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 vein close to the heart. A Hickman Line can have one or two lumens. If the Hickman Line has two lumens and you use one lumen for intravenous therapy, ensure that you flush the other one. A Hickman is flushed with Hepsal 10 units per ml. However, if the line is being used a few times a day, it can 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 pressure being exerted which could result in a damaged catheter. Before starting the procedure, open the clamp and move along the surface of the line and squeeze the line in-between your finger and thumb. Place the clamp 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 pack Sterile gloves (powder free) Sterile chlorhexidine 2% in alcohol 70% swab (Clinell) or chlorhexidine liquid 2% in alcohol 70% 3 x 10ML or syringes 10ML 0.9% Sodium Chloride Hepsal 10mls (10units per ml) Blue needle Sharps bin Procedure 1. Wash hands thoroughly

MH/IVAccess/VCC/WrittenJune2011

2. Prepare your infusion line or bolus drugs prior to accessing the line. 3. Prepare equipment, opening the dressing pack onto a clean surface and tip syringes, needle and sterile wipe onto pack. Open Sodium Chloride 0.9% ampoule and place outside of the sterile field. (and hepsal 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 sterile gauze), clean the very end of needle free connector thoroughly with the 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 not have 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 need to handle the ampoule then use sterile gauze. Detach needle into sharps bin. Place the saline filled syringe to the side. 9. Open the clamp. Place the empty syringe into the needle free connector at the end of the line and pull on the plunger to withdraw blood into the syringe. If the blood does not come out, flush with a small 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 to infuse 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 is complete using sterile technique, draw up 10mls of Hepsal and flush the line using a turbulant, (pulsating push pause) action, finishing with a positive pressure. Positive pressure flushing means continuing to simultaneously flush whilst at the same time clamping the catheter. Flushing technique: A turbulant flush can be described as a rapid push pause action. The turbulence created by this form of flushing will cleanse the internal lumen of the catheter more efficiently. A positive pressure flush means that the line is full of flush up to the brim to prevent blood reflux back into the catheter which could cause a blockage. Dont ever force a flush into a Hickman.

Disconnecting an infusion:

MH/IVAccess/VCC/WrittenJune2011

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

MH/IVAccess/VCC/WrittenJune2011