Hickmann Catheter Insertion

Hickman catheter insertion procedure

A Hickman is a kind of central venous catheter in a tunnel and is employed in:

• Long-term IV (chemotherapy, antibiotics, parenteral nutrition) treatment.
• Frequent blood sampling
• Stem cell transplantation

It is normally placed into a huge central vein (mostly the internal jugular vein or subclavian vein) and placed under the skin to minimize the risk of infection.

Indications

• Long-term IV treatment (weeks to months)
• Patients with recurring blood tests.
• Inefficient peripheral venous access.
• Transplantation or chemotherapy of stem cells.

Pre-Procedure Preparation

Patient Assessment:

• Examine past medical history, allergies, coagulation levels.
• Look at active infections or skin lesions at port of insertion.

Informed Consent:

• Abnormalize: infection, bleeding, thrombosis, pneumothorax.

Pre-Procedure Imaging (where necessary):

• Localization of veins with ultrasound.

Equipment Preparation:

• Sterile catheter kit
• Ultrasound machine
• Local anaesthetic
• Sutures and dressings

Procedure Steps

Patient Positioning

• Lying on his back with his head turned a bit towards opposite side of insertion.
• Placing the neck in a pillow or towel under the shoulders can be used to extend the neck.

Site Preparation

• Sterile procedure: antiseptic skin preparation across neck/ chest.
• Cover the patient to ensure sterile field.

Venous Access

• Guiding should include use of ultrasound (preferred) with internal jugular vein or subclavian vein.
• Introduce a guidewire through Seldinger technique.
• Diagnose the proper placement of the veins through aspiration and occasionally fluoroscopy.

Tunnel Creation

• Make a small opening 3-5 cm below the entry point of the vein (chest wall).
• The catheter should be tunneled subcutaneously between the exit site and the venous entry site.
• This aids in infection prevention and it enables fixation in a safe way.

Catheter Insertion

• Increase the catheter above the guidewire into the central vein.
• Proper placement verified through the use of fluoroscopy or X-ray (tip ought to be located in the superior vena cava close to right atrium).

Securing the Catheter

• Suture at the exit site.
• Secure the catheter with an anchoring device that is a Dacron cuff.
• Apply sterile dressing.

Post-Procedure Care

Immediate:

• X-ray of the chest to exclude pneumothorax or malposition.
• Check vital signs and insertion site.

Catheter Maintenance:

• Warm heparinized saline or saline according to protocol.
• Frequently replace change dressing (usually weekly, when wet/soiled).
• Keep an eye on infection, thrombosis or catheter malfunction.

Patient Education:

• Eliminate tugging or pulling of catheter.
• Use with high standards of hygiene.

Central venous Hickman catheter insertion

A Hickman catheter is a long run central venous catheter (CVC) that is placed into one of the major central veins (internal jugular, subclavian, or femoral vein) as a permanent means of venous access, typically in:

• Chemotherapy
• Stem cell transplantation
• Long-term antibiotics
• Total parenteral nutrition (TPN).

The catheter is subcutaneous, and a Dacron cuff is to avoid infection.

Indications

• Violations (weeks to months of intravenous therapy).
• Frequent blood sampling
• Poor peripheral access
• Requirement of good central venous pressure monitoring.

Hickman line insertion complications

The complications are generally categorized as early (during or immediately after insertion) and late (after days to months).

Early Complications

These happen either at the time of insertion or shortly after.

Mechanical Complications

Pneumothorax / Hemothorax:

• Typically in case of subclavian or internal jugular vein puncture, injures lung or pleura.
• Symptoms: dyspnea, chest pain, loss of oxygen saturation.
• Diagnosed by chest X-ray

Arterial puncture:

• Unintended carotid or subclavian artery puncture.
• May result in bleeding or blood poisoning.

Catheter malposition:

• Take off in poor vein (e.g., azygos vein, or right atrium)
• Has the potential to result in arrhythmias or poor functioning.

Guidewire complications:

• Kinking, looping or loss into vein.

Bleeding / Hematoma

• Minor bleeding is common
• Hematomas can be large and cause a compression of surrounding structures.

