Care of Your Hickman Catheter Johns Hopkins Kimmel Cancer Center,

Care of Your
Hickman Catheter
Johns Hopkins Kimmel Cancer Center,
Revised 7/11
Contents
What is a Hickman Catheter?
Page 3
Does the Catheter Limit My Activities?
Page 4
How Do I Care for My Catheter?
Page 5
Flushing Your Catheter
Page 6
Capping Your Catheter
Page 8
Changing the Transparent Dressing
Page 9
Changing the Gauze Dressing
Page11
Identifying and Reporting Problems
Page12
Catheter-associated Bloodstream
Infections
Page13
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What is a Hickman Catheter?
•
A Hickman is a long, purple tube
placed into a large vein in your
chest, just above the heart
•
As part of the procedure to place the
catheter, you may have a stitch in
your lower neck or skin glue will be used. This is called
the “entrance” site. The stitch stays in for 7 days.
•
The catheter is tunneled under the skin and comes out
in your upper chest area. This area is called the “exit”
site. It also has stitches which will be left in for 30 days.
•
The catheter has a cuff that attaches under the skin to
help keep the catheter in place even after the stitches
are taken out.
•
Your catheter may have one, two or three lumens,
depending on the type of treatment you need.
•
This catheter can be used to give you medications,
chemotherapy, or blood products, and can also be used
to draw blood, so you will not have to be stuck with
needles as often.
•
It can also be used for injections of IV contrast dye for
CT Scans.
•
Your catheter can stay in place for as long as it is
needed.
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Does a Hickman Catheter Limit My Activities?
You may need to change some of your activities because of the
catheter.
•
You may shower, but you must completely cover your
dressing and connections with plastic wrap and tape or a
dressing cover such as Aquaguard™.
•
Do not let your catheter go under water, in the tub or pool.
•
If your dressing gets loose or soiled, it must be changed
right away.
•
Do not damage or pull on the catheter. If your catheter
dangles, secure it by taping it up or attaching it to a chain.
•
Exercise, sexual activity and light housekeeping are
permitted as long as your catheter and dressing are secure.
•
You may not vacuum or iron, play tennis, golf, bowl or lift
weights while you have the catheter. Moving the arm on the
same side of the catheter over and over again may damage
the catheter or cause it to move out of the vein
•
If you have any other questions about activities you may or
may not do, talk with your doctor or nurse.
4
How Do I Care for My Catheter?
You must learn to do the following tasks:
1.
2.
3.
4.
Flushing your catheter
Changing your catheter caps
Changing the dressing
Identifying and reporting problems
**A home care company will deliver the supplies you will need to care for your catheter.
The supplies sent may be slightly different from what is described below. A nurse will
review this procedure with you.
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Flushing Your Hickman Catheter
•
To keep blood from clotting in the catheter, you must learn to
flush the catheter.
•
You will flush each lumen once a day with 5 cc’s of heparin
solution.
•
Your homecare company will give you pre-filled heparin
syringes for flushing your catheter.
•
Pre-filled syringes do not have to be refrigerated.
Procedure:
1. Wash your hands.
2. Scrub the cap (end) of the
catheter with an alcohol
pad very well (at least 10
times).
3. Remove cap from end of
heparin flush syringe, then
gently push and twist the
syringe into the catheter
cap.
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4. Open the clamp on the
catheter.
5. With slow and steady
pressure, push the heparin
solution into the catheter. If
you meet resistance, do
not force.
Call your doctor or nurse
Immediately!
6. Clamp the catheter while
pushing in the last ½ cc of
heparin solution. This
prevents blood from
backing up into your
catheter.
7. Take off the syringe and put
it in the trash.
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Capping Your Catheter
Your catheter cap should be changed every 7 days.
Supplies needed:
1. New injection cap
2. Alcohol wipe
3. Masks
Procedure:
1. Patient and caregiver put on masks.
2. Wash your hands.
3. Be sure your catheter is clamped.
4. Remove the old cap by rotating it
counter clockwise.
5. Scrub the catheter end with an
alcohol pad very well (at least ten times).
6. Replace with a new sterile injection
cap, rotating it clockwise until it is
tight (but not too tight.) Be careful
to touch only the outside of the cap
and not the inside part that goes
into the catheter.
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Changing the Transparent Dressing
You must change your dressing every 7 days, or immediately
if it becomes loose or soiled. You will be able to see through
the dressing. You should look at your catheter site and touch
it over the dressing every day. If you see redness, swelling,
drainage or have tenderness when you press, call your
doctor or nurse. (See page 12)
Supplies needed:
A dressing kit or individual supplies listed below:
1.
2.
3.
4.
Chloraprep™ stick or Tincture of Iodine Swabsticks
1 transparent dressing
1 package of skin prep™ or other skin protectant
2 masks
Procedure:
1. Wash hands.
2. Patient and caregiver put
on masks.
3. Prepare supplies by opening all packages and
leaving the supplies in their sterile wrappers on a
clean table.
4. Remove the old dressing from the chest.
5. Wash hands again.
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6. Open chloraprep or tincture of iodine stick.
7. Using a scrubbing motion, clean in a
circle, starting at the catheter exit site
and moving away from it. Never retrace
your steps!
