(Done by RNs, physician extenders
(with credentialing), and APN’s (with credentialing) who have
completed an annual competency check off) PURPOSE:
To safely
remove non-tunneled central venous catheters (Hickman, Cook, Arrow,
Quinton, Cordis, etc.), and arterial lines; excluding Peripherally
Inserted Central Catheters. EQUIPMENT:
1.
Physicians order for catheter removal.
2.
Sterile instrument pack
3.
Sterile Gloves
4.
Chlorahexidine swab
5.
Clean gloves
6.
4x4 gauze
7.
2x2 gauze
8.
Sterile container if tip is to be cultured
9.
Second sterile instrument pack if tip is to be cultured
10.
Goggles or fluid shield face mask
11.
Tape
NURSING ACTION:
Must
have physicians order to remove any line. PROCEDURE STEPS:
*USING UNIVERSAL PRECAUTIONS*
1.
Explain procedure to the patient/ family.
2.
Place the
patient supine in slight Trendelenberg position (only supine if
Trendelenberg is contraindicated or not tolerated)
to potentially prevent
embolism. Have
patient turn head away from catheter if removing jugular or
subclavian catheter.
Exception: Do not place in this position
if removing any arterial line except femoral.
3.
Wash hands.
4.
Prepare sterile field and open supplies.
5.
Remove old dressing and dispose in appropriate container.
6.
Wash hands and put on sterile gloves.
7.
Clean site with sterile chlorahexidine prep.
8.
Clip and remove sutures and hold the catheter making sure the catheter
is completely free.
9.
Type of Catheters
A.
Central
Venous Catheters
1.
Discontinue intravenous solutions or relocate any necessary infusion to
an alternate site.
Attach empty syringe to lumen as soon as IV line is removed
2.
Instruct the patient to take a deep breath and hold it if removing
jugular or subclavian lines.
3.
Grasp the catheter with the dominant hand and withdraw catheter in one
continuous motion.
4.
With the non-dominant hand, immediately apply pressure as indicated for
site or until hemostasis is achieved over the puncture site with
sterile 2x2 with 4x4 over it.
Avoid any contamination of the catheter tip during removal if culture
is to be obtained.
B.
Arterial
Lines
1.
Attach a 3-5 ml syringe to the blood sampling port or use the blood save
vamp, turn the stop cock off to the flush solution, and draw back
through the tubing.
2.
Grasp the catheter with the dominant hand and withdraw catheter in one
continuous motion.
3.
Apply pressure 1-2 fingerwidths
above the insertion site.
4.
With non-dominant hand, immediately apply pressure as indicated for site
or until hemostasis is achieved over the puncture site with sterile
2x2 gauze with 4x4 gauze over it.
Avoid any contamination
of the catheter tip during removal if culture is to be obtained.
NURSING ACTION
:If site bleeds, leave the 2x2
undisturbed while changing the 4x4 and thereby avoid interfering
with clot formