Going Home with a Tunneled Catheter (Hickman, Broviac, Groshong)

A tunneled central venous catheter is a long-term central line designed for months to years of use. Unlike a PICC (which enters through a vein in the arm) or a port (which is completely under the skin), a tunneled catheter is surgically placed so that it passes under the skin of the chest before exiting the body — a design that provides both stability and infection protection.

Common brand names include Hickman, Broviac, and Groshong catheters. There are important differences between types — particularly around flushing — so this guide covers all of them, with specific notes where the care differs.

How Your Tunneled Catheter Works

Your catheter was placed in a large central vein (usually the subclavian or internal jugular vein), and its tip sits in the superior vena cava — the large vein just above the heart. What makes it “tunneled” is that before the catheter exits the skin, it travels under the skin of the chest for several centimeters. This tunnel serves two important functions:

Stability: A small felt ring on the catheter called a Dacron cuff is positioned inside the tunnel. Over the first 2–4 weeks after placement, your body’s tissue grows into this cuff, anchoring the catheter securely without stitches.
Infection protection: The tunnel creates a physical barrier that makes it much harder for bacteria from the skin surface to travel along the catheter into the bloodstream.

What you see: One or two (or three) soft, flexible tubes — the catheter lumens — exiting your skin on the chest, usually just below and to the side of your collarbone. Each lumen has a clamp and a needleless connector (cap) at the end.

Write down:

Number of lumens: ___
Catheter type/brand: ___________________________
Placement date: ___________________________
Flush schedule (each lumen): ___________________________

The Early Weeks: Cuff Healing

For the first 2–4 weeks after placement, the Dacron cuff is still healing into the surrounding tissue. During this period:

The exit site (where the catheter exits the skin) has a small wound that is healing, similar to a small surgical incision.
The catheter is less securely anchored than it will be once the cuff fully integrates.
Extra care is needed to avoid pulling on the catheter or disrupting the healing tissue.

During cuff healing:

Your surgeon or care team may place a temporary suture near the exit site to hold the catheter in place until the cuff heals. This suture will be removed at a follow-up appointment.
Dressings over the exit site should not be left off for extended periods.
Report any significant swelling, redness, or discharge around the exit site during this period.

Once the cuff has fully healed (typically confirmed by your care team), some patients transition to a non-dressing approach — covering the exit site with only a small bandage or no dressing at all, depending on your specific catheter and the clinical protocol at your facility. Others continue with a dressing. Your care team will guide you.

Exit Site Care

The exit site is where the catheter emerges from your skin. It requires regular inspection and, in most cases, regular cleansing and dressing.

Assessing the exit site

Every dressing change, inspect the exit site for:

Normal: Clean, healed skin around the catheter exit; no redness, no drainage, no swelling; catheter appears stable
Concerning: Redness or warmth spreading from the exit site; any discharge or pus; tenderness directly at the site; skin breakdown or erosion; the catheter appearing to have moved (longer or shorter than usual)

Cleaning and dressing

Exit site care is typically performed by a trained nurse (home infusion nurse, visiting nurse, or at an outpatient clinic). The exit site is cleaned with an antiseptic (usually chlorhexidine) and covered with a dressing that includes an antimicrobial disc at the skin entry point.

Dressing schedule: Typically every 7 days for transparent dressings, or as directed. Your care team will establish your specific schedule.

Never pull on the catheter when changing dressings or during daily activities. The external portion of the catheter should be secured gently against your body (often with a small loop held by a strip of tape or securement device) to prevent accidental traction.

Flushing: Critical Differences by Catheter Type

This is the most important section to understand because Groshong catheters are flushed differently than Hickman/Broviac catheters. Using the wrong technique can damage the catheter or increase clotting risk.

Hickman and Broviac Catheters

Hickman and Broviac catheters have an open-ended tip — the end of the catheter is open, meaning blood can enter the tip when the clamp is open and pressure is equalized. These catheters require:

Saline flush before and after each use (10 mL per lumen)
Heparin flush to “lock” the catheter when not in use — the heparin solution fills the lumen and prevents blood from clotting inside the tip
Always clamp the lumen before disconnecting a syringe or tubing (to prevent air entry and blood backflow)
SASH technique: Saline → Administer medication → Saline → Heparin

Clamp position: Your catheter has a slide clamp on each lumen. The clamp must be closed (clamped) before disconnecting anything from the hub. Never leave a lumen open and unclamped when not in active use.

Groshong Catheters

Groshong catheters have a special pressure-sensitive valve at the tip — a slit that opens when fluid is actively injected or aspirated, but remains closed at rest. This valve prevents blood from entering the catheter tip passively.

