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 Here 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 Here to see a single lumen repair kit.

Instructions

    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. 1 pair sterile gloves and a face mask
  2. 100 u/cc Heparin flush
  3. Either: povidone-iodine solution, alcohol, and 4x4 gauze pads OR: povidone-iodine swab sticks, alcohol swab sticks, bottle of alcohol, and 4x4 gauze pads.
  4. One 10 cc syringe
  5. One 20 gauge needle
  6. Sterile tongue blade
  7. Sterile atraumatic plastic clamp
  8. #11 knife blade
  9. Fenestrated sterile drape

Component Nomenclature

  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.

  1. Make sure catheter has been clamped close to the patient.
  2. Apply face mask, wash your hands.
  3. Use sterile drape to prepare sterile field over table.
  4. Open catheter repair kit and additional sterile supplies on to the sterile field using sterile technique.
  5. 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).
  6. Put on sterile gloves. Wipe powder from gloves with alcohol and 4x4 gauze sponge.
  7. Carefully arrange fenestrated drape around catheter to create sterile field
  8. Have assistant hold heparin vial and draw up 5 ml heparin flush. Flush replacement catheter tubing, leaving syringe attached.
  9. Load adhesive into syringe barrel, then insert plunger and attach blunt needle.

  1. Reposition atraumatic clamp near the skin exit site.

  1. 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).

  1. 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.

  1. 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.
  2. 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.
  3. 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.

  1. 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

  1. Fasten catheter repair joint to tongue blade splint with tape.

  1. 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.