Hickman catheters were the major venous access devices utilized at the
University of Maryland Cancer Center from November 1978 to 1987. This
study provided an opportunity to standardize insertion technique, to
manage catheter-related activities and daily maintenance procedures in
order to examine the progression of Hickman-catheter-related problems
, to identify those factors that may minimize them, and to develop gui
delines for the management and prevention of complications and malfunc
tions. In all, 690 Hickman catheters (368 double lumens) were placed i
n patients with acute leukemia and other cancers: 401 catheters were p
laced in patients with leukemia; 269 were placed during neutropenia; a
nd 230 at platelet counts of <50000/mul. Two surgeons inserted 490 cat
heters, and the remaining 200 were placed by a group of rotating surge
ons. All catheters were placed with the intention that they would rema
in in place as long as clinically necessary. Total Hickman catheter da
ys were 134273. Infectious complications included exit site infections
(160), tunnel infections (46) and bacteremias (397). There were 438 i
nstances of noninfectious complications including thrombosis, lack of
function, catheter migration, fracture and hemorrhage. Recommendations
for prevention and treatment of Hickman-catheter-related complication
s include the development of a select group committed to placement, da
ily maintenance and management of problems; prompt removal of catheter
s with Candida sp. fungemia and bacteremia due to Bacillus sp. or a ba
cteremia that persists for >48 h after initiation of appropriate antib
iotics, tunnel infections or Hickman-catheter-associated thrombosis. T
he majority of bacteremias and exit site infections can be effectively
treated with antibiotics and local care.