Hickman catheter

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Hickman catheter in a leukemia patient. It runs under the skin in a tunnel to the collarbone vein.

A Hickman catheter is a central venous catheter (CVC) made of silicone and named after its inventor, the doctor Robert O. Hickman . It is usually implanted for chemotherapy or the regular, long-term administration of other drugs and in this context can also be used to take blood. Hickman catheters are also available with two or more leads , and there are also special types for dialysis or apheresis . Compared to the comparable Broviac catheter , Hickman catheters have slightly larger lumens (indicated by Hickman with ID 0.32 mm). Hickman and Broviac catheters can be left in place for a longer period of time until the end of therapy and are put on “tunneled under”. The plastic ( Dacron ) sleeves (one from Broviac, two from Hickman), depending on the manufacturer, are usually present in catheters and can optionally be antibiotic or antibacterial impregnated (e.g. with silver ions).

implantation

The implantation (placement) of a Hickman catheter usually takes place under sedation and local anesthesia or under general anesthesia . At the level of the third or fourth intercostal space , an incision is made next to the breastbone and the catheter is pulled through (tunneled) under the skin with a surgical stick into the shoulder area. The Dacron sleeve of the catheter should then be approx. 1.5–2 cm behind the point where the catheter penetrates the skin. Then either the internal or external jugular vein is opened. From there, the catheter is now passed into the superior vena cava and to the right atrium of the heart. This is done using the Seldinger technique , in which a special guide wire is first inserted and placed. Then the actual catheter is pushed over this and the wire is pulled out again.

Then the area above the vein is sewn up and the catheter is covered with a sterile plaster at its exit point in order to avoid contamination . During the implantation, the position of the catheter is checked with an image converter and ultrasound , after which an x-ray is usually made for documentation purposes.

history

Long-term venous catheters became available in 1968, the design was by Broviac et al. 1973 improved. Broviac used instead of the previously common catheters made of polyethylene, those made of soft and flexible silicone. Hickman et al. , after which the system was named, introduced application-specific improvements in the late 1970s, such as a slightly larger inner diameter (better suited for parenteral feeding solutions) and a second Dacron sleeve on the catheter as an additional infection barrier. Robert O. Hickman was a pediatrician and nephrologist at Children's Hospital in Seattle .

Complications

Possible complications of long-term catheters in general include bleeding and pneumothorax as a result of implantation, thrombosis and infections while the catheter is in place. The length of time a central venous catheter (CVC) remains in place correlates with the infection rate, but there are no generally accepted guidelines as to how long a CVC can be left in place. Only the CVC introduced via a peripheral vein should be treated like a Braunule and thus removed after 48 hours. To prevent the catheter from becoming clogged with clotted blood, an unused Hickman catheter should be flushed regularly. Sterile physiological saline solution is used for this. Likewise, sterility must be ensured at the exit point of the catheter and when handling it, especially in immunosuppressed patients such as B. is the case in oncological patients during or after chemotherapy. Fever can be a sign of catheter-associated infection. With this and other symptoms, e.g. For example, if there is swelling or bleeding in the area of ​​the exit point, patients should seek medical help immediately.

See also

literature

  • JW Broviac, JJ Cole, BH Scribner: A silicone rubber atrial catheter for prolonged parenteral alimentation . In: Surg Gynecol Obstet . 136, No. 4, April 1973, pp. 602-6. PMID 4632149 .
  • RO Hickman, CD Buckner, RA Clift, JE Sanders, P Stewart, ED Thomas: A modified right atrial catheter for access to the venous system in marrow transplant recipients . In: Surg Gynecol Obstet . 148, No. 6, June 1979, pp. 871-5. PMID 109934 .

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