Central Line: removal
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 can't 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
- Do not remove or lift the dressing during the removal or while holding pressure. Continue to hold pressure and reinforce the dressing as needed to control bleeding
- Observe site for bleeding and hematoma formation
- Patient remains supine for 30 minutes post CVC removal or as appropriate to the clinical situation
Complications
- Monitor for signs of distress during and after removal. If distress is observed, CALL RRT. Don’t hesitate. If respiratory distress occurs place patient on left side, trendelenburg position, administer 100% oxygen; side roll
patient if nausea or vomiting develops—do not sit up.