soon to be hanging out of his chest for the rest of the year, it would serve as a visual reminder that there was something wrong with him that would limit his ability to go about the general toddler life of being a menace. It was explained that a line would sit in his heart, come up through his neck and turn back down to exit his chest. He would have a double lumen line, providing more scope to run more than one medication at the same time.
Whilst new to us, we soon realised that Hickman installation appears to be both popular and straightforward amongst pediatric patients. Ok, sounds good, what are the downsides? Well, line blockages and infection risks become your new enemy. Line blockage is prevented by regular flushing of the lines upon every treatment and interaction in the hospital and at home, Mason has never had a blockage to date [July-21]. The infection bit is the main responsibility for us parents, basically, keep the site clean, don’t let him pull the cables (sometimes impossible) or let food near the lumen ends and the extremely tricky bit is no swimming, showers, and very brief limited baths. Anxious much?
We were.... but thankfully this thing has worked fantastically.
Prior to his Hickman line installation, Mason would have blood taken regularly, and when blood wasn’t being taken he’d require a canular to administer medication or anaesthesia…..what a drama! I mean who likes being pinned down and having needles prodded into your hands and feet to find a vein. It was painful for him, us, and the staff whilst they attempted to locate a vein. There was an occasion where 10+ attempts did not suffice and he had multiple holes on each hand and foot, combined with pre-op fasting, this little man had nothing left in his tank.
His Hickman line has allowed for straightforward, pain-free blood samples, anaesthesia, hydration, antibiotics, anti-sickness, and all chemotherapy to be administered. Pass me a beer!
Local charity Latch kindly provided aftercare with an ‘Olly the brave’ lion who has a Hickman line (wigglies) and a storybook. They also provided ‘Chemo duck’ & storybook - in conjunction with the give a duck foundation. These have been instrumental in educating Mason's big sister Paige (4) about what he will be going through and how she needs to be a little more forgiving with him when they play around, steal each other’s toys, and wrestle.
The Hickman line does take a little adjusting to but gets a thumbs up from us. As Mason is still in baby vests his lines can be safely tucked away without fear of being exposed. He also don's a tube top line-holder regularly which is basically a boob tube but has a slot to store his lines, attached with velcro and usually made by those who are handy with fabrics and then donated to the wards or charities. For older kids, there is a wiggly bag option.
Video Link: Having your central line put in