Central Line: removal

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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

See Also

Video

References

Authors:

Ross Donaldson