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This page tells you about having a Tunnelled line Insertion (also called a Hickman line). It explains what is involved and what the possible risks are. It is not meant to replace an informed discussion between you and your doctor but can act as a starting point or reminder for such discussions. If you have any questions about the procedure, please ask the doctor who has referred you or the department which is going to perform it.
Your procedure will take place in the Radiology department. The radiology department may also be called the ‘X-ray’ or ‘Imaging’ department. It is the facility in the hospital where radiological examinations are carried out, using a range of x-ray equipment, such as a CT (computed tomography) scanner, an ultrasound machine and an MRI (magnetic resonance imaging) scanner.
The team undertaking your procedure will include an Interventional Consultant Radiologist who performs the procedure and they are doctors specially trained to carry out imaging guided complex procedures. They are supported by specialist nurses who are highly trained in interventional procedures, sedation, recovery and patient support alongside support from radiographers who are highly trained to carry out x-rays and other imaging procedures. There is a possibility that there will be various students and trainees involved as this is a teaching hospital.
A tunnelled line (sometimes also called a Hickman line) is a long, flexible tube that is inserted under your skin, usually on your chest just below your collar bone. The line runs under the skin and then into a large vein, normally in your neck. It is used for giving fluids, chemotherapy or medicine into your bloodstream. It can also be used for taking blood samples. If necessary, a tunnelled line can stay in for several months and you can go home with it.
Tunnelled lines are used in many different situations. Some patients may need a tunnelled line to avoid having needles put into their arms every time they need treatment or a blood test. Others need a line because of the type of treatment they are having, or to help reduce the amount of time they spend in hospital.
If you are unsure why you are being offered a tunnelled line, please speak to the team looking after you or one of the central venous access nurses.
Risks during insertion
Most insertions go smoothly. There is a very small risk of puncturing a blood vessel in the chest, air entering your bloodstream or a collapsed lung. These complications can be serious, but we take every precaution to prevent them and they are very unlikely to happen.
Infection
It is possible for an infection to develop in the skin around the port or in the bloodstream. Contact your nursing or medical team, or one of the central venous access nurses, as soon as you can if you experience any of the following symptoms:
- a high temperature (over 38°C)
- feeling shivery
- pain, redness or swelling around the port.
If you have an infection, you will need to take a course of antibiotics and your port may need to be removed.
Blood clot
It is possible for a blood clot (thrombosis) to form in the vein used for the line. If you notice swelling or pain in the shoulder, neck or arm on the same side as the port, contact your nursing or medical team, or one of the central venous access nurses, as soon as possible. If you have a clot, you will need medication to dissolve it. The port can often stay in place. There is also a small risk of a blood clot on the lungs. This is rare. If you experience chest pain or sudden shortness of breath, go to your local Emergency Department (A&E) or call an ambulance.
Breakage
On rare occasions the tunnelled line may develop a leak. This could cause an infection or allow air to enter your bloodstream which can be serious. If you notice a hole or a leak in your line, try to stop air from entering your bloodstream by folding the tubing back on itself and taping it with household tape. Contact your nursing or medical team or the central venous access team immediately as your line will either have to be repaired or removed.
Tunnelled line displacement
For the first 21 days there will be stitches around the line to hold it in place. During this time the line will become embedded in the tissues which will hold it in place once the stitches are removed. Rarely the line may fail to embed properly and can fall out. To reduce the risk of this you should always avoid pulling on the line. If it does fall out, please contact your nursing or medical team as soon as possible.
Radiation risk
During the procedure, you are exposed to X-rays. They are a type of radiation called ionising radiation. Interventional radiology (IR) is when we use medical imaging guidance to do minimally invasive procedures. The dose (amount) of radiation from these procedures is generally low. More complex procedures might involve a medium (moderate) dose of radiation.
The Interventional Radiologist and radiographer make sure that:
- Your radiation dose is kept as low as possible.
- The benefits of having X-rays during your procedure are greater than the radiation risks.
This will depend on the type of treatment you are having. You should discuss your options with your doctor or nurse if you have any concerns.
An alternative would be a PICC or an implantable port. Your doctor or nurse may have suggested a tunnelled line for you but if you would like to find out more about these alternatives, please talk to the team looking after you or one of the central venous access nurses.
