Hickman Catheter

Nurse Education Workforce Strategy – Gippsland RegionGippsland Oncology Nurses Group (GONG)

Management of Central Venous Access Devices

2. HICKMAN CATHETER

TUTORIAL Management of Central Venous Access Devices

HICKMAN CATHETER

This Tutorial

Hickman Description

Advantages /

Disadvantages

Confirm Placement

Principles of Care

> Accessing

> Syringe Size

> Removal

> Flushing

> Heparin Lock

> Cap/ Bung Description

> Changing a Cap / Bung

> Changing a Dressing

> Changing and IV line

> Taking Blood

> Documentation

Complications

> Blockage of lumen

> Infection

> Thrombosis

> Damage

Resources

GONG Products

CVAD TUTORIAL SERIES

1. INTRODUCTION

2. HICKMAN CATHETER

3. PORT

4. PICC

Acknowledgements

This project is an initiative of :Nurse Education Workforce Strategy –Gippsland

Content supplied by:Gippsland Oncology Nurses Group (GONG)- an initiative of

Gippsland Region Integrated Cancer Services (GRICS)

Special thanks: Anny Byrne (Gippsland Regional Integrated Cancer Services)

Anne Maree Day (West Gippsland HealthCare Group)Dianne Fahy (Nurse Education Workforce Strategy)

Anne Johnson (Latrobe Regional Hospital) Linda Langskaill (Central Gippsland Health Service)

Melanie Regan (Gippsland Regional Integrated Cancer Services)

See other sources and references at the end of this presentation. Further reading is encouraged to complement these tutorials.


HICKMAN CATHETER

This Tutorial

Hickman Description

Advantages /

Disadvantages

Confirm Placement

Principles of Care

> Accessing

> Syringe Size

> Removal

> Flushing

> Heparin Lock





> Taking Blood

> Documentation

Complications

> Blockage of lumen

> Infection

> Thrombosis

> Damage

Resources

GONG Products


1. INTRODUCTION

2. HICKMAN CATHETER

3. PORT

4. PICC

Scope of Tutorial

• What is a Hickman Catheter? • List the advantages and disadvantages • What care should be provided when changing a

cap/bung?• What is the strength of heparin lock used for a Hickman

catheter?• Describe how to flush in a ‘pulsatile’ manner• What is the minimum size syringe used when

accessing a Hickman Catheter? • List the essentials for documentation• What are the main complications with a Hickman

Catheter and how to troubleshoot them?


HICKMAN CATHETER

This Tutorial

Hickman Description

Advantages /

Disadvantages

Confirm Placement

Principles of Care

> Accessing

> Syringe Size

> Removal

> Flushing

> Heparin Lock





> Taking Blood

> Documentation

Complications

> Blockage of lumen

> Infection

> Thrombosis

> Damage

Resources

GONG Products


1. INTRODUCTION

2. HICKMAN CATHETER

3. PORT

4. PICC

Hickman Catheter - Description

• A Hickman Catheter is a tunnelled Central Venous Catheter. The tip of the Hickman Catheter resides in the Superior Vena Cava. The remaining lumen is tunnelled under the skin and exits the chest or abdominal wall. A cuff attached to the lumen adheres to the skin and tissues close to the exit site, which anchors the catheter.

• A Hickman catheter can consist of single, double or triple lumens.

• A Hickman catheter is used for intermediate and long term therapies usually in the haematology setting.


HICKMAN CATHETER

This Tutorial

Hickman Description

Advantages /

Disadvantages

Confirm Placement

Principles of Care

> Accessing

> Syringe Size

> Removal

> Flushing

> Heparin Lock





> Taking Blood

> Documentation

Complications

> Blockage of lumen

> Infection

> Thrombosis

> Damage

Resources

GONG Products


1. INTRODUCTION

2. HICKMAN CATHETER

3. PORT

4. PICC

Hickman Catheter

ADVANTAGES • Large bore lumens• Pain free when

accessed• Single, double or triple

lumens for multiple infusions

DISADVANTAGES• High maintenance• Altered body image• Theatre for insertion /

removal • Increased risk of

infection


HICKMAN CATHETER

This Tutorial

Hickman Description

Advantages /

Disadvantages

Confirm Placement

Principles of Care

> Accessing

> Syringe Size

> Removal

> Flushing

> Heparin Lock





> Taking Blood

> Documentation

Complications

> Blockage of lumen

> Infection

> Thrombosis

> Damage

Resources

GONG Products


1. INTRODUCTION

2. HICKMAN CATHETER

3. PORT

4. PICC

Confirmation of placement

• Every time the Hickman Catheter is accessed, the nurse is responsible for confirming correct placement by:– Aspiration of blood– Ability to easily infuse solutions – Normal appearance of site and patient’s chest– Written x-ray report confirming correct placement of

