The Hickman Catheter

Tuesday night I scrubbed my chest and neck and shoulders with a bacterial soap. I did the same thing Wednesday morning. This prepped me for a minor surgical procedure: the installation of a Hickman double lumen catheter. I now have a hockey puck sized dressing sitting on the right side of my chest. It has two ports that dangle about four inches from a hole in my chest wall. The ports connect to a single bilateral tube that tunnels under my skin up and into the jugular vein at my neck. From there it descends into the right atrium of my heart. That is about 10-12 inches of plastic.

It is my new best friend; the biggest “hickey” I’ve ever had. For those of you who like body jewelry, the piece is a serious adornment and very 4th of July in its red, white, and blue. This gadget will keep me company as I proceed through the transplant. No more needle pokes and no more IV insertions for the next couple of months.

My new "hickey"
My new "hickey"

You will notice in the photo I’m wearing a black necklace with a bulldog clip. That trinket is a low-tech accessory with several functional uses. The clip, as you can see, lifts the ports when not in use so that they are not weighting down the tunneled tubing. The clip also attaches to my nightshirt so that during active dreaming or flopping around when sleeping, I do not inadvertently pull the whole contraption out. Finally, it can also be used as an emergency clamp should I accidentally get a pinhole or somehow or other cut the external tubing. So, no more running naked with scissors. Seriously, Murphy’s Law applies; the nurse who briefed us warned me to not go anywhere without my bulldog.

A little history: Long-term venous catheters became available in 1968. Dr. Robert O. Hickman, a pediatric nephrologist after whom this system is named, improved upon the design. He modified the principles with subcutaneous tunneling and a Dacron cuff. That ingenious cuff provides an infection barrier. Originally, these catheters were created with kidney patients in mind. However, as the role of blood cell transplants evolved, the Hickman became a valuable tool for cancer patients. It was first used in oncology in the mid-70s. I was fortunate to have the one and only Dr. Hickman install my catheter. He is now semi-retired but still does installs. His warm-hearted bedside manner made this procedure unforgettably fun. (The narcotics also helped…a lot)

Beginning Monday, July 7th, my Hickman will be busy. I am to receive pre-transplant chemo. I promise more on the rationale for this in another update.

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