You will need to have a blood test to measure your full blood count (FBC) and clotting before the procedure. Your doctor or nurse specialist will tell you how to book your blood test when they recommend a tunnelled line.
You should inform the imaging department prior to your appointment if you are taking any blood thinning medication.
You need to attend the Imaging Department at the time instructed on your appointment letter. You will be asked not to eat for six hours before your appointment time, though you can continue to drink clear fluids up to two hours prior to your appointment. Please take all your medication on the morning of the procedure unless you have been informed to omit it by your doctor or the Imaging department.
On arrival you will be checked into the department by a nurse. The nurse will fill in some paperwork and do some clinical observations-like blood pressure and pulse. The Radiologist will come and explain the procedure and sign off the Consent form with you. This is where you have the opportunity to talk to the Radiologist doing your procedure and they will be able to address any concerns you may have.
This procedure is commonly performed under local anaesthetic, however if you are expecting sedation, it is necessary that you have escort to take you home and stay with you overnight. This is the policy for sedation so if you are expecting sedation, please ensure so you can make the necessary arrangements. If you are having sedation during the procedure, the nurse or radiographer will place a cannula into your vein prior to the procedure.
If you have any allergies, you must let your doctor know. If you have previously reacted to intravenous contrast medium (the dye used for kidney x-rays and CT scans), then you must also tell your doctor about this.
We want to involve you in all the decisions about your care and treatment.If you decide to go ahead with procedure, by law we must ask for your consent and will ask you to sign a Consent form. This confirms that you agree to have the procedure and understand what it involves.
The consent form is a form that both you and the operating doctor sign confirming that you have discussed the procedure and been informed of the risks/benefits/alternatives and have agreed to carry on with the interventional procedure. (You can have a copy of this form to take with you.)
Please feel free to ask any questions that you may have and, remember that even at this stage, you can decide against going ahead with the procedure if you so wish.
You will lie on the X-ray table, generally flat on your back. A needle will be inserted into a vein in your arm, so that a sedative or painkillers can be given if required (This is generally not needed as the procedure is usually tolerated very well with just a local anaesthetic). You may have monitoring devices attached to your chest and finger and may be given oxygen.
The procedure is performed under sterile conditions and the interventional radiologist and radiology nurse will wear sterile gowns and gloves to carry out the procedure. The skin near the point of insertion, usually the neck, will be swabbed with antiseptic and you will be covered with sterile drapes.
The radiologist will inject some local anaesthetic into your skin on your chest and neck to numb the area. This may sting a little as it goes in. After this you should only feel pressure, and you should not feel any pain. Please let the nurse know if you are uncomfortable.
When the area is completely numb, the doctor or nurse will make a small cut in the skin near the collarbone. This is called the insertion site. They will gently thread the tip of the line into a large vein, towards the heart. They then tunnel the other end of the line under the skin to where it comes out of the body. This is known as the exit site. We will check the position of the catheter and tunnelled line with the X-ray machine. If it is in the correct position, the cuts are then stitched, and a dressing is put over the wound.
Some discomfort may be felt in the skin and deeper tissues during the injection of the local anaesthetic. After this, the procedure should not be painful. There will be a nurse, or another member of clinical staff, standing nearby looking after you. If the procedure does become uncomfortable, they will be able to arrange for you to have a painkiller through the needle in your arm.
Every patient’s situation is different, and it is not always easy to predict how complex or how straightforward the procedure will be. Generally, the procedure will be over in about an hour.
You will be taken to the recovery area on a trolley. A recovery nurse will carry out routine observations, such as taking your pulse and blood pressure. They will also look at the skin entry point to make sure there is no bleeding from it.
You will generally stay in bed for about an hour, until you have recovered. The nurses will let you know when they are happy for you to be discharged from recovery. You will be allowed to go home after this but will need someone to escort you if you have had sedation. You will need to take it easy for the rest of the day, but you can resume normal activities the following day.
You will have a dressing on the site and on the base of your neck.
If needed, the line can be used straight after it has been put in. You may feel a bit sore and bruised around the insertion site for a few days after the procedure. You can take mild painkillers, such as paracetamol, to ease this. Once the bruising has settled down, the tunnelled should be painless.
Dressings and stitches
You will have a small dressing on the side of your neck. This and any stitches will be removed after seven days.
