Hickman vs. medport vs. picc line

I have a picc line for my TPN. My GI doc wants me to change to a hickman, but I've heard a medport may be better suited for swimming. Anyone have opinions on this?
4feet

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This is what I've heard from speaking with many patients and physicians over the years about ports:

Swimming (and bathing) is easier with a port when it is not accessed (with a needle).

Another plus for ports: they are less visible, and there is no tube hanging out to get caught on clothing, etc.

Some patients hate the needle sticks, others think they are no big deal.

Some patients find the port bulky and uncomfortable under their skin.

Most physicians don't like using ports for long term TPN, although most of them allow their patients who really want one to have one.

As one physician noted: If you need a minor repair, a port requires surgery, where a Hickman takes 10 minutes with a nurse in the office or ER. He also notes that catheters can be inserted on lateral aspect of thigh if the patient is concerned about beach appearance.

A second physician added that she likes her patients with ports to access daily and de-access when infusion is complete to reduce the chance of infection.

Hope this is helpful.

Roslyn Dahl
Oley Staff Member
dahlr@mail.amc.edu

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Hi there:

I think there are 2 things that are important to consider with a port, which may or may not have been clear from Roslyn's post 1) to really enjoy the benefits of the port, you have to be comfortable "accessing" the line yourself; and 2) if you need TPN every single day or night, I'm not sure it makes as much sense.

I love the port. With training and encouragement I got comfortable accessing the port myself. You have to follow a very strict, sterile procedure when 'accessing' or putting the needle into the piece under the skin. But, once you get used to it, it's just part of the process. Personally, I don't find the needle painful. As Roslyn said, others seem to feel more pain/discomfort. You can always use ice or a numbing cream. Though I will say, I'm sure that even the most squemish people find that the pain is less the longer you have the port. You develop a bit of scar tissue, and after a while I found I didn't feel the needle at all.

I may have the tubes hanging out for several days out of the week, because I hook up 4 nights/week, and often a few days in a row on so I can then take a few nights off. If I want to wear clothes that are more revealing, or if I want to swim or hot tub, or whatever, I always have the option of taking the needle and tubing out. Which I love...I feel much more in control of the situation and less limited in my activities.

I am on my 2nd port, and where I'm at (Kaiser, California) they seem quite keen on ports for TPN patients. While I'm on my 2nd port, I've not had any infection trouble. I had port #1 for 2.5 years, and had it removed b/c they feard infection, but when it was removed and tested none seemed to be there. I have had port #2 since July '08.

Good luck in your decision.

-Fran

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My son was on TPN for about 9 months at home and on TPN several times in the hospital. He had a port because of so many hospitalizations and it worked great for short term hydration and IV antibiotics but anytime he was on TPN for more than a couple of weeks the port would get infected. In the end he had a hicman that he used for the TPN and when he was back to G-tube feeds we went back to a port.

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never had a port so i cant help there. i have had PICC's and my hickman has now been in use for 6 years this month! woo hoo! although i would love to swim i dont for several reasons. none being the line itself.. i had an open abdominal fistula for 4 years so that was the limiting factor then, and now i just dont have the strength except to be a "floater"!.. i do take baths and showers with it uncovered and bever had a problem.. if i were to go swimming, i might use a biopatch and a double dressing of opsite and do a thorough cleaning right after . i would also stick with a chlorinated pool Vs. a lake, stream or pond/ocean type water source.

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Hi:

My surgeon would not put a port in me because he said it defeats the purpose if you are using it for 20 hours per day. Therefore, I have a hickman. I can't complain - it's better than a PICC line! Is your surgeon giving you the option?

Mimi

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my daugther has a mediport . since nov 2008. after over 198 admittions in two year. their were no entry left. three pic lines in 4 days was the finial thing. she can swim and we have a 10 man hot tub she uses weekly.

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Hi, In what way is the Hickman better than the PICC Line? My GI dr at Mayo suggested Hickman, my home health nurse thought I should talk to him about the port-a-cath. My surgeon said the Hickman has chance of infection also, and involves surgical removal, whereas the PICC Line just gets pulled out if infected. I'm not in any hurry to have surgery. What do you do with showers & swimming? I live in AZ and have 3 boys under 12, we swim alot in the summer.
Thanks for replying - 4feet

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I guess a lot of it is personal preference. I hated the PICC line with a passion. Especially after I'd had the port. I hated having the line hanging out of my arm all the time. It annoyed me to have to cover it up with clothing (and I live in SF, so it's not nearly so hot here as it is for you in AZ). It annoyed me to have to look at and deal with the tubing at all times. I find this kind of depressing. (With the port, either it's not accessed and I can forget about it or when it is accessed, there's less tubing and I just stick it in my bra or tape it up and forget about it.) It annoyed me to have to put a plastic bag around the PICC tubing for a shower and to avoid bathing and hot tubbing. I don't do the latter very often, but for example, I was at a lovely hotel for my anniversary in December in Big Sur. They have a hot tub overlooking the ocean (infinity-style), and if I couldn't have gone in that tub during our 2-day stay, I would have been heartbroken. I understand now from this list that there's a product that can protect the PICC from water, but I didn't know about it when I had my PICC - so maybe this is not such an issue.