Hickman Catheter available in patient record

• If unable to confirm correct placement refer to the troubleshooting section of the GONG Cancer Care Guidelines ‘Hickman Catheter Management’ (see Resources)


HICKMAN CATHETER

This Tutorial

Hickman Description

Advantages /

Disadvantages

Confirm Placement

Principles of Care

> Accessing

> Syringe Size

> Removal

> Flushing

> Heparin Lock





> Taking Blood

> Documentation

Complications

> Blockage of lumen

> Infection

> Thrombosis

> Damage

Resources

GONG Products


1. INTRODUCTION

2. HICKMAN CATHETER

3. PORT

4. PICC

Principles of Care

• Clamps are ESSENTIAL on Hickman catheters

• Must be left open when a positive pressure bung is in use

• Must be closed if a non-positive pressure bung is in use

• Must be closed when the system is opened i.e. cap/bung removed

Non Positive Pressure Bung

Positive Pressure Bung

Note: Above is a sample of one type of bung currently available


HICKMAN CATHETER

This Tutorial

Hickman Description

Advantages /

Disadvantages

Confirm Placement

Principles of Care

> Accessing

> Syringe Size

> Removal

> Flushing

> Heparin Lock





> Taking Blood

> Documentation

Complications

> Blockage of lumen

> Infection

> Thrombosis

> Damage

Resources

GONG Products


1. INTRODUCTION

2. HICKMAN CATHETER

3. PORT

4. PICC

Accessing

• A clean technique* is required for accessing a closed system through a cap/bung

• Aspirate for blood return to check patency and position

• Flush with 10 ml normal saline in a pulsatile manner when position confirmed

• Connect to IV line

• * Recommended clean technique: clean gloves and clean with 3 alcohol swabs and allow to air dry before proceeding to access a closed system


HICKMAN CATHETER

This Tutorial

Hickman Description

Advantages /

Disadvantages

Confirm Placement

Principles of Care

> Accessing

> Syringe Size

> Removal

> Flushing

> Heparin Lock





> Taking Blood

> Documentation

Complications

> Blockage of lumen

> Infection

> Thrombosis

> Damage

Resources

GONG Products


1. INTRODUCTION

2. HICKMAN CATHETER

3. PORT

4. PICC

Syringe Size

• Syringes no smaller than 10 ml to be used• Smaller syringes increase the pressure in the

catheter wall and increase the risk of rupture of the catheter


HICKMAN CATHETER

This Tutorial

Hickman Description

Advantages /

Disadvantages

Confirm Placement

Principles of Care

> Accessing

> Syringe Size

> Removal

> Flushing

> Heparin Lock





> Taking Blood

> Documentation

Complications

> Blockage of lumen

> Infection

> Thrombosis

> Damage

Resources

GONG Products


1. INTRODUCTION

2. HICKMAN CATHETER

3. PORT

4. PICC

Catheter Removal

• Only to be performed by a doctor in a hospital setting


HICKMAN CATHETER

This Tutorial

Hickman Description

Advantages /

Disadvantages

Confirm Placement

Principles of Care

> Accessing

> Syringe Size

> Removal

> Flushing

> Heparin Lock





> Taking Blood

> Documentation

Complications

> Blockage of lumen

> Infection

> Thrombosis

> Damage

Resources

GONG Products


1. INTRODUCTION

2. HICKMAN CATHETER

3. PORT

4. PICC

Flushing

• Flush with Normal Saline 10 ml in a pulsatile (stop/start) manner: that is, push then pause the plunger of 10ml syringe continuously in short bursts until syringe empty

• On accessing the Hickman Catheter to determine patency

• Before and after drug administration• After blood sampling• Weekly, when not in use


HICKMAN CATHETER

This Tutorial

Hickman Description

Advantages /

Disadvantages

Confirm Placement

Principles of Care

> Accessing

> Syringe Size

> Removal

> Flushing

> Heparin Lock





> Taking Blood

> Documentation

Complications

> Blockage of lumen

> Infection

> Thrombosis

> Damage

Resources

GONG Products


1. INTRODUCTION

2. HICKMAN CATHETER

3. PORT

4. PICC

Heparin Lock

• Weak heparin lock (heparinization) 50u/s in 5ml is all that is required – After each use, and weekly, when a non-positive

pressure bung is in use

* Remember never use a syringe smaller than a 10ml


HICKMAN CATHETER

This Tutorial

Hickman Description

Advantages /

Disadvantages

Confirm Placement

Principles of Care

> Accessing

> Syringe Size

> Removal

> Flushing

> Heparin Lock





> Taking Blood

> Documentation

Complications

> Blockage of lumen

> Infection

> Thrombosis

> Damage

Resources

GONG Products


1. INTRODUCTION

2. HICKMAN CATHETER

3. PORT

4. PICC

Cap / Bung Descript ion

• The positive pressure bung maintains a positive pressure in the line to prevent back flow of blood into the end of the catheter.

