Using a Hickman Line (Tunelled Cuffed Catheter) for Intranevous Therapy

7/30/2019 Using a Hickman Line (Tunelled Cuffed Catheter) for Intranevous Therapy

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How to Access a Tunnelled cuffed Catheter Hickman

Introduction

A Hickman Line is a long hollow tube that goes from the chest wall into a veinclose to the heart. A Hickman Line can have one or two lumens. If theHickman Line has two lumens and you use one lumen for intravenoustherapy, ensure that you flush the other one. A Hickman is flushed withHepsal 10 units per ml. However, if the line is being used a few times a day, itcan be flushed with saline but locked with hepsal at the end of the day.

You should always verify a blood return (i.e get blood back into your syringe)from one of the lumens prior to using the line for any infusion.

As with all Central lines, 10 mls is the minimum size of syringe to be used with

a Hickman line. Using smaller syringe size can result in excessive pressurebeing exerted which could result in a damaged catheter.

Before starting the procedure, open the clamp and move along the surface ofthe line and squeeze the line in-between your finger and thumb. Place theclamp back onto the re-inforced area and close. Repeat with other lumen.

Please use strict aseptic technique.

Pre-use Assessment:Observe for:

Redness, pain exudate at the line entry site Swelling of the neck, chest or shoulder

Pain in the neck, chest or shoulder

Any history of rigors or feeling unwell post flushing!! IMPORTANT!

Report this immediately to more experienced practitioner or Doctor.

If any of the above present, contact Velindre Cancer Centre for advice:02920 615888 bleep 194 (chemo pager)

Equipment required:

Sterile dressing packSterile gloves (powder free)Sterile chlorhexidine 2% in alcohol 70% swab (Clinell) or chlorhexidine liquid2% in alcohol 70%3 x 10ML or syringes10ML 0.9% Sodium ChlorideHepsal 10mls (10units per ml)Blue needleSharps bin

Procedure

1. Wash hands thoroughly

MH/IVAccess/VCC/WrittenJune2011


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2. Prepare your infusion line or bolus drugs prior to accessing the line.

3. Prepare equipment, opening the dressing pack onto a clean surfaceand tip syringes, needle and sterile wipe onto pack. Open SodiumChloride 0.9% ampoule and place outside of the sterile field. (andhepsal if required, see above)

4. Wash or gel hands

5. Put on sterile gloves.

6. Using a strict aseptic technique (hold the end of the line with sterilegauze), clean the very end of needle free connectorthoroughly withthe sterile alcohol wipe and chlorhexidine 2% (clinnell) and allow to dry.It is imperative that the solution is left to dry naturally. If you do nothave any chlorhexidine solutions in alcohol use an alcohol swab.

7. Visually check that the end of the end connector is dry

8. Draw up 10MLS of 0.9% Sodium Chloride into the syringe. If you needto handle the ampoule then use sterile gauze. Detach needle intosharps bin. Place the saline filled syringe to the side.

9. Open the clamp. Place the empty syringe into the needle freeconnector at the end of the line and pull on the plunger to withdrawblood into the syringe. If the blood does not come out, flush with asmall amount of saline and try again.

10.Waste 3-5mls of blood and discard.

11.Attach a syringe containing the 10mls of 0.9% Sodium Chloride onto

the end connector and flush with 5-10mls of saline.12.Connect the infusion line firmly onto the end of the line. You can use a

volumetric infusion pump with a Hickman line. You can use the line toinfuse medication via secondary line.

13.If you are giving bolus medication, infuse directly into the line and

flush thoroughly after administration. When the bolus administration iscomplete using sterile technique, draw up 10mls of Hepsal and flushthe line using a turbulant, (pulsating push pause) action, finishing witha positive pressure. Positive pressure flushing means continuing tosimultaneously flush whilst at the same time clamping the catheter.

Flushing technique:A turbulant flush can be described as a rapid push pause action. Theturbulence created by this form of flushing will cleanse the internal lumen ofthe catheter more efficiently.A positive pressure flush means that the line is full of flush up to the brim toprevent blood reflux back into the catheter which could cause a blockage.

Dont ever force a flush into a Hickman.

Disconnecting an infusion:



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Always flush a Hickman with a bolus syringe flush after disconnecting aninfusion line. Follow second half of figure 12 above using strict asepsis.


Using a Hickman Line (Tunelled Cuffed Catheter) for Intranevous Therapy

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