Because of this valve:

Heparin flushing is not required in most protocols — saline alone is sufficient
Clamping is generally not necessary (the valve does it automatically), though many clinicians still recommend clamping as a backup precaution — follow your specific instructions
Saline flush is used before and after each use (20 mL per lumen is common for Groshong due to its longer length — confirm your volume)
Weekly saline flush when not in active use (vs. daily for heparinized open-ended catheters in some protocols — your schedule will be specified)

The key point: If you have a Groshong, do not flush with heparin unless specifically instructed. If you are unsure which type you have, ask your care team.

General flushing rules for all tunneled catheters

Use only pre-filled syringes from your home infusion pharmacy — do not use syringes drawn up at home unless specifically instructed
Always use a 10 mL syringe or larger — never smaller
Scrub the needleless connector hub for 15 seconds with an alcohol wipe and allow 15 seconds to dry before each access
Use smooth, gentle pressure — never force a flush
If you feel resistance, stop. Call your nurse. Do not force.

Connecting and Disconnecting IV Tubing

When connecting IV tubing or a syringe to your catheter:

Wash hands.
Scrub the hub (needleless connector) with an alcohol wipe — 15 seconds scrub, 15 seconds air dry.
For Hickman/Broviac: confirm the clamp is closed before connecting.
Twist the connector firmly clockwise to secure.
For Hickman/Broviac: open the clamp after connecting.

When disconnecting:

For Hickman/Broviac: complete the final saline (and heparin) flush, then clamp while still pushing the final few drops of the flush (positive pressure technique). Then disconnect.
For Groshong: complete the flush, then disconnect.
Ensure a new sterile cap is attached if the old one was removed.

Cap changes: The needleless connectors (caps) on each lumen are changed at regular intervals (typically weekly or when visibly soiled or compromised). Your home infusion nurse manages this. If a cap accidentally falls off or is removed, do not reconnect a used or fallen cap. Clamp the lumen immediately (Hickman/Broviac), keep the open end away from contamination, and call your nurse.

Bathing and Water Activities

First 2–4 weeks (cuff healing period)

The exit site is a healing wound. Protect it from all water:

No submerging of the chest area
Shower carefully with the exit site covered and protected
No swimming or bathing in tubs

After the exit site has fully healed

Your care team will advise when you have more flexibility. In general:

Showering is permitted with the exit site protected and the catheter lumens tucked in securely and kept dry
Tub bathing: Avoid submerging the catheter exit site in bathwater
Swimming in pools/ocean: Generally discouraged for the duration of catheter use due to the risk of water contamination at the exit site — discuss with your care team if this is important to you
Protect the exit site and catheter from contamination during any bathing

Activity and Daily Life

Tunneled catheters are designed for a much more active life than short-term central lines. General principles:

Permitted:

Normal daily activities and light to moderate exercise
Walking, cycling, low-impact activities
Travel (with proper planning — see the Travel guide)
Driving and most routine activities

Avoid or discuss with your care team:

Heavy lifting or vigorous upper body exercise (particularly on the side of the catheter)
Contact sports or any activity with risk of a direct blow to the chest/catheter
Activities that could catch or pull the external catheter tubing (e.g., rough physical play with children, certain sports)

Protecting the external catheter:

When not in use, the external lumens should be secured against the body — tucked into a pocket, worn in a small pouch/belt, or secured with a catheter holder available from your home infusion supplier
Avoid tension or dangling tubing that could be caught and pulled
Never let the external catheter hang freely where it could snag

Warning Signs

Call your home infusion nurse for:

Exit site looks more red or has any new drainage
Dressing is loose, wet, or soiled
Catheter appears to have shifted position
Resistance when flushing (never force)
Cap comes off or is lost
Any infusion alarm you cannot resolve
Any question or uncertainty

Go to the Emergency Room for:

Fever (≥38°C / 100.4°F) with shaking chills — possible bloodstream infection; urgent
Uncontrolled bleeding from the exit site
Catheter accidentally pulled out — keep it, apply pressure, go to ER
Air embolism signs: sudden shortness of breath, chest pain, rapid heartbeat, dizziness after any disconnection event
Shortness of breath or chest pain (any cause)
Significant swelling of the neck, face, or arm on the catheter side

Air embolism prevention

With open-ended catheters (Hickman, Broviac), air can enter the bloodstream if the clamp is open and the lumen is open to air. Always clamp before disconnecting. If you ever open a lumen accidentally, clamp immediately, lie on your left side, and call for help.

Long-Term Management

Tunneled catheters are designed to last for months to years with proper care. Over the long term:

Lab monitoring will continue on whatever schedule your treatment requires
Exit site and dressing care continue indefinitely
Monthly (or more frequent) review of catheter necessity by your care team
Repair kits are available for some catheter types if the external portion becomes damaged — do not attempt repairs yourself; contact your vascular access team

This guide is for educational purposes. Always follow the specific instructions provided by your care team for your catheter type and treatment.