A Hickman line is a small silicone tube that passes through the skin on your chest and enters a main vein in your neck. The aim is to give easy long term access to your vascular system for infusing fluids or medications. In 2010 I developed gastroparesis and lost the ability to eat food, or even drink much fluid. I spent a long period in hospital and in 2011 had my first Hickman line fitted. I looked after it carefully, but in 2017 it failed without warning. It had to be replaced and I spent six nights in hospital as I had to wait for a surgical slot to be available.
I looked after the new line as carefully as I could, but over the last year it became harder and harder to use. The internal diameter of a Hickman line is only one millimetre, so partial and full blockages are common. There are a couple of ways of improving the function of a Hickman line. An enzyme called Urokinase, which is made by the kidney and found in human urine, can be injected in the line for a few hours. Thankfully the medicinal version of Urokinase is made in a lab and not donated! The aim of Urokinase is to break up any blood clots in the line. I tried it several times but it didn’t help my line at all.
Click to enlarge.
The other option is putting 70% Ethanol into the line for up to an hour, which I found to be quite effective. It gives you a headache and makes you feel a bit drunk, but I haven’t drunk any alcohol in 15 years, so I quite enjoyed that!
Unfortunately, the improvement from Ethanol only lasted a few weeks. I’m under the care of the nutrition team at The Royal London Hospital who suggested the line was reaching the end of its life and should be replaced, which could be done in one day as an outpatient.
Hickman lines typically last 2-3 years. I’d had two, and managed to get both to last six years, which is a pretty good record. I hate spending any time in hospital, but reluctantly agreed getting the line replaced as a day patient was sensible. If I waited until the line failed I could spend six nights in hospital again.
The NHS is under huge strain at the moment so getting an elective surgical slot can be slow. I was given a date about a month ahead. I started preparing a few days beforehand, but was then told the procedure was postponed due to a doctor’s strike. That was disappointing, but I strongly support the doctors in their fight for pay restoration, and thankfully the replacement date was only a week further on.
The big day was …long. An ambulance arrived to collect me about 6.30am. We travelled to The Royal London Hospital in Whitechapel which takes about two hours. Everything was extremely well organised by the nutrition team. The best Hickman line for my needs was ready and waiting with my name written on it, and I was first on the surgical list. Remarkably I was even allocated one of the hospital’s top surgeons. The procedure takes about half an hour under a local anaesthetic. It’s performed in the Interventional Radiology department. Throughout the procedure the surgeon is guided by a moving ‘x-ray’ of the inside of my chest on a large screen. My head was covered by a paper sheet for hygiene purposes, so I didn’t get to watch which was a shame.
I had about ten stitches, which have to stay in for three weeks. Part of my chest became quite swollen and painful, which didn’t happen after my previous line insertions, but I was cleared to go home. The return ambulance took four hours to arrive, which was dull but fairly normal. I got home about 5.30pm. As I knew it would be a difficult day, I’d arranged for a nurse to visit in the evening to set up TPN for me. That didn’t go well and I ended up doing it myself, but that was the only problem I had all day.
It was my first trip to a London hospital since the pandemic started and overall it went extremely well. Thank you to the Royal London Hospital nutrition team and Interventional Radiology team, who were all excellent and friendly and fun too. Also thank you to Sarah, the carer who travelled with me and carried all the vital items you need when you’re having surgery, e.g. iPod and headphones. 😀
Thanks for reading, Ceri.
Interventional Radiology