Cardiac Arrhythmias

• May be present when there exists guidewire or catheter tip irritation of the right atrium.
• On average temporary but can be compensated.

Air Embolism

• Rare but serious
• The entry of air to the venous system occurs during the insertion.
• Avoided using Trendelenburg position and occlusive procedure.

Early Infectious Complications

• Immediate after insertion is rare.
• Exit site usually localized redness, warmth or purulent discharge.

Late Complications

These phenomena take place days to months following the insertion.

• Catheter-Related Infection (CRI).
• Majority of late complications.
• And may lead to sepsis, untreated.
• Symptoms: fever, chills, redness, or pus at porta.
• Averted through rigid aseptic manipulation and frequent changing of the dressing.

Catheter Occlusion / Thrombosis

• Because of fibrin sheath, clotting or precipitation of medication.
• Symptoms: trouble with passing or drawing blood.
• Under the thrombolytic agent or catheter replacement.

Catheter Migration/ Fracture

• Catheter may migrate out of SVC to smaller veins or may fracture at cuff.
• Uncommon, can be surgically retrieved.

Extravasation / Leakage

• In case of perforation of catheter on vein wall.
• May result in swelling, pain, or damage of tissue.

Venous Stenosis / Thrombosis

• The persistent irritation can result in the narrowing of veins.
• May makes next central access more complicated.

Skin or Tunnel Infection

• Subcutaneous tunnel or cuff Dacron infection.
• May requires the removal of catheters.

Hickman catheter insertion risks and side effects

The following is a list of risks and side effects of the insertion of the Hickman catheters in details:

Mechanical / Procedural Risks

Pneumothorax or Hemothorax

• Accidental lung puncture causes air or blood build up in the mammal (happier with subclavian vein access).
• Symptoms: dyspnea, chest pains, low oxygenation.

Arterial Puncture / Hematoma

• Carotid or subclavian accidental puncture- bleeding, swelling, or bruises.

Catheter Malposition

• Wrongly placed tip - bad functioning, threat of arrhythmia.

Air Embolism

• Uncommon but serious; this may happen when air gets into the vein when inserting.

Cardiac Arrhythmias

• Irregular heart beat in the short term in case the heart is irritated by catheter tip.

Infectious Risks

Exit Site Infection

• Warmth, erythema, pus at catheter outlet.

Tunnel or Cuff Infection

• Tunnel infection; may be transmitted to blood.

Catheter Bloodstream Infection (CRBSI)

• Fever, chills, sepsis; the most typical severe long-term risk.

Thrombotic / Vascular Risks

Catheter-Associated Thrombosis

• Catheter or central vein clot formation- swelling, pain or vein blockage.

Venous Stenosis

• Vein constriction with time passing by, make future access difficult.

Catheter Occlusion

• Finds it hard to flush or draw blood because of clot or fibrin sheath.

Catheter Complications

Migration or Fracture

• Catheter shifts or ruptures out of place → might need to be removed or operated.

Extravasation / Leakage

• Leakage of fluid in tissues in case of perforation of vein wall walls → swelling, pain.

Mechanical Wear

• Infrequent, chronic risk of cuff or hub catheter weakening.

General Side Effects

• Pain or Suffering at point of insertion/exit.
• Sedimentary or Haemorrhagic appearance near catheter.
• Minor bleeding on or soon after insertion.

Hickman catheter insertion recovery time

The summary of the recovery time of Hickman catheter insertion and expectations is as follows:

Immediate Recovery

• Time of Procedure: It typically takes 30-60 minutes.

Post-Procedure Observation:

• Complications that are observed and managed include bleeding, pneumothorax, or arrhythmia which is monitored in the patient in 1-2 hours.
• Vital signs, site of insertion, and checking of breathing is done.
• Pain: At the sites of insertion and exit, mild pain is normal; which is normally treated using acetaminophen.
• Mobility: Patients are usually able to sit up and walk once they get over with sedation/local anaesthesia.

Catheter Use

Flushing and Dressing:

• To keep catheters patent, saline or heparin is used to flush the catheter.
• Dressings are placed and they must be dry.

Timing of Use:

• Others use the centers immediately, whereas others suggest a waiting period of 12-24 hours.

