About ASN

Robert Hickman, MD

April 4, 2019

Dr. Robert O. Hickman, a pediatric nephrologist and inventor of a catheter that revolutionized care for cancer patients, died on April 4. He was 92.

In the 1970s, Hickman was a founding member of the transplant team at Fred Hutchinson Cancer Research Center that pioneered the Nobel-Prize winning treatment. His contribution to that effort: The lifesaving device that bears his name and is still used worldwide to deliver IV nutrition, draw blood and deliver chemotherapy.

The Hickman catheter "was a gift to the world," said Dr. Fred Appelbaum, executive vice president and deputy director of Fred Hutch, who worked with Hickman. "People make contributions in lots of ways," he said. "Some have deep scientific insights that uncover DNA or how viruses work. Bob's contribution, from a scientific standpoint, was relatively simple. But his invention saved more suffering, anxiety and pain than almost anyone I can imagine." That invention transformed doctors' ability to access a patient's bloodstream. And it was born out of desperate need. Among the many hardships early bone marrow transplant patients faced was an endless nightmare of needle sticks, Appelbaum recalled. "Patients were starving to death nutritionally," he said. "They couldn't eat because of chemotherapy and radiation therapy. They were losing enormous amounts of weight that made them much more susceptible to infections."

That meant they had to be fed intravenously. But nurses and physicians often struggled to find a vein to do so. "These were very sick patients," Hickman recalled in 2002. "They had come to the Hutch as a last resort, and after all the other treatments they'd been through, the vast majority of their veins had been used. You'd stand in awe of the nurses who could find usable veins."

At the time, he was conducting kidney consults for patients in the Hutch transplant program. One day in 1973, nurses repeatedly tried and failed to find a usable vein in a patient with advanced leukemia. Hickman offered to try to place a device called a Broviac catheter.

Invented by a colleague of Hickman's at the University of Washington, the Broviac catheter passed through a vein in the chest into the right atrium of the heart and allowed for successful delivery of intravenous nutrition. The device worked well, but it hadn't been tried in bone marrow transplant patients.

Until Hickman did. Although the patient ultimately succumbed to her disease, her positive response to the intravenous nutrition was dramatic enough to open the transplant team's eyes to the potential.

Gradually, Hickman placed more Broviac catheters in transplant patients. He credited Fred Hutch nurses who played a critical role in the evolution of the device. "The nurses said, 'Well, this is nice, but we need a bigger line,'" he said. "So we had the engineers design new catheters. The Broviac line was sacred, for nutrition and nothing else. But the nurses said, 'We need to draw blood.' We developed a new catheter with additional lumens, the portals through which fluids can pass."

The Hickman catheter, as it came to be known, instantly transformed transplant care, said Dr. Rainer Storb, who was on that pioneering transplant team and is one of the founding scientists of Fred Hutch. "The [invention of the] catheter was an incredible event," Storb said. "We were able to leave all the pain and tension of constant punctures behind us."

It didn't just benefit patients in Seattle. Cancer centers worldwide soon adopted the catheter, and they still use it today. "No one ever improved on the Hickman catheter. It's an amazing legacy," Storb said.

Hickman's skills at placing the devices — he was very gentle with his patients — became legendary. "The patients just fell in love with him, and for good reason," Appelbaum said. "Bob was a saint." His colleagues felt the same, Storb added. Hickman would respond day or night to put in the catheters. And his personality would brighten any room, operating or otherwise, he entered. "He was always smiling, always in a good mood," Storb said. "That says something about the man. There aren't that many people who are kind and nice and willing. Working with him was a joy."

Hickman retired in 2009, shortly after turning 82. He credited a deep devotion to his patients as the reason why he continued to scrub in. "We treated hundreds of patients every year, and I kept working well beyond the age of retirement," Hickman said. "But that's because I enjoyed working with them so much. They were wonderful people, and they contributed a great deal to my life."