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Hickman and PICC lines during blood cancer treatment | CION Cancer Clinics
A Hickman line is a soft tube placed in a large chest vein so that chemotherapy, transfusions and antibiotics can go in, and blood tests can come out, without repeated needles. A PICC line does the same through the arm. This page explains why blood cancer treatment often needs one, how it is put in and taken out, and which warning signs mean going to hospital the same day. At CION Cancer Clinics, our haematology team supports patients and families through treatment, cost questions and life at home.
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Medically reviewed by Dr. Basudev PokhrelConsultant Haematologist · last reviewed September 2026, next review due September 2027
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On this page
- What is a Hickman line, and why would you need one?
- How is a Hickman line different from a PICC line?
- What happens when a Hickman line is put in?
- What will the line be used for during treatment?
- What can go wrong, and how does the line come out?
- What do families often worry about with a Hickman line?
- Common questions about Hickman and PICC lines
The short answer
What is a Hickman line, and why would you need one?
A Hickman line is a thin, soft tube that sits in a large vein in your chest and comes out through the skin, so that treatment can go in and blood can come out without a new needle each time. A PICC line does the same job but goes in through a vein in the upper arm.
Why blood cancer treatment so often needs one
Treatment for leukaemia, lymphoma and myeloma can mean weeks of chemotherapy, blood and platelet transfusions, antibiotics and daily blood tests. The small veins in the hand and forearm do not hold up to that. A central line delivers everything into a large vein where blood flows fast and the medicine is diluted straight away.
Who may not need one
Not everyone with a blood cancer needs a central line. If your treatment is tablets, a short injection under the skin, or a short course through good arm veins, an ordinary cannula may be enough. The decision rests on your treatment plan, your veins and your blood counts, and your haematology team makes it with you.
Side by side
How is a Hickman line different from a PICC line?
Hickman line
PICC line
Comes out of the skin on the chest
Comes out of the skin on the inner upper arm
Tunnelled under the skin, which helps hold it in place
Not tunnelled, and held with a small fixing device and dressing
Usually chosen for long, intensive treatment such as leukaemia induction
Often chosen for a shorter or less intensive course
Put in under local anaesthetic, often with light sedation
Put in under local anaesthetic at the bedside or in a procedure room
Both arms stay free for daily life
That arm should avoid heavy lifting and blood pressure cuffs
Not sure whether this applies to you?
Ask an oncologistOn the day
What happens when a Hickman line is put in?
Blood tests and consent
Your platelet count and clotting are checked first, because a low platelet count raises the chance of bleeding. You may need a platelet transfusion beforehand. The doctor explains the procedure and its risks, and asks you to sign a consent form.
Numbing the skin
You lie on your back, usually in a procedure room with an ultrasound machine and an X-ray screen. The skin at the base of the neck and on the chest is cleaned and numbed. Some people are also given a medicine to help them relax.
Placing the tube
The doctor finds the vein with ultrasound, passes the tube into it, and tunnels the outer part under the skin to an exit point on the chest. You feel pushing and pulling. Tell the team if anything hurts, because more numbing medicine can be given.
Checking the position
An X-ray confirms the tip sits in the right place. There are usually a couple of small stitches at the neck and the exit point, and a clean dressing goes over both. Most people go back to the ward or home the same day.
Day to day
What will the line be used for during treatment?
Once it is in, almost everything that would have needed a needle goes through the line instead.
Chemotherapy
Drugs that would irritate or burn a small vein go straight into a large one.
Transfusions
Red cell and platelet transfusions are common during blood cancer treatment. The line lets them run without hunting for a vein when your counts are low and you already feel unwell.
Blood tests
Samples are drawn from the line, often every day while you are an inpatient. For many people this is the single biggest relief the line brings.
Antibiotics and fluids
If you develop a fever with low white cells, antibiotics can start through the line within minutes of arriving on the ward.
Also given this way
- Fluids and salts
- Anti-sickness medicines
- Liquid nutrition, when eating is hard
!
Signs that cannot wait until your next visit
Go to the nearest emergency department the same day, or call 108, if you have a fever or shivers, especially after a flush, a swollen arm or neck on the line side, or a cracked or slipped line. Tell the staff you have a central line and are on blood cancer treatment. Do not take a fever medicine first to see if it settles.
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Being straight with you
What can go wrong, and how does the line come out?
Most lines do their job with no serious trouble. The problems that do happen are infection, a blockage, or a clot in the vein around the tube, and all three are easier to deal with when they are caught early.