8. Let dry for 1 minute. Do not wave hands to
dry the site.
9. Apply skin prep to the skin where
the outer edge of the dressing will
be. Allow to dry for 1 minute.
10. Remove the backing from the
transparent dressing.
11. Apply the dressing over the
catheter with the catheter exit site
showing through the window.
12. Remove the paper strip and smooth
out the edges.
13. Apply strip under the catheter.
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14. If you have a dangling catheter, clip the
catheter with the clip on your chain to keep it
from pulling. You may also tape the catheter
up or tuck it into your bra.
Changing the Gauze Dressing
You may be taught to use a gauze dressing if you have an
infected catheter, drainage at the site or irritated skin. The
dressing can be changed every other day if it does not get
wet, loose or soiled. If the dressing gets wet, loose or soiled,
it must be changed right away. You should look at your
catheter site every time you change the dressing. If you see
redness, swelling, drainage or the site is sore, call your
doctor or nurse. (See page 12.)
Please follow the same steps for changing the transparent
dressing.
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Identifying and Reporting Problems
It is very important to watch for and report the following
symptoms to your doctor or nurse immediately.
1. Fever greater than 100.5°
2. Shaking chills (rigors) after flushing your catheter.
3. Redness, tenderness, bleeding or drainage at your
catheter site or along the tunnel.
4. Skin rash under the dressing.
5. Pain, swelling, or numbness in your arm or neck on the
same side as the catheter.
6. Catheter cuff seen at the exit site.
7. Difficulty flushing the catheter. If this occurs, do not force,
since this may cause the catheter to rupture.
8. Breaks, leaks or tears in your catheter. If this occurs:
clamp the catheter between the damaged area and your
body. Cover the catheter with a sterile 4x4 gauze pad and
call your doctor or nurse immediately.
9. Your catheter may need to be removed if complications
occur.
My Doctor is_________________
Phone Number_______________
My Nurse is__________________
Phone Number_______________
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FAQs
(frequently asked questions)
about
“Catheter-Associated
Bloodstream Infections”
(also known as “Central Line-Associated Bloodstream Infections”)
What is a catheter-associated bloodstream infection?
A “central line” or “central catheter” is a tube that is placed into a patient’s large vein, usually in the neck,
chest, arm, or groin. The catheter is often used to draw blood, or give fluids or medications. It may be left
in place for several weeks. A bloodstream infection can occur when bacteria or other germs travel down a
“central line” and enter the blood. If you develop a catheter-associated bloodstream infection you may
become ill with fevers and chills or the skin around the catheter may become sore and red.
Can a catheter-related bloodstream infection be treated?
A catheter-associated bloodstream infection is serious, but often can be successfully treated with
antibiotics. The catheter might need to be removed if you develop an infection.
What are some of the things that hospitals are doing to prevent catheter-associated bloodstream
infections?
To prevent catheter-associated bloodstream infections doctors and nurses will:
• Choose a vein where the catheter can be safely inserted and where the risk for infection is small.
• Clean their hands with soap and water or an alcohol-based hand rub before putting in the catheter.
• Wear a mask, cap, sterile gown, and sterile gloves when putting in the catheter to keep it sterile. The
patient will be covered with a sterile sheet.
• Clean the patient’s skin with an antiseptic cleanser before putting in the catheter.
• Clean their hands, wear gloves, and clean the catheter opening with an antiseptic solution before using
the catheter to draw blood or give medications. Healthcare providers also clean their hands and wear
gloves when changing the bandage that covers the area where the catheter enters the skin.
• Decide every day if the patient still needs to have the catheter. The catheter will be removed as soon as it
is no longer needed.
• Carefully handle medications and fluids that are given through the catheter.
What can I do to help prevent a catheter-associated bloodstream infection?
• Ask your doctors and nurses to explain why you need the catheter and how long you will have it.
• Ask your doctors and nurses if they will be using all of the prevention methods discussed above.
• Make sure that all doctors and nurses caring for you clean their hands with soap and water or an alcoholbased hand rub before and after caring for you.
• If the bandage comes off or becomes wet or dirty, tell your nurse or doctor immediately.
• Inform your nurse or doctor if the area around your catheter is sore or red.
• Do not let family and friends who visit touch the catheter or the tubing.
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• Make sure family and friends clean their hands with soap and water or an alcohol-based hand rub before
and after visiting you.
What do I need to do when I go home from the hospital?
Some patients are sent home from the hospital with a catheter in order to continue their treatment. If you
go home with a catheter, your doctors and nurses will explain everything you need to know about taking
care of your catheter.
• Make sure you understand how to care for the catheter before leaving the hospital. For example, ask for
instructions on showering or bathing with the catheter and how to change the catheter dressing.
• Make sure you know who to contact if you have questions or problems after you get home.
• Make sure you wash your hands with soap and water or an alcohol-based hand rub before handling your
catheter.
• Watch for the signs and symptoms of catheter-associated bloodstream infection, such as soreness or
redness at the catheter site or fever, and call your healthcare provider immediately if any occur.
If you have additional questions, please ask your doctor or nurse.
If you do not see your providers clean their hands, please ask them to do so.
Co-sponsored by:
SHEA, IDSA, AHA, APIC, CDC and JCAHO
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