A Hickman line is a long, flexible tube inserted into a large vein in your chest that provides reliable access to your bloodstream for months or even years. It’s a type of tunneled central venous catheter, meaning part of the tube runs under your skin before entering a vein, which makes it more secure and less prone to infection than a standard IV. Doctors typically recommend one when you need frequent or long-term intravenous treatment and repeated needle sticks in your arms are no longer practical or safe.
Why a Hickman Line Is Used
The most common reason for placing a Hickman line is chemotherapy. Many cancer drugs are harsh enough to damage smaller veins in the hands and arms, so delivering them into a large central vein protects surrounding tissue from irritation. But chemotherapy isn’t the only use. Your doctor may recommend a Hickman line if you need long-term antibiotics, if you can’t eat and require all your nutrition through a vein (called total parenteral nutrition), or if your veins have become so difficult to access that even routine blood draws are a problem.
Because the line can stay in place for months to years, it eliminates the need to place a new IV each time you come in for treatment. Blood samples can also be drawn directly through it, sparing you additional needle sticks.
How the Line Is Designed
A Hickman line is a thin, flexible catheter typically made from silicone or polyurethane. It can have one, two, or three separate channels running through it, called lumens. A triple-lumen version, for example, allows clinicians to give multiple medications simultaneously or draw blood through one channel while infusing fluids through another. Each lumen ends in its own connector outside the body, fitted with a clamp to seal it when not in use.
One distinctive feature is a small fabric cuff (often called a Dacron cuff) that sits on the catheter where it passes under the skin. Over a few weeks, your body’s tissue grows into this cuff, anchoring the line in place and creating a barrier against bacteria that might otherwise travel along the tube toward the vein.
How It’s Inserted
Placement is a minor surgical procedure, usually done under local anesthesia with sedation. The surgeon makes two small incisions: one near the collarbone where the catheter enters a large vein, and a second one lower on the chest where the tube exits the skin. Between these two points, the catheter is threaded through a tunnel under the skin. This tunneling is what sets a Hickman line apart from non-tunneled central lines and is the main reason it carries a lower infection risk.
The Dacron cuff is positioned about 2 centimeters inside the tunnel. The tip of the catheter is guided through the vein until it sits just above the heart, at the junction of the superior vena cava and the right atrium. The surgeon confirms correct positioning with imaging before securing everything in place. Most people go home the same day.
Living With a Hickman Line
Day-to-day life with a Hickman line requires some adjustments, mainly around keeping the exit site clean and dry. The external portion of the catheter, including the connectors and clamps, hangs outside your chest and is usually taped down or tucked under clothing.
Showering and Bathing
You can shower with a Hickman line, but the dressing over the exit site must stay completely dry. The dressing itself is not waterproof, so you’ll need to cover it before getting in. Cling wrap from the grocery store works well for this: wrap it around your chest and neck area so it adheres to your skin and seals over the dressing. A detachable shower head helps you direct water away from the covered area. If you have a caregiver, it’s easier to have them help position the wrap on your back and chest. The line should never be submerged in water, even with a cover, so baths, swimming pools, and hot tubs are off limits. If the dressing does get wet, don’t remove it yourself. Contact your care team so it can be replaced under sterile conditions.
Flushing the Line
To keep the catheter from clogging, each lumen needs to be flushed regularly with a saline solution, typically 10 milliliters per lumen. Lines with clamps also receive a small amount of a blood-thinning solution (2 milliliters per lumen) to prevent clots from forming at the tip. Your care team will teach you or a caregiver how to do this at home using a sterile technique. Only syringes of 10 milliliters or larger should be used, because smaller ones can generate enough pressure to rupture the catheter.
Possible Complications
Most people use a Hickman line without serious problems, but complications do occur. A study of 91 Hickman catheters in pediatric leukemia patients found that about 27% experienced some type of complication over a median follow-up of 190 days. These broke down into three categories: mechanical issues (13%), infections (about 8%), and blood clots (about 6%).
Infection
Infection is the most closely watched risk. Bacteria can enter at the exit site, travel along the tunnel, or get into the bloodstream through the catheter itself. Signs include redness, swelling, or discharge around the exit site, along with fever or chills. The tunneled design and Dacron cuff significantly reduce this risk compared to non-tunneled catheters, but strict hand hygiene and sterile technique during flushing and dressing changes remain essential.
Blockage
A thin layer of fibrin, a protein involved in clotting, forms around virtually all central venous catheters within the first two weeks. Most of the time this coating doesn’t cause problems. Occasionally, though, it can partially block the catheter tip or a clot can form inside one of the lumens. You might notice that the line flushes with more resistance than usual or that blood can’t be drawn back through it. When this happens, a clot-dissolving medication can be instilled directly into the blocked lumen. These agents clear the obstruction in the majority of cases, often within 30 minutes to two hours.
Mechanical Problems
The catheter can crack, kink, or in rare cases migrate out of position. Accidentally pulling on the external tubing is the most common cause. Securing the line against your body and being mindful during physical activity helps prevent this. If you notice any fluid leaking from the catheter or feel a change in how it’s functioning, your care team should assess it promptly.
How It’s Removed
When treatment is complete, removing a Hickman line is a brief procedure done under local anesthesia. The main challenge is the Dacron cuff, which by this point has tissue grown into it. The clinician makes a small incision over the cuff, carefully separates it from surrounding tissue, and frees the catheter. The portion inside the vein is usually encased in a fibrin sleeve that also needs to be released. Once the catheter is pulled free, pressure is applied over the vein entry point to prevent bleeding, and the small incisions are closed. The whole process typically takes 15 to 30 minutes, and most people find it far less involved than the original placement.