- Reference Number: HEY612/2026
- Departments: Nutrition Support
- Last Updated: 30 April 2026
Introduction
This leaflet has been produced to give you general information about your procedure and answer most of your questions. It is not intended to replace the discussion between you and the healthcare team but may act as a starting point for discussion. If after reading it you have any concerns or require further explanation, please discuss this with a member of the healthcare team caring for you.
What is a Skin Tunnelled Line?
A skin tunnelled line is a long, hollow tube inserted into one of the veins in the neck or under the collar bone. You might hear it referred to as a ‘line’, ‘skin tunnelled line’ or ‘Hickman line’.
It has openings on both ends and the space inside the line is called a lumen. A line can have one or two lumens. The lumens can be found at one end of the line, while the other end, which is the tip, will sit in a large vein located just outside your heart. The lumens have clamps on them which will remain closed when not in use. The end of the lumens will have needle free devices attached to them.
It is held in place by a small ‘cuff’ around the line which can be felt under the skin near the exit site (where the line comes out of your body).
This information leaflet will explain why you need a line, what to do before you have the procedure and how to care for it when you are at home.
Why do I need a Skin Tunnelled Line?
A skin tunnelled line allows you to receive Parenteral Nutrition (PN) or Intravenous (IV) Fluids at home.
Can there be any complications or risks?
Serious problems are extremely rare while a skin tunnelled line is being placed. However as with most procedures, there are some risks involved. The doctor placing your skin tunnelled line will explain these to you.
How do I prepare for the Skin Tunnelled Line?
Most skin tunnelled lines are put in as a ‘day case’ procedure (this means that you will not have to stay in hospital overnight). Your doctor or nurse will tell you what time you should come into hospital to have your line inserted if you are not already an inpatient. If you are an in patient you will attend the radiology department
What will happen?
The skin tunnelled line is inserted by a specially trained doctor. Local anaesthetic is administered to numb the area where the line enters the body. A small opening is made on the skin near to the collarbone or neck to help find the correct vein. This is called the insertion site. The exit site is where the line comes out of the chest.
After the line has been put in you will have a chest X-ray to check it is in the right place. You will have stitches on the skin, holding the line in place. Insertion site sutures removed 7 days after insertion and exit site sutures are removed 21 days after insertion. The site will be covered by a clear dressing. This will be changed once a week.
The nurses will update either the ward team, if you are an in-patient or your homecare team for when these are due to be removed.
Should I feel pain?
You may have some bruising and be a little sore for a few days. Some patients take mild pain relief medication to ease this. Please follow the instructions on the medicine packet. Once the bruising has gone the skin tunnelled line should be painless.
What will happen after the procedure?
The local anaesthetic will wear off after you have returned to the day unit or the ward. It is normal to feel some discomfort, and you will be given pain relief medication to ease this. There may also be some blood on the dressing and bruising. This is all normal. The dressings will be changed after 24 hours. If you are at home, arrangements will be made for a nurse to complete this.
Who will care for my Skin Tunnelled Line?
While in hospital your skin tunnelled line will be looked after by nursing staff on the ward. This involves:
- Cleaning the exit site and applying a new dressing once a week.
- Flushing the line every week to prevent blockages when it is not being used.
- Checking the skin tunnelled line and the area it enters your chest every day for problems with the tubing or exit site.
Before you leave hospital, you will be shown how to care for your line and go through a training package with your nutrition nurse. If you are unable to care for the line, the nutrition nurses will discuss different options with you.
Caring of your Skin Tunnelled line at home
Showering
Use a see through/transparent dressing to cover the line, these will be provided to you on your fortnightly ancillary order. This will ensure the exit site is kept dry during a shower.
Having a bath
Bathwater is not as clean as shower water so if you have a bath, please make sure to keep the exit site and the end of the line out of the water. The line must not be placed under water.
Sports
Sports like tennis, golf or strenuous gym exercises should be avoided. There is a risk your skin tunnelled line could become dislodged due to a lot of upper body movement. Swimming is not advised with a tunnelled line as you are not be able to keep the exit site or end of line out of water. This could increase the risk of infection. Your doctor or nutrition nurse can advise you about other sports which you can do.
