An external catheter is a thin, flexible, partially implanted silicone tube which extends outside the body. Inside the body, the catheter lies under the skin of the chest. It goes into a central vein near a small incision by the neck.
Key points to remember
- an external catheter is a thin, flexible, partially implanted silicone tube which extends outside the body
- inside the body, the catheter lies under the skin of the chest
- it goes into a central vein near a small incision by the neck
- it comes out of the body, near the nipple line on the chest known as 'the exit site'
- you may be able to learn to care for your child's catheter when you are at home
What is it?
This page is part of a whole section about childhood cancer.
Hickman is the brand name of the most commonly used semi-permanent, external catheter. It is a thin, flexible, partially implanted silicone tube which extends outside the body. The line may have a single lumen (channel), 2 lumens or occasionally 3 lumens.
Where is the external catheter positioned?
Inside the body, the catheter lies under the skin of the chest. It goes into a central vein near a small incision by the neck. It comes out of the body, near the nipple line on the chest known as 'the exit site'.
A small cuff on the catheter is positioned under the skin at the exit site and stitched in place to prevent the catheter dislodging. Over time, surrounding tissue attaches to the cuff and this further helps the catheter remains secure. The cuff is also a barrier against organisms which could cause infection.
What about catheter care?
You may be able to learn to care for your child's catheter when you are at home. Ask your child's nurse about this.
A transparent, waterproof, adhesive dressing always covers the exit site and the first few inches of the outside catheter. You (or a nurse) will need to change this dressing each week or sooner if it becomes unstuck.
Flushing the catheter
While changing the dressing, you or a nurse will also need to flush the catheter lumen with sterile saline and heparin solution. This is to keep the catheter clear of blockages. The catheter clamp on the lumen always stays closed when the catheter is not in use.
Changing the bung
The bung on the catheter ends will also need changing each week when the dressing is changed.
How to prevent pulling or dragging on the external catheter?
The small loop of the catheter at the exit site secured under the dressing helps to prevent pulling and dragging.
Can my child swim and play sport with an external catheter in place?
No, your child should not swim or play some sports because of the danger of the catheter being pulled out or becoming infected. See Frequently asked questions about care at home.
Can my child shower and bath?
Your child can shower. The dressing is splash proof and if it is attached to the skin, it will protect the catheter during a shower. You should not allow it to soak in water as it may become unstuck.
So, your child can shower and have shallow baths with the water only at hip level. The bath water should never come above the waist. You need to keep the end of the catheter that has the bung out of the water.
What should I do if I notice water under the dressing?
If you know how to do it, you should change it straightaway. Otherwise, tell your child's nurse or phone the ward if you are at home.
How is the catheter used?
When a nurse needs to put something into the catheter they will do it in 1 of 2 ways.
Attaching a bag of fluid
The nurse will use a plastic tube to attach a bag of fluid to the external line. This will stay in place during treatment. Treatment may be several hours or days.
Connecting a syringe
A nurse will connect a syringe containing the medicine to the external line. The nurse will then inject the medicine into the catheter.
When should I seek help?
Medical advice is always available.
If the catheter is leaking, close the clamp on the line above the leak, or block the line by pinching the tube. Then immediately phone the hospital and speak to the doctor or nurse on the ward.
If the catheter comes out, press the neck wound using a soft cloth or tissue for 5 minutes. You may not see any bleeding, but there is a possibility that it will be happening under the skin in the neck. Then immediately phone the hospital and speak to the doctor or nurse on the ward.
Phone the ward if any of the following occur:
What happens when the catheter is removed?
A few months after the end of treatment, a doctor or nurse will remove the catheter in the operating theatre under a general anaesthetic. See Surgery for childhood cancer: Does surgery hurt?
Your child can usually go home the same day. There will be small scars on their chest and neck. They will not disappear completely but will fade with time.