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
• 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 signs of respiratory distress:
  • 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

• Central line
• Central line removal - UIC youtube