• A positive pressure bung should be used with a Hickman Catheter. If a positive pressure bung is unavailable then use a non positive pressure bung and weak heparinization is required.

Non Positive Pressure Bung

Positive Pressure Bung

Note: Above is a sample of one type of bung currently available


HICKMAN CATHETER

This Tutorial

Hickman Description

Advantages /

Disadvantages

Confirm Placement

Principles of Care

> Accessing

> Syringe Size

> Removal

> Flushing

> Heparin Lock





> Taking Blood

> Documentation

Complications

> Blockage of lumen

> Infection

> Thrombosis

> Damage

Resources

GONG Products


1. INTRODUCTION

2. HICKMAN CATHETER

3. PORT

4. PICC

Changing a Cap / Bung

• Aseptic technique required using a sterile tray and sterile gloves

• Positive pressure cap/bung should always be insitu and must be changed at least every 7 days

• Clamp line before removing cap/bung


HICKMAN CATHETER

This Tutorial

Hickman Description

Advantages /

Disadvantages

Confirm Placement

Principles of Care

> Accessing

> Syringe Size

> Removal

> Flushing

> Heparin Lock





> Taking Blood

> Documentation

Complications

> Blockage of lumen

> Infection

> Thrombosis

> Damage

Resources

GONG Products


1. INTRODUCTION

2. HICKMAN CATHETER

3. PORT

4. PICC

Changing a dressing

• Always use an aseptic technique• Initial dressing should be changed 24 hours

post insertion • Dressing should be changed every 7 days or

earlier if necessary• Dressing usually not required 21 days post

insertion • Entry site may be left uncovered when healed


HICKMAN CATHETER

This Tutorial

Hickman Description

Advantages /

Disadvantages

Confirm Placement

Principles of Care

> Accessing

> Syringe Size

> Removal

> Flushing

> Heparin Lock





> Taking Blood

> Documentation

Complications

> Blockage of lumen

> Infection

> Thrombosis

> Damage

Resources

GONG Products


1. INTRODUCTION

2. HICKMAN CATHETER

3. PORT

4. PICC

Changing an IV Line

• A clean technique* is required when the system is closed ie. bung is in place

• Continuous IV infusion line is changed every 72 hours• For intermittent IV infusion, change line with each

infusion• Change IV TPN/Lipid line every 24 hours• Blood product infusion sets changed to an IV infusion

set on completion of the blood product infusion

*Recommended clean technique: clean gloves and clean with 3 alcohol swabs and allow to air dry before proceeding to access a closed system


HICKMAN CATHETER

This Tutorial

Hickman Description

Advantages /

Disadvantages

Confirm Placement

Principles of Care

> Accessing

> Syringe Size

> Removal

> Flushing

> Heparin Lock





> Taking Blood

> Documentation

Complications

> Blockage of lumen

> Infection

> Thrombosis

> Damage

Resources

GONG Products


1. INTRODUCTION

2. HICKMAN CATHETER

3. PORT

4. PICC

Taking Blood

• Perform initial flush to determine patency (except for blood cultures)

• Discard the first 5ml of blood withdrawn before collecting sample

• When taking blood cultures do not perform initial flush to determine patency, do not discard a sample. Retain initial sample for blood culture

• Flush Hickman Catheter, in a pulsatile manner, with 20ml of Normal Saline after blood sampling and continue with treatment as ordered and / or heparinization if required


