Repair of Hickman Catheters
If a Hickman catheter is damaged or
cut, a repair should be done immediately. The catheter should be clamped with a plastic Halstead-type disposable clamp
proximal to the damaged part and a repair kit obtained. At no time should a hole be taped
or glued as a temporizing procedure and repair performed the next day.
Repair kits are available for single arms or
for the main catheter for multilumen catheters. Click
for a list of Davol order numbers for ordering the repair kits. Be sure to
order the proper kit as the wrong kit will not work. For example, single vs. double lumen
catheter repair kit, and proximal repair vs. distal arm repair. Click
to see a single lumen repair kit.
The following instructions for the
repair of Davol (Hickman) catheters in adult patients have been modified from those
provided in each repair kit. It is the responsibility of the patient's physician either
to perform, or arrange for someone else to perform, the repairs. Many ward nurses are
knowledgeable and may assist. If no individual is available to perform the repair, the TPN
Team nurses can be paged for advice (970-6619). Please read the entire procedure before
you begin. Remember, this is a sterile procedure! A repair should be attempted ONLY if
there is at least 3 cm of undamaged catheter remaining. If less than 3 cm remains, the
catheter should be removed.
NOTE: The catheter should be clamped with an atraumatic plastic clamp between
the catheter exit site and the damaged area, and remain clamped during the repair.
Additional Supplies to be obtained from the ward:
- 1 pair sterile gloves and a face mask
- 100 u/cc Heparin flush
- Either: povidone-iodine solution, alcohol, and 4x4 gauze
pads OR: povidone-iodine swab sticks, alcohol swab
sticks, bottle of alcohol, and 4x4 gauze pads.
- One 10 cc syringe
- One 20 gauge needle
- Sterile tongue blade
- Sterile atraumatic plastic clamp
- #11 knife blade
- Fenestrated sterile drape
Repair Procedure NOTE: these
instruction apply to repair of the common channel of a dual lumen Hickman catheter before
the bifurcation, the instructions would be nearly identical, however, for single and
triple lumen catheters.
- Make sure catheter has been clamped close to the patient.
- Apply face mask, wash your hands.
- Use sterile drape to prepare sterile field over table.
- Open catheter repair kit and additional sterile supplies
on to the sterile field using sterile technique.
- Surgically prep external portion of Hickman catheter with
3 alcohol swabs for 60 seconds, then with 3
povidone-iodine swabs. Allow to dry one full minute (you may need assistance to hold cleaned catheter away from skin).
- Put on sterile gloves. Wipe powder from gloves with
alcohol and 4x4 gauze sponge.
- Carefully arrange fenestrated drape around catheter to
create sterile field
- Have assistant hold heparin vial and draw up 5 ml heparin
flush. Flush replacement catheter tubing, leaving
- Load adhesive into syringe barrel, then
insert plunger and attach blunt needle.
Reposition atraumatic clamp near the skin exit site.
- Cut off damaged end of catheter at a
right angle using tongue blade and scalpel. Adjust catheter
length so that once repaired the total length will be approximately the same as
the original length. The length of the old catheter must be
sufficient to permit catheter repair and prevent
retraction of the repair under the skin or so close as to irritate the skin
(no less than 3 cm).
- Insert the splice connector stint
attached to the replacement catheter segment into the catheter lumens until the end of the replacement catheter tubing
is 1/8 inch from the cut end of the catheter.
Note: Do not remove the splicing sleeve that is
loose-mounted on the replacement catheter segment.
- Dry space between catheter ends with a
sterile 4x4 inch gauze pad. Fill the 1/8 inch space
with adhesive and approximate the catheter ends.
- Use syringe to apply adhesive onto the
outside of the catheter around the spliced joint, covering
an area about 1 inch overall length. Slide splicing sleeve down and center it
over the joint between the catheter segments.
- Inject adhesive underneath each end of
the splicing sleeve. Roll the splicing sleeve between
fingers to distribute and extrude excess adhesive. Wipe away excess adhesive.
- Remove clamp and gently flush remainder
of heparin flush through the catheter and place
sterile cap on end of catheter.
Sterile Field Is No Longer Required
- Fasten catheter repair joint to tongue
blade splint with tape.
- If necessary, catheter may be used for
infusion after 4 hours. The joint will not achieve full
mechanical strength for 48 hours. Remove the splint after 48 hours.
Pictures from Bard Nursing Procedure Manual, June 1994.