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 Identifying and Reporting Problems Catheter-associated Bloodstream Infections Page11 Page12 Page13 2
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. 3
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. Flushing your catheter 2. Changing your catheter caps 3. Changing the dressing 4. 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. 5
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. 6
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. 7
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. 8
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. Chloraprep stick or Tincture of Iodine Swabsticks 2. 1 transparent dressing 3. 1 package of skin prep or other skin protectant 4. 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. 9
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. 10
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. 11
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 12
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. 13
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 14