HICKMAN CATHETER

This Tutorial

Hickman Description

Advantages /

Disadvantages

Confirm Placement

Principles of Care

> Accessing

> Syringe Size

> Removal

> Flushing

> Heparin Lock





> Taking Blood

> Documentation

Complications

> Blockage of lumen

> Infection

> Thrombosis

> Damage

Resources

GONG Products


1. INTRODUCTION

2. HICKMAN CATHETER

3. PORT

4. PICC

Documentation

Clear, consistent documentation is essential after each treatment or shift. This should include: • Ability to confirm placement• Medications and flushes administered • Strength of heparinization (if used)• Type of bung/cap used• Dressing change • Signs and symptoms of infection or thrombosis• Troubleshooting* Written x-ray report confirming correct placement at

time of insertion should be available in patient documentation


HICKMAN CATHETER

This Tutorial

Hickman Description

Advantages /

Disadvantages

Confirm Placement

Principles of Care

> Accessing

> Syringe Size

> Removal

> Flushing

> Heparin Lock





> Taking Blood

> Documentation

Complications

> Blockage of lumen

> Infection

> Thrombosis

> Damage

Resources

GONG Products


1. INTRODUCTION

2. HICKMAN CATHETER

3. PORT

4. PICC

Complications

1. Blockage of lumens2. Infection at insertion site or in catheter3. Thrombosis4. Damage to exposed catheter


HICKMAN CATHETER

This Tutorial

Hickman Description

Advantages /

Disadvantages

Confirm Placement

Principles of Care

> Accessing

> Syringe Size

> Removal

> Flushing

> Heparin Lock





> Taking Blood

> Documentation

Complications

> Blockage of lumen

> Infection

> Thrombosis

> Damage

Resources

GONG Products


1. INTRODUCTION

2. HICKMAN CATHETER

3. PORT

4. PICC

1. Blockage of lumen

Difficulty flushing and/or aspirating blood• Ensure any clamps are open• Change position of patient • Change cap or bung


HICKMAN CATHETER

This Tutorial

Hickman Description

Advantages /

Disadvantages

Confirm Placement

Principles of Care

> Accessing

> Syringe Size

> Removal

> Flushing

> Heparin Lock





> Taking Blood

> Documentation

Complications

> Blockage of lumen

> Infection

> Thrombosis

> Damage

Resources

GONG Products


1. INTRODUCTION

2. HICKMAN CATHETER

3. PORT

4. PICC

2. Infection

• Redness, discharge, tenderness, heat, patient feels unwell, pain and swelling at Hickman Catheter site may be symptoms of infection

• If signs of infection are present do not access Hickman Catheter and consult physician

• Septic shower may occur immediately after flushing due to infection in the line. There may be an absence of obvious infection at entry site, however the patient will experience rigors and generally feel unwell. Consult physician


HICKMAN CATHETER

This Tutorial

Hickman Description

Advantages /

Disadvantages

Confirm Placement

Principles of Care

> Accessing

> Syringe Size

> Removal

> Flushing

> Heparin Lock





> Taking Blood

> Documentation

Complications

> Blockage of lumen

> Infection

> Thrombosis

> Damage

Resources

GONG Products


1. INTRODUCTION

2. HICKMAN CATHETER

3. PORT

4. PICC

3. Thrombosis

• Do not access Hickman Catheter and consult physician


HICKMAN CATHETER

This Tutorial

Hickman Description

Advantages /

Disadvantages

Confirm Placement

Principles of Care

> Accessing

> Syringe Size

> Removal

> Flushing

> Heparin Lock





> Taking Blood

> Documentation

Complications

> Blockage of lumen

> Infection

> Thrombosis

> Damage

Resources

GONG Products


1. INTRODUCTION

2. HICKMAN CATHETER

3. PORT

4. PICC

4. Damage to exposed catheter

Check catheter every time it is accessed for: – Perishing, splitting, damage and if the cap

is firmly in place– Refer to physician if integrity is

compromised – This is more common in children


HICKMAN CATHETER

This Tutorial

Hickman Description

Advantages /

Disadvantages

Confirm Placement

Principles of Care

> Accessing

> Syringe Size

> Removal

> Flushing

> Heparin Lock





> Taking Blood

> Documentation

Complications

> Blockage of lumen

> Infection

> Thrombosis

> Damage

Resources

GONG Products


1. INTRODUCTION

2. HICKMAN CATHETER

3. PORT

4. PICC

Resources

GONG Cancer Care Guidelines have been accepted to guide the management of all patients with a CVAD in Gippsland and are available at each Gippsland Health Service.

Also available on-line at: www.gha.net.au/grics


HICKMAN CATHETER

This Tutorial

Hickman Description

Advantages /

Disadvantages

Confirm Placement

Principles of Care

> Accessing

> Syringe Size

> Removal

> Flushing

> Heparin Lock





> Taking Blood

> Documentation

Complications

> Blockage of lumen

> Infection

> Thrombosis

> Damage

Resources

GONG Products


1. INTRODUCTION

2. HICKMAN CATHETER

3. PORT

4. PICC

GONG Products

www.gha.net.au/grics

http://www.gha.net.au/grics

Documents

Hickman Catheter