"Hickman Line fitting"

About: Forth Valley Royal Hospital / Day Surgery Sheffield Teaching Hospitals NHS Foundation Trust

(as the patient),

In September 2011 at the RFVH Larbert a Hickman Line was inserted into my chest. This procedure was carried out as a day patient and I reported to the Day Patient Ward at 8: 50am.

A Hickman line is an intravenous catheter made from silicon, it is inserted into the chest by a radiologist or trained radiographer. Although a single line within the chest wall it has two lumens (connections) one red and one white which hang from the right side of the chest below the shoulder.

Following a five and a half hour delay I was taken to a corridor to await the arrival of the specialist responsible for carrying out the procedure. At approximately 3: 00pm the procedure of fitting the Hickman Line was completed. I was surprised this was achieved in the unsterile area of a corridor.

At no time during the procedure were Ultra sound, or x-rays used to aid the fitting.

This contravenes The NHS Forth Valley Patient Information Guide Lines on Central Venous Catheter (CVC) patient information which in part states:

‘Your Hickman line will be inserted at the hospital by a doctor. This is usually done in the Radiology Department in Forth Valley Royal Hospital. Your neck will be checked for a suitable vein using an ultrasound machine and the area where the line is to be inserted will then be cleaned and a local anaesthetic used to numb the area. ’

Locating my records also proved a problem causing the long delay, but eventually the insertion was allowed to continue when records were borrowed from the Oncology Clinic.

Before the procedure began a local anaesthetic was injected to the top right side of my chest where the line would be fitted.

The line enters the jugular vein in the lower neck or subclavian vein beneath the collar bone.

The white connection can be used for antibiotics, chemotherapy, or other medication, while the red connection may be used for drawing blood samples or medication. The procedure lasted approximately thirty minutes and was completed without a problem.

Since the Hickman line was fitted I have obtained a leaflet from Sheffield Teaching Hospitals which states: The Hickman Line should be fitted within the X-ray department using x-rays and ultra sound as guidance. Also stated: quote, ‘You will be asked to lie on your back on the x-ray table. You will be connected to monitoring equipment to check your heart tracing, blood pressure blood oxygen levels. ‘ It is very important to insert Hickman lines under sterile conditions to avoid infections. ’ Unquote.

Why then did this specialist decide to insert the Hickman Line without the assistance of the equipment mentioned? Could it be he was a little over confident due to the number of occasions they had carried out this procedure and decided the corridor was the best place? Could it have been it was nearing the end of the working day, or maybe they just saw another old person and didn’t really care?

At the time of fitting this Hickman line I had no idea of how or where it should be completed, but after reading the leaflet from Sheffield Teaching Hospital I realised the importance of it being fitted in a sterile area and of the equipment that should be used. At the moment I am writing my memoirs and this story will be included.

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Response from Arlian Mallis, Person Centred Health and Care Co-ordinator, Department of Nursing, NHS Forth Valley

Hi, thanks for sharing your experience, there a few areas that I think it is important to discuss with you. The conditions you describe would not be our normal practices. Would it be possible for you to contact me directly so that I can provide an informed response to your posting. This would be very useful.

you can contact me by email - arlian.mallis@nhs.net

I look forward to hearing from you

many thanks


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Update posted by John McRae (the patient)

Hello Everyone at Patient Opinion


Thanks for sharing my story with others.

As you can see Arlian Mallis, Person Centered Health & Care Co-ordinator, Department of Nursing NHS Forth Valley has responded to my posting regarding fitting of Hickman Line and would like me to contact that office directly so they can provide an informed response.

I am willing to do this if it can help other patients avoiding the same problem as I experienced, but can you give me your thoughts on contacting this person directly.

I will appreciate your advice.


Response from Natalie Deacon, Engagement and Support Officer, Care Opinion Scotland

picture of Natalie Deacon

Hi John McRae

We can see you’ve sent us a response to your Hickman Line fitting story. It looks as if you are asking us a question so hope you don’t mind us wading in here.

We see that Arlian Mallis has included her email address in the previous response. arlian.mallis@nhs.net Our experience of Arlian and of NHS Forth Valley generally is that they are very interested in hearing people’s experiences and to use these to learn. We’d encourage you to be in contact with Arlian, if you feel up to it.

Thanks for being in touch

Take Care


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Update posted by John McRae (the patient)

I have forwarded an E-Mail to Arlian informing her I cannot add anything to what I have already said, but have told her if she would prefer a face to face meeting to clarify any points I am willing to meet her.

My story has been related exactly how events transpired on that day in 2011.

Response from Arlian Mallis, Person Centred Health and Care Co-ordinator, Department of Nursing, NHS Forth Valley We are preparing to make a change

Thanks very much for your time this morning and for sharing your experiences through your journey. It was interesting to hear about your experience in relation to the Hickman line insertion, and as agreed I will follow up our current practice. Im sure this does not happen now, as all Hickman lines are carried out in the intervention room within the x ray department. However this allows us to have a quality check, which is always a good opportunity to ensure we are delivering the best possible care.

It is our practice to remove Hickman lines in the area you describe as a corridor.. which is a four bedded / trolley area, something we need to consider in terms of environment.

I see that two other people have experienced something similar, it would be great to hear from them too.

If you would like to have a visit to the department to look at the intervention room we would be more than happy to accomadate, just let me know.

Thanks again for your feedback.

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Response from Patient Partnership, Sheffield Teaching Hospitals NHS Foundation Trust

Dear Sir

Sheffield Teaching Hospitals NHS Foundation Trust were concerend to learn about your experiences. However by reading our leaflet this has prompted discussion and learning in another area.

Thank you for your posting. Kind regards.

Deborah Hopkinson, Patient Experience Co-ordinator

Update posted by John McRae (the patient)

Hello Deborah

Its really good to hear that my experience has prompted some action, but in saying that I must repeat that this happened at my Hickman Line insertion and not on its removal as Arlian thinks.


Response from Arlian Mallis, Person Centred Health and Care Co-ordinator, Department of Nursing, NHS Forth Valley

Morning, thanks for your postings, just to make sure Im not confusing any one, I did realise that you were making referance to the insertion of the line, which would be inserted in a sterile intervention room, however when lines are removed this can be done in an area that can accomodate four trolleys/ beds in FVR.

Deborah, it would be good to hear what changes you have made in Sheffield.



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Update posted by John McRae (the patient)

Hello Again Arlian

The last post was written just to clarify things as it did seem as though your response referred to the removal of the Hickman Line. Thanks again for your interest.

Regards John McRae

Response from Patient Partnership, Sheffield Teaching Hospitals NHS Foundation Trust

Hello Arlian

Just to clarify the changes I referred to were changes that resulted as Mr McRae had read our Sheffield Teaching Hospitals'leaflet and then changes were implemented across the wider health community.

Kind regards.

Deborah Hopkinson

Patient Experience Co-ordinator

Update posted by John McRae (the patient)

Its good to know my posting has helped in some small way to make a difference across the wider health community.


John McRae

Updates, changes and questions related to this story