Information for patients undergoing removal of a cuffed tunnelled central line (Hickman/Groshong/Cook)
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Preparation for Line Removal
Your doctor or Chemotherapy /Oncology nurse will arrange a date with you to come and have your Hickman line removed in the Macmillan Unit. This procedure will be performed by a Nurse Practitioner in the Macmillan Unit who has been specially trained, or by one of the Oncology Registrars. The person removing your line will sit down with you and explain the procedure, including potential benefits and potential risks. You will have an opportunity to ask questions and if you are happy to proceed with the procedure you will be asked to read and sign a Consent Form.
If you have been on a blood thinning medication such as Apixaban, Warfarin or Heparin injections, you will need to stop taking this medication 48 hours before your line is removed. You will have a blood test prior to the procedure to check that your blood clotting is at a safe level.
If you have recently had chemotherapy, you will need to have a blood test to check that your platelets (blood clotting cells) are at a safe level.
If your platelets are low, your Doctor or Nurse may arrange for you to have a platelet transfusion immediately before the procedure. Your Doctor or Nurse may decide that it is best to wait until your platelet count has returned to normal before the procedure is performed.
On the day
You should tell the Nurse if you are allergic to anything.
Bring a copy of any medications that you are taking, including any natural remedies or medication purchased at the chemist.
You may eat & drink as normal on the day of your line removal.
How is the line removed?
•You will be asked to remove the clothing from your chest area and lie down on the bed provided;
•The area around the line will be examined to locate the cuff area beneath the skin;
•The area will then be cleaned using an antiseptic solution. Sterile towels are used to keep the area sterile.
•To ensure you are comfortable during the procedure, a local anaesthetic will be injected to numb the area surrounding the cuff of the line.
•Once you and the nurse are happy that the area is numb then a small cut (approx 2-3cm) will be made into the skin over the top of the cuff and the fibrous (scar) tissue which has formed around the cuff to hold it in place during your treatment is teased away with forceps until the cuff is free.
•You may feel the nurse’s hands resting against your skin but you will not feel anything sharp or painful.
•Once the cuff is free, the top part of the line which sits in the vein slides out. This is not uncomfortable and you may not even realise that it has happened. The rest of the cuff is removed from beneath the skin and the tube is cut so that the external part of the line can slide out of the skin.
•The skin over the cuff site is then glued or stitched with 2 stitches and a small dressing replaced.
After the line has been removed
The skin where the stitches are may feel a little sore for a day. Occasionally there is a little oozing of blood on the day of removal. This is normal. Should bleeding occur which soaks through the dressing, or the area becomes red and inflamed then you should contact the Macmillan Unit or if out of hours the Ambulatory Emergency Care Unit (AECU) at the hospital.
The skin heals quickly and the stitches can be removed in 7 days. This can be done in the Macmillan Unit via an appointment or by booking in with the nurse at your GP Surgery.
If it is urgent for your line to be removed out of normal working hours or in the absence of the nurse that can perform this procedure it is sometimes necessary for a surgeon to remove your line, but for most patients this will be a planned procedure.
If you have any queries contact The Macmillan Unit on 01908 99635.