Short-Term Recovery (Week 1)

Activity:

• Avoid lifting heavy or straining during 5-7 days to enable the healing process.
• Light exercises are usually harmless.

Wound Care:

• Maintain a clean and dry exit site.
• Assess redness, swelling or drainage.

Follow-Up:

• First dressing change usually changed after 2-3 days by a trained nurse.

Long-Term Recovery

Full Healing:

• Dacron cuff subcutaneous tunnel typically heals within 7-14 days.
• The cuff would assist in fixing the catheter and prevent infections.

Routine Care:

• Dressing changes every week (or according to hospital requirements)
• Periodical toilet flushing to avoid clotting.

Lifestyle:

• The majority of the daily life can be resumed, but no swimming, contacts, and activities that pull on the catheter.

Factors Affecting Hickman catheter insertion cost India

The price of inserting Hickman catheters in India depends on a number of factors. Here's a detailed breakdown:

Hospital Type and Location

• Private Hospitals: These are normally costlier as they have advanced facilities and personal care.
• Tier 1 Cities (e.g., Delhi, Mumbai, Bengaluru): More costs because of the demand and the operation costs.
• Tier 2 -3 Cities: Less expensive, but quality of care can be different.

Procedure Complexity

• Insertion under Ultrasound: Precise, safe, and can be charged an extra fee.
• Fluoroscopy-Guided Insertion: Gives real-time imaging, which increases the cost.
• Bedside vs. Operating Room Insertion: There is the possibility of bedside being cheaper. 

Hospital Equipment and Supplies

• Catheter Type: The cuffed Hickman catheters are chosen as long-term catheters because they have lower chances of infection.
• Other Supplies: Other supplies such as sterile cover, gloves, and dressings are part of total expenses.

Anaesthesia and Monitoring

• Local Anaesthesia: This is used most frequently, although there are centers that may bill anaesthesia services separately.
• Sedation and Monitoring: Other charges might be added in case the patient needs to be sedated or the procedure is to be conducted in an operating room.

Post-Procedure Care

• Hospitalization: There are patients who might need an overnight stay, which will increase the price.
• Follow-Up Visits: Frequent check-ups and change of dressing play a very important role in avoidance of complications.
• Catheter Care: Continued expenditure of flushing and dressing change and possible removal.

Hickman catheter insertion hospital India

• Artemis Hospital, Gurgaon
• Medanta-The Medicity, Gurgaon
• Fortis Memorial Research Institute, Gurgaon
• Max Hospital, Saket

Conclusion

Hickman catheter insertion is a safe and effective technique of long term central venous access, which is commonly employed in chemotherapy, stem cell transplantation, parenteral nutrition and recurrent blood sampling. This process entails the use of ultrasound on the venous access, subcutaneous tunneling, and correct positioning of the catheter tip, where post-procedure care is very vital in averting complications. The recovery process is normally fast and patients can resume light activity within one day and complete the process of recovery within 1-2 weeks. In general, when properly planned, inserted, and taken care of after the procedure, a Hickman catheter offers effective long-term access to the venous system at a comparatively low risk of complications, which can be considered one of the key stones in the treatment of patients who need a long-term intravenous treatment.

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FAQ

1. What is the duration of the process?

• The process typically lasts 30-60 minutes based on complexity and anatomy of the patient.

2. Is the procedure painful?

• At the exit and insertion sites, local anaesthesia is applied.
• Mild pressure or discomfort can be experienced by the patients in the process of tunneling, though severe pain is very rarely observed.
• Minor pain at the exit site can take a couple of days to go.

3. What must be done with the catheter?

• Keep the area of exit mouth clean and dry.
• Clean the catheter on a frequent basis.
• Hospital change dressings (typically weekly or when wet/soiled).
• Do not tug or traumatize catheter.

4. What is the maximum length of stay of a Hickman catheter?

• Usually weeks to months, or even more, according to the treatment and situation of the patient.
• Removal of catheter should be done when infected, defective or unnecessary.

5. Will having a Hickman catheter allow me to live a normal life?

• Majority of the daily activities can be done, but swimming, contact games and activities that pull on the catheter should be avoided.
• Safe and long term usage is possible with proper care and hygiene.