Semi-Permanent External Venous Catheter

Key points about external catheters

• an external catheter is a thin, flexible, partially implanted silicone tube that 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 an external catheter?

Hickman is the brand name of the most commonly used semi-permanent, external catheter. It is a thin, flexible, partially implanted silicone tube that extends outside the body. The line may have a single lumen (channel), 2 lumens or occasionally 3 lumens.

You may also be interested in reading the overview page about central venous catheters

Where in the body does the external catheter go?

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 from dislodging. Over time, surrounding tissue attaches to the cuff and this further helps the catheter remain secure. The cuff is also a barrier against organisms that could cause infection.

How can I care for my child's external catheter?

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.

Changing dressings

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 end of the catheter will also need changing each week when the dressing is changed.

How can I prevent pulling or dragging on my child's 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. 

Check some frequently asked questions about care for your child with cancer at home

Can my child shower and bath with an external catheter in place?

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 external catheter dressing?

If you know how to do it, you should change the dressing straightaway. Otherwise, tell your child's nurse or phone the ward if you are at home.

How do the healthcare team use my child's external catheter?

When nurses need to put something into the catheter, they will do it in one of 2 ways:

• by using a plastic tube to attach a bag of fluid to the external line during treatment - this may last several hours or days
• by connecting a syringe containing the medicine to the external line and injecting the medicine into the catheter

How does the healthcare team connect a syringe to my child's external catheter?

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 for my child with an external catheter?

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:

• redness
• swelling
• pain
• discharge
• leakage

What happens when the healthcare team remove my child's external catheter?

A few months after the end of treatment, a doctor or nurse will remove the catheter in the operating theatre under a general anaesthetic.

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.

Read more about childhood cancer