Central Line: removal: Difference between revisions
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*Verify review of labs (INR, plts, etc.) | *Verify review of labs (INR, plts, etc.) | ||
*Verify timing of CVC removal with transfusion services if the patient has received plasmapheresis in the last 24 hours | *Verify timing of CVC removal with transfusion services if the patient has received plasmapheresis in the last 24 hours | ||
*Patient in Trendelenburg position (IJ/Subclavian) or supine (femoral or | *Patient in Trendelenburg position (IJ/Subclavian) or supine (femoral or cannot tolerate Trendelenburg) | ||
*Explain valsalva, have patient perform | *Explain valsalva, have patient perform | ||
**For mechanically ventilated pull catheter at the end-inspiration. | **For mechanically ventilated pull catheter at the end-inspiration. | ||
| Line 23: | Line 23: | ||
*Remove old dressing and cut sutures, discard old gloves and change to sterile | *Remove old dressing and cut sutures, discard old gloves and change to sterile | ||
*Remove CVC | *Remove CVC | ||
** Instruct the patient to valsalva | **Instruct the patient to valsalva | ||
**Gently withdraw catheter while applying firm direct pressure using sterile gauze with antibiotic ointment (occlusive dressing) to insertion site. | **Gently withdraw catheter while applying firm direct pressure using sterile gauze with antibiotic ointment (occlusive dressing) to insertion site. | ||
**Tell the patient to breathe normally after the CVC is removed. | **Tell the patient to breathe normally after the CVC is removed. | ||
**If you encounter resistance, stop the removal and escalate following the chain of command | **If you encounter resistance, stop the removal and escalate following the chain of command | ||
*Continuously apply firm pressure for several minutes until bleeding stops | *Continuously apply firm pressure for several minutes until bleeding stops | ||
*Observe site for bleeding and hematoma formation | *Observe site for bleeding and hematoma formation | ||
*Patient remains supine for 30 minutes post CVC removal or as appropriate to the clinical situation | *Patient remains supine for 30 minutes post CVC removal or as appropriate to the clinical situation | ||
==Complications== | ==Complications== | ||
* | *If catheter fracture during withdrawl | ||
patient if nausea or vomiting | **Pressure over site | ||
**Stat CXR | |||
**Notify interventional radiology | |||
**If fragment felt | |||
***Apply pressure proximal to prevent migration to heart | |||
***Apply pressure distal to prevent air embolism | |||
**Place patient Trendelenburg and left side | |||
*If signs of respiratory distress: | |||
**Consider [[Air embolism|air embolism]] | |||
**Call RRT | |||
**Place patient on left side, Trendelenburg position | |||
***Side roll patient if nausea or vomiting develops; do not sit up | |||
**Administer 100% oxygen | |||
==See Also== | ==See Also== | ||
*[[Central line]] | *[[Central line]] | ||
==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:Procedures]] | [[Category:Procedures]][[Category:Critical Care]] | ||
Latest revision as of 18:48, 17 April 2024
Background
- Assess daily the need for central lines
- Discontinue as soon as possible
Equipment
- Suture Removal Kit
- Sterile 4 X 4’s
- Antibiotic Ointment
- Face mask/splash guard, sterile/non-sterile gloves
- Tape or Transparent Dressings
- In order to culture tip:
- CHG or alcohol swabs
- Sterile gloves
- Sterile container
Procedure
- Verify review of labs (INR, plts, etc.)
- Verify timing of CVC removal with transfusion services if the patient has received plasmapheresis in the last 24 hours
- Patient in Trendelenburg position (IJ/Subclavian) or supine (femoral or cannot tolerate Trendelenburg)
- Explain valsalva, have patient perform
- For mechanically ventilated pull catheter at the end-inspiration.
- Mask, hand hygiene, gloves
- Remove old dressing and cut sutures, discard old gloves and change to sterile
- Remove CVC
- Instruct the patient to valsalva
- Gently withdraw catheter while applying firm direct pressure using sterile gauze with antibiotic ointment (occlusive dressing) to insertion site.
- Tell the patient to breathe normally after the CVC is removed.
- If you encounter resistance, stop the removal and escalate following the chain of command
- Continuously apply firm pressure for several minutes until bleeding stops
- Observe site for bleeding and hematoma formation
- Patient remains supine for 30 minutes post CVC removal or as appropriate to the clinical situation
Complications
- If catheter fracture during withdrawl
- Pressure over site
- Stat CXR
- Notify interventional radiology
- If fragment felt
- Apply pressure proximal to prevent migration to heart
- Apply pressure distal to prevent air embolism
- Place patient Trendelenburg and left side
- If signs of respiratory distress:
- Consider air embolism
- Call RRT
- Place patient on left side, Trendelenburg position
- Side roll patient if nausea or vomiting develops; do not sit up
- Administer 100% oxygen