Another huge issue, way beyond an annoyance is that my PICCs have never lasted very long for blood draws. A big part of the reason I like having a line is so they can draw blood from it, which is a frequent happening for me. PICCs are notorious for crapping out on the blood draws. Things continue to go in successfully, but can't be taken out.

Lastly, I've always understood PICCs to be only a temporary solution for TPN. I see that some people on this list have had PICCs for a long period of time, but my health care providers have always said that they will become infected much sooner than other lines. So, they always want me to switch from a PICC before this happens to something more long-lasting.

Hope this helps.

-Fran

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I think it might be personal preference. I've had life-threatening infections with the PICC and I just have a bias that I think it's dirtier than the other lines. My hickman has only been in a month but already I like it better when it comes to dressing and going anywhere. I can take my coat on and off without unhooking myself first from the TPN (which can increase infection). I had to do that with a PICC line. I use shower guards to cover the hickman when showering. They are pretty good. The PICC was easier in the sense that I had the Dry Pro cover for showering (and you can swim with it). I've had about 12 PICC lines and they had a harder and harder time finding a place to put them when I needed them. The hickman was inserted in the operating room (like a port) and, of course, there is also risk of infection, but I felt like the PICC had a higher risk.

Mimi

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I had a meeting with surgeon today to discuss putting in a line for IV antibiotics (for Lyme disease). He presented me with all the options: PICC in the arm or the chest, a hickman, or a port. He said either a port or a hickman would be best for me...but it's my decision. How am I supposed to know which is better? Anyone have experience with either...advantages and disadvantages of both? I'd really appreciate help! I haven't even decided if I'm going to go through with the IV therapy...but I have to make a decision soon!

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sorry...typo (lyme brain!) I meant to say the surgeon said either a picc in the chest or a hickman would be the best options...

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I just had surgery to place the hickman. They took out the picc line, which had been in for 9 months. (My home health nurse took it out at my house, very easy, never felt a thing) I never had any problems with the picc line, though my Mayo GI Dr. wanted it out after 3 months. He felt that the picc line was only meant to be temporary and it has more chance for infection. The hickman is a more permanent solution and has to be surgically placed and surgically removed. It was an outpatient proceedure, I was in recovery for about 1 hour, and had to have someone drive me home. I was in pain for about a week and a half, the surgeon gave me hydrocodone, which helped. It's been 3 weeks now and I still have a bandage (tagaderm) over the incision, but my home health nurse says after it heals (maybe 2 months) the bandage can come off. I can wear my bra and tuck in the line and no one knows it's there, the picc line is hard to hide with short sleeves. I would recommend the picc line if your iv therapy is temporary. I was mildly sore for only 1 week after the picc line was placed and didn't need pain pills. They just get you numb in the arm and place it. It's a bit uncomfortable, but bearable. And it only takes a minute to pull it out, where the hickman requires surgery again. I don't know much about the port. Good Luck

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Is there more than 1 type of Hickman? The only one I know a little about is a tunnel catheter. It did require anesthetic/surgery to inset and remove.

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I have a hickman after having 12 different PICC lines. I like the hickman so much better, though I got my first hickman infection only a couple of months after getting the hickman. But now I use ethanol locks at bedtime every night in order to prevent another infection. The hickman is so much nicer than the PICC line and I feel much cleaner. I never left the original dressing on for 2 months though - I never heard of that. It is much easier having it in the chest than in the arm. I have a double lumen hickman.

Mimi

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thanks mimi and under3feet, both your stories helped a lot. If I go through with the iv therapy, I'm thinking a hickman...because after talking to one of my nurses today, she said that most likely it will be at least 3 months long, thus the reason for a longer term solution. Plus, the surgeon didn't sound like he was a big fan of piccs because of the difficulty sometimes in getting them in, and risk of infection. One more question...does it really take up to 2 months for the hickman to heal up??

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No, the discomfort may last a week, but I remember my first PICC line giving me discomfort for a week as well. My surgeon used dermabond to close everything up rather than sutures, so there was nothing to remove either. A week after he did the hickman my dressing was changed and has been changed every week since then. I've had 12 PICC lines and I like the hickman much better. Good luck!

Mimi

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Just remembered something else about PICCs -- sometimes they are sewn onto patient's skin and sometimes they have a small bandagy-thing called a statlock (it has little plastic tabs that attach to little plastic wings on the PICC line). My husband usually gets the statlock. Of course we didn't know he needed to ask for that until someone sewed his line to his skin. (The stitches ripped out right away so, surprise surprise, we just got back in the car and headed right back to the hospital.)

The statlock gets changed every couple of weeks. It does need to be covered with a dressing.

The only drawback that I've seen for the statlock (so far) is that you can't use a biopatch with it.

Carol

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My picc line had a statlock and a biopatch. I'm sure it varies by what nurse/hospital places and changes it.

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Yeah, I'm allergic to biopatches but I've had both a statlock and a biopatch at the same time. I still think the hickman is so much better than the PICC!

Mimi

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Where was the biopatch in relation to the statlock?

Thanks,
Carol

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