Hickman line
Encyclopedia
A Hickman line is an intravenous catheter
Central venous catheter
In medicine, a central venous catheter is a catheter placed into a large vein in the neck , chest or groin...

 most often used for the administration of chemotherapy
Chemotherapy
Chemotherapy is the treatment of cancer with an antineoplastic drug or with a combination of such drugs into a standardized treatment regimen....

 or other medications, as well as for the withdrawal of blood for analysis. Some types of Hickman lines are used mainly for the purpose of apheresis
Apheresis
Apheresis is a medical technology in which the blood of a donor or patient is passed through an apparatus that separates out one particular constituent and returns the remainder to the circulation...

 or dialysis
Dialysis
In medicine, dialysis is a process for removing waste and excess water from the blood, and is primarily used to provide an artificial replacement for lost kidney function in people with renal failure...

. Hickman lines may remain in place for extended periods and are used when long-term intravenous access is needed.

The insertion of a Hickman line is usually done under sedation
Sedation
Sedation is the reduction of irritability or agitation by administration of sedative drugs, generally to facilitate a medical procedure or diagnostic procedure...

 or a general anesthetic by a radiologist or surgeon
Surgery
Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...

. It involves two incisions, one at the jugular vein
Jugular vein
The jugular veins are veins that bring deoxygenated blood from the head back to the heart via the superior vena cava.-Internal and external:There are two sets of jugular veins: external and internal....

 or another nearby vein or groove, and one on the chest wall. At the former incision site (known as the "entrance" site), a tunnel is created from there through to the latter incision site (known as the "exit" site), and the catheter is pushed through this tunnel until it "exits" the latter incision site. The exit site is where the lumens are seen as coming out of the chest wall. The catheter at the entrance site area is then inserted back through the entrance site and advanced into the superior vena cava
Superior vena cava
The superior vena cava is truly superior, a large diameter, yet short, vein that carries deoxygenated blood from the upper half of the body to the heart's right atrium...

, preferably near the junction of it and the right atrium of the heart. The entrance site is sutured. The catheter at the exit site is secured by means of a "cuff" just under the skin at the exit site, and the lumens are held down otherwise by a sterile
Asepsis
Asepsis is the state of being free from disease-causing contaminants or, preventing contact with microorganisms. The term asepsis often refers to those practices used to promote or induce asepsis in an operative field in surgery or medicine to prevent infection...

 gauze
Gauze
Gauze is a thin, translucent fabric with a loose open weave.-Uses and types:Gauze was originally made of silk and was used for clothing. It is now used for many different things, including gauze sponges for medical purposes. When used as a medical dressing, gauze is generally made of cotton...

 or dressing centered on the exit site, which also serves the purpose of preventing potential contamination at the exit site. Throughout the procedure, ultrasound
Medical ultrasonography
Diagnostic sonography is an ultrasound-based diagnostic imaging technique used for visualizing subcutaneous body structures including tendons, muscles, joints, vessels and internal organs for possible pathology or lesions...

 and X-ray
X-ray
X-radiation is a form of electromagnetic radiation. X-rays have a wavelength in the range of 0.01 to 10 nanometers, corresponding to frequencies in the range 30 petahertz to 30 exahertz and energies in the range 120 eV to 120 keV. They are shorter in wavelength than UV rays and longer than gamma...

s are used to ascertain the positioning of the catheter.

Long-term venous catheters became available in 1968, and the design was improved by Broviac et al. in 1973. Hickman et al., after whom the system is named, further modified the principles in 1979 with subcutaneous tunneling and a Dacron cuff that formed an infection barrier. Dr Robert O. Hickman was a pediatric
Pediatrics
Pediatrics or paediatrics is the branch of medicine that deals with the medical care of infants, children, and adolescents. A medical practitioner who specializes in this area is known as a pediatrician or paediatrician...

 nephrologist
Nephrology
Nephrology is a branch of internal medicine and pediatrics dealing with the study of the function and diseases of the kidney.-Scope of the specialty:...

 at the Seattle Children's Hospital.

Potential complications of placement of such a line include hemorrhage and pneumothorax
Pneumothorax
Pneumothorax is a collection of air or gas in the pleural cavity of the chest between the lung and the chest wall. It may occur spontaneously in people without chronic lung conditions as well as in those with lung disease , and many pneumothoraces occur after physical trauma to the chest, blast...

 during insertion and thrombosis
Thrombosis
Thrombosis is the formation of a blood clot inside a blood vessel, obstructing the flow of blood through the circulatory system. When a blood vessel is injured, the body uses platelets and fibrin to form a blood clot to prevent blood loss...

 or infection
Infection
An infection is the colonization of a host organism by parasite species. Infecting parasites seek to use the host's resources to reproduce, often resulting in disease...

 at later stages. Patients with a Hickman line therefore require regular flushes of the catheter with heparin
Heparin
Heparin , also known as unfractionated heparin, a highly sulfated glycosaminoglycan, is widely used as an injectable anticoagulant, and has the highest negative charge density of any known biological molecule...

, in order to prevent the line becoming blocked by blood clots. Preventing contamination at the exit site and ensuring that the lumens are flushed frequently is especially important for oncology
Oncology
Oncology is a branch of medicine that deals with cancer...

 patients, as they may have become immunocompromised as a result of cytotoxic chemotherapy
Chemotherapy
Chemotherapy is the treatment of cancer with an antineoplastic drug or with a combination of such drugs into a standardized treatment regimen....

. Pyrexia (fever) is one of the symptoms of contamination. This symptom, and others, including the observance of swelling or bleeding at the exit site, indicate that the patient should seek medical attention as soon as possible.

External links

The source of this article is wikipedia, the free encyclopedia.  The text of this article is licensed under the GFDL.
 
x
OK