"Hickman Line fitting"

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.