Infection
The line is a direct route from the skin into the bloodstream, and blood cancer treatment lowers the white cells that would normally fight germs. That is why fever matters so much. Sometimes the line has to come out, and your team decides that on the basis of the germ and how you respond.
Blockage and clots
A line that will not flush or will not give blood may have a small clot at its tip, or may be kinked. Nurses have safe ways to clear it. Never force a flush yourself. A clot in the vein itself shows as swelling of the arm or neck, and it needs to be seen the same day.
Taking it out
A PICC line slides out gently on the ward in a few moments. A Hickman line has a small cuff under the skin that the body grows around, so it is removed with local anaesthetic and a small cut. The line stays until your team no longer needs it, which for some people is the whole of treatment.
This page cannot tell you which line you will be offered or how long you will keep it. That depends on your diagnosis and plan, and your haematologist is the person to ask.Commonly believed
What do families often worry about with a Hickman line?
"The tube goes into the heart, so it is dangerous."
The tip sits in a large vein just above the heart, where blood flows fast. That position is chosen on purpose because it dilutes the medicine safely. It is checked on X-ray before the line is used, and it does not affect how the heart beats.
"Having a line means the cancer is very serious."
A line reflects how treatment will be given, not how advanced the disease is. Many people with a very treatable blood cancer have one simply because the course is long or needs many transfusions.
"We should refuse the line and use hand veins instead."
Repeated needles through weeks of treatment usually damage the small veins, delay transfusions and antibiotics, and raise the risk of chemotherapy leaking into the skin. Ask your team to explain the choice before deciding.
"If the line gets infected, it was our fault at home."
Good hand washing and dressing care lower the risk, but infections still happen to careful families, because low white cells make everyone more vulnerable. What matters most is acting the same day on a fever, not blaming yourself afterwards.
Questions we are asked
Common questions about Hickman and PICC lines
Does putting in a Hickman line hurt?
The numbing injection stings briefly. After that most people feel pressure and tugging rather than sharp pain. The neck and chest can ache for a few days afterwards, and simple pain relief your team approves usually helps. Tell the doctor during the procedure if you feel pain, because more local anaesthetic can be given.
How long can a Hickman line stay in?
A tunnelled line is designed to stay for months if it is working and not infected. Many people keep it through the whole of their treatment, including consolidation and any stay at a transplant centre. Your team removes it once it is no longer needed, or earlier if it causes an infection or clot that cannot be settled.
Can I bathe with a line in?
You can usually wash, but the line and dressing must stay dry. Most families use a bucket bath with the dressing covered in a waterproof cover, and avoid soaking in a tub or swimming. If the dressing gets wet, it needs changing that day.
Who flushes the line and changes the dressing?
At first it is done by trained nurses, usually on your treatment day or at a weekly visit. Some families are taught to do it themselves, especially if they live far from the hospital in a district town. Never flush or open the line unless you have been trained and given the supplies to do it safely.
Is a port better than a Hickman line?
A port sits completely under the skin and needs a needle each time it is used. It suits people who need treatment at intervals over a long time. For intensive leukaemia treatment with daily transfusions and blood tests, a Hickman line with several channels is often more practical. Your team chooses based on your plan.
Can I sleep, work and hold my child with the line?
Yes, with some care. Sleep on the side away from the line if it pulls. Wear loose clothes that do not rub the dressing. Keep the ends taped or tucked so a small child cannot grab them. Desk work is usually possible between treatments, while heavy lifting and contact sports should wait until the line is out.
Will the line leave a scar?
A Hickman line usually leaves two small marks, one at the base of the neck and one on the chest where it came out. They fade over the following months but rarely disappear completely. A PICC line usually leaves only a tiny mark on the arm.
Is the line covered by Aarogyasri or insurance?
When the line is part of an approved blood cancer treatment plan, it is usually included in the treatment package under Aarogyasri, PM-JAY, CGHS, ECHS, EHS or cashless insurance. Scheme rules change, so check your current entitlement. Call the helpline with your card details and we will check what your cover includes before admission.
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Dr. Basudev Pokhrel reviews blood counts, transfusion needs and blood disorders, and works with the CION tumour board on blood cancers.
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Sources
- Macmillan Cancer Support — Central lines
- Cancer Research UK — Cancer treatment
- National Cancer Institute — Infection and cancer treatment
- Blood Cancer UK — Blood Cancer UK
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Caring for a central line at homeDaily checks, safe handling and infection signs at homeMouth care during prolonged low white cellsAnother everyday way to lower infection riskTransfusion reactions and what they feel likeWhat to watch for when blood runs through the lineSupportive care in haematologyAll the supportive care guides in one place
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