Exit site
To prevent infection, your skin tunnelled line must be kept clean and dry. The dressing should be changed once weekly or more frequently if the dressing becomes soiled, loose or wet.
Keeping the skin tunnelled line working
If your skin tunnelled line is not always being used, the plastic clamp must stay closed.
Other advice: Remember to check it is closed every day and that the needle free device on the end is securely attached. Flushing your line before and after each infusion will help to prevent it becoming blocked. We recommend your line is flushed once a week with normal saline. You will be trained how to complete this or if you are unable to care for your line, the homecare team will complete this for you. The needle free device at the end of your line should be changed at the same time (weekly).
Possible Problems
You should contact your specialist nurse Monday to Friday between 7:00am and 4:00pm for any of the possible problems listed below. Contact details will be provided at the end of the leaflet.
Infection:
It is possible for an infection to develop inside the line or in the area where it goes into the vein. If you develop a temperature of 38 degrees or higher, notice any swelling or redness, along the vein above the insertion site, contact your specialist nurse or home care team out of hours (after 5pm and during bank holidays and weekends).
Leaking of Parenteral Nutrition (PN), Blood or Fluid:
If you notice any leaking from the line, it may be a hole that has developed in the line. Stop using the line. Contact your specialist nurse or home care team.
Line blocked / infusion stops:
If you have any difficulties flushing your line, for example, your infusion of parenteral nutrition (PN) or Intravenous Fluid (IVF) will not flow through the line, or you are unable to flush using normal pressure, report these to your specialist nurse. They may need to arrange admission to hospital to ensure you continue to receive your home prescription to prevent dehydration. In this instance you may be required to have a cannula inserted for the administration of peripheral fluids or peripheral parenteral nutrition.
The line breaks or you accidentally cut the line:
If you notice a cut or tear in the line, contact your specialist nurse or homecare team who will arrange a replacement of your tunnelled line.
Air in the tunnelled line entering the bloodstream:
If you suddenly have difficulty breathing, experience chest pain, dizziness or confusion, stop the infusion and immediately clamp the catheter, contact the emergency services.
If possible, lie down with your head lower than your hips and feet until assistance arrives.
Contact details and further advice
Should you require further advice on the issues contained in this leaflet, please do not hesitate to contact:
North Bank:
Intestinal Failure Team via switchboard on tel: 01482 875875 and ask for Bleep 771
Castle Hill Hospital or
Bleep 640 Hull Royal Infirmary Specialist Nurses direct on the mobile phone number 07827 937025.
South Bank:
Nutrition Support Nurses at Diana Princess of Wales, Grimsby on Bleep 286 or at Scunthorpe General Hospital on Bleep 2108
After 4pm, at weekends and Bank Holidays:
Please contact your discharging ward or your homecare team for additional advice.
General Advice and Consent
Most of your questions should have been answered by this leaflet, but remember that this is only a starting point for discussion with the healthcare team.
Consent to treatment
Before any doctor, nurse or therapist examines or treats you, they must seek your consent or permission. In order to make a decision, you need to have information from health professionals about the treatment or investigation which is being offered to you. You should always ask them more questions if you do not understand or if you want more information.
The information you receive should be about your condition, the alternatives available to you, and whether it carries risks as well as the benefits. What is important is that your consent is genuine or valid. That means:
- you must be able to give your consent
- you must be given enough information to enable you to make a decision
- you must be acting under your own free will and not under the strong influence of another person
Information about you
We collect and use your information to provide you with care and treatment. As part of your care, information about you will be shared between members of a healthcare team, some of whom you may not meet. Your information may also be used to help train staff, to check the quality of our care, to manage and plan the health service, and to help with research. Wherever possible we use anonymous data.
We may pass on relevant information to other health organisations that provide you with care. All information is treated as strictly confidential and is not given to anyone who does not need it. If you have any concerns please ask your doctor, or the person caring for you.
Under the General Data Protection Regulation and the Data Protection Act 2018 we are responsible for maintaining the confidentiality of any information we hold about you. For further information visit the following page: Confidential Information about You.
If you or your carer needs information about your health and wellbeing and about your care and treatment in a different format, such as large print, braille or audio, due to disability, impairment or sensory loss, please advise a member of staff and this can be arranged.
