External catheter

External catheter

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 at what is called the exit site.

What is it?

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), two lumens or occasionally three 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 at what is called 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 becoming dislodged. Over time, surrounding tissue attaches to the cuff and this further ensures the catheter remains secure. The cuff is also a barrier against the entry of organisms which could cause infection.

What about catheter care?

It may be possible for you 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. This dressing is changed each week or sooner if it becomes unstuck
  • at the same time as the dressing is changed, the catheter lumen is flushed with sterile saline and heparin solution. This is to keep the catheter clear of blockages
  • the bung on the catheter ends is also changed each week at the time the dressing is changed
  • the catheter clamp on the lumen is always closed when the catheter is not being used

How can pulling or dragging on the external catheter be prevented?

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 nor play some sports because of the danger of the catheter being pulled out or becoming infected.

See:

Can my child shower and bath?

Your child can shower. The dressing is splash proof and if it is fully 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 and the end of the catheter which has the bung on it, must be kept out of the water.

What should I do if I notice water under the dressing?

You should change it straight away if you have been shown how. Or tell your child's nurse or phone the ward if you are at home.

How is the catheter used?

When something is to be put into the catheter the nurse at the hospital will do it in one of two ways. A bag of fluid will be attached by a plastic tube to the external line for the treatment period which may be several hours or days. Or a syringe containing the medicine will be connected to the external line and the medicine injected into the catheter quite quickly.

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 five 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:

  • redness
  • swelling
  • pain
  • discharge
  • leakage

What happens when the catheter is removed?

A few months after the end of treatment, the catheter will be removed in the operating theatre under a general anaesthetic.

See:

Your child will usually be discharged the same day. There will be small scars on the chest and on the neck. They will not disappear completely but will fade with time.

Acknowledgements

All the fact sheets in the Childhood cancer section of this website have been written by health professionals who work in the field of paediatric oncology. They have been reviewed by the members of the National Child Cancer Network (NZ). Medical information is authorised by the National Child Cancer Network Clinical Leader.

This page last reviewed 03 April 2013.
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