You will also have a dressing where the line comes out (the ‘exit site’). This should be changed weekly, and the stitches will be removed after 21 days. You will probably need to keep a dressing on the exit site if the tunnelled line is in place, even after the stitches have been removed.
Other care
The line will need to be flushed once a week to stop it from getting blocked. This is a painless procedure where a syringe is attached to the line and fluid is flushed into it.
Dressing changes and line flushing can be done by nurses at the hospital or by a district nurse – you will need to make an appointment to have them done. Some people prefer to care for the line themselves, or for their partner, a family member or a close friend to learn.
If this is something you would like, please talk to one of the central venous access nurses or one of your specialist team nurses.
Can I have a shower or a bath?
It’s important not to get the exit site wet for the first three weeks.
Showering
We will give you a transparent dressing to put over the exit site to keep it dry during a shower. If you have a dry dressing instead, you will need to keep shower water away from it for the
first three weeks. After that time, you can let the exit site get wet in the shower but you will need to clean and dry the skin around the exit site and put a new dressing on after your shower. We will talk to you about this in more detail. If you are unsure about what to do, please contact your nursing or medical team.
Having a bath
If you have a bath while the line is in, you should keep the exit site out of the water.
Things to look out for at home
While your port is in place, it is important that you contact your nursing or medical team, or one of the central venous access nurses, if you notice any of the following:
- a high temperature (over 38°C)
- feeling shivery
- pain, redness or swelling around the port
- chest pain
- shortness of breath.
A tunnelled line can stay in for several weeks or months. A specialist nurse from the central venous access team or a member of the interventional radiology team will remove it when you no longer need it.
Removing the line is a minor procedure which can usually be carried out under local anaesthetic.
Some of your questions should have been answered on this page but remember that this is only a starting point for discussion about your treatment with the doctors looking after you. Make sure you are satisfied that you have received enough information about the procedure.
Contact and references
British Society of Interventional Radiology
Macmillan Cancer Information
For general information about radiology departments, visit The Royal College of Radiologists
NHS Direct
For health advice or information you can call NHS Direct on 0845 45647 or visit the website: www.
The NHS Clinical Knowledge Summaries website: www.
UCL Hospitals cannot accept responsibility for information provided by other organisations.
Please contact the Clinical Nurse Specialist (CNS)
Direct line: Interventional radiology CNS: 079 7487 5629
UCH Switchboard: 020 3456 7890
Address:
Interventional Radiology Imaging Department
University College Hospital
2nd Floor
235 Euston Road
London
NW1 2BU
Admin Queries Email: uclh.
Radiology Admin enquiries phoneline: 020 3447 3267
Website: www.
If you have been referred by the Central venous access team, please contact:
(Monday to Friday, 9am to 5pm)
Telephone: 020 3447 7491
Supportive Care Unit
(Monday to Friday, 8am to 8pm)
Telephone: 020 3447 1808
Out of hours Oncology patients: 079 4795 9020
Haematology patients: 078 5222 0900
Teenagers and young adults: 079 0846 8555
If you are not under any oncology team, please contact our interventional clinical nurse specialist.
Procedures:
The Imaging Department, Level 2 Podium in the main University College Hospital building with the entrance on Euston Road (see map below).
Travelling to the hospital
No car parking is available at the hospital. Street parking is limited and restricted to a maximum of two hours.
Please note the University College Hospital lies outside, but very close to the Central London Congestion Charging Zone.
Tube
The nearest tube stations, which are within two minutes’ walk are:
- Warren Street (Northern and Victoria lines)
- Euston Square (Hammersmith & City, Circle and Metropolitan lines)
Overground trains
Euston, King Cross & St Pancras and Kings Cross Thames link railway stations are within 10-15 minutes’ walk.
Bus
Further travel information can be obtained from http://
Hospital transport service
If you need (and are eligible for) transport, please call:
020 3456 7010 (Mon to Fri 8am-8pm) to speak to a member of the Transport Assessment Booking Team.
If you have a clinical condition or mobility problem that is unlikely to improve you will be exempt from the assessment process. However, you will still need to contact the assessment team so that your transport can be booked. If your appointment is cancelled by the hospital or you cannot attend it, please 020 7380 9757 to cancel your transport.
University College Hospital Area Map
Page last updated: 31 July 2024