Hickman Catheter: Information, Care and Maintenance, and Complications
Complete Hickman catheter guide: what it is, indications, care and maintenance (exit site care, heparin flushing), complications and their management, removal, and how to take care of a Hickman catheter at home.
Tunneled central catheters — the Hickman catheter chief among them — are the workhorse external long-term central line. This guide covers what a Hickman is, its indications, day-to-day care and maintenance, complications and how to manage them, removal, and how patients care for a Hickman catheter at home.
Parent guide: Tunneled Central Venous Catheters: Hickman, Broviac, and Groshong Clinical Guide · Central Venous Catheters: Complete Clinical Reference
What is a Hickman catheter?
A Hickman catheter is the classic open-ended tunneled central venous catheter. A soft silicone catheter is passed under the skin from a chest-wall exit site to a venous entry point (typically the internal jugular or subclavian vein), with the tip positioned at the cavoatrial junction. The subcutaneous tunnel physically separates the skin exit site from the vein, and a Dacron polyester cuff in the tunnel promotes tissue ingrowth over 2–4 weeks — anchoring the catheter and creating a biological barrier against infection.
Hickman catheters are available in single, double, and triple lumen configurations and in sizes from roughly 6.6 Fr to 14 Fr. Each external lumen has a clamp, which is kept closed at rest because the open-ended tip allows blood to reflux into the lumen.
Hickman vs. Broviac vs. Groshong
| Catheter | Tip design | Lock solution | Typical use |
|---|---|---|---|
| Hickman | Open-ended (clamp required) | Heparin 100 units/mL | Adult long-term access, home TPN, transplant |
| Broviac | Open-ended (clamp required) | Heparin 100 units/mL | Pediatric/neonatal and smaller adult access (down to 2.7 Fr) |
| Groshong | Pressure-sensitive valve | Saline only | Heparin allergy/HIT; eliminates routine heparin lock |
The Broviac is simply a smaller-diameter Hickman cared for in the same way; see the Broviac catheter guide for pediatric specifics.
Indications
Hickman catheters are chosen when a patient needs reliable central access for frequent (daily or near-daily) external use over months to years, and when an implanted port is not suitable:
- Home total parenteral nutrition (TPN)
- Long-term IV antibiotics
- Chemotherapy and oncology access
- Hematopoietic stem cell (bone marrow) transplantation
- Frequent blood draws and transfusions
Hickman catheter care and maintenance
Three tasks define safe Hickman maintenance: exit-site care, flushing, and protecting the catheter.
Exit-site care
The exit site is the primary infection entry point and the most important maintenance activity.
- First 2–4 weeks (before the cuff heals): daily sterile dressing changes.
- After the site is healed and the cuff is fibrosed: per institutional policy, typically weekly.
- Technique: clean with a CHG-based antiseptic, inspect the exit site for erythema, swelling, tenderness, and drainage, palpate along the subcutaneous tunnel for tenderness or warmth, apply a new sterile dressing, and secure the catheter so there is no tension on the exit site.
Flushing and locking
- Flush each lumen with normal saline before and after every use (SASH where medications are given).
- Lock with heparin 100 units/mL when the lumen is not in use — required because the open-ended tip allows blood reflux.
- Keep the clamp closed whenever the lumen is not connected.
- Scrub the hub with alcohol or CHG for 15 seconds and allow it to dry before every access.
Protecting the catheter
Secure external lumens to prevent snagging, keep the dressing intact and dry, and keep a clamp nearby in case of catheter damage.
Hickman catheter complications
| Complication | Recognition | Management |
|---|---|---|
| CLABSI | Fever/rigors with use, positive cultures | Blood cultures (peripheral + catheter), antibiotics; removal for confirmed CLABSI |
| Exit-site infection | Localized redness, tenderness, purulent drainage at exit site | Topical/systemic antibiotics; catheter salvage often possible |
| Tunnel infection | Erythema/warmth/tenderness along the tunnel tract | Catheter removal generally required |
| Occlusion | Inability to flush or withdraw | Assess cause; alteplase (Cathflo) for thrombotic occlusion per protocol |
| Catheter-related thrombosis | Arm/neck/facial swelling, collateral veins | Anticoagulation; imaging to confirm |
| Cuff extrusion / dislodgement | Cuff visible at exit site, increased external length | Evaluate position; often requires replacement |
| Catheter breakage | Leak, fluid at hub, inability to infuse | Clamp proximal to the break immediately; repair kit or replacement |
For the full complication workups (alteplase dosing, DVT management, CLABSI bundle), see Catheter Complications: Recognition, Prevention, and Management and the CLABSI Prevention Framework.
How to take care of a Hickman catheter at home
Patients and caregivers managing a Hickman at home should:
- Keep the dressing clean, dry, and intact. Cover it for showering as instructed; never let the exit site get wet under an unsealed dressing.
- Flush exactly as taught — saline, then heparin lock — and keep the clamp closed between uses.
- Scrub the hub before connecting anything.
- Watch for warning signs: fever or chills, redness/swelling/drainage at the exit site, pain or swelling in the arm, neck, or face, or a line that won’t flush.
- Protect the line from pulling and keep a clamp on hand in case of damage.
The complete patient walkthrough — bathing, activity, and when to call — is in Going Home with a Tunneled Catheter (Hickman, Broviac, Groshong).
Removal
A Hickman is removed when therapy is complete or a complication requires it. Because the Dacron cuff is fibrosed into the tunnel, removal is a minor procedure: the cuff is freed (by traction or, if needed, a small cut-down) and the catheter withdrawn with the exit site dressed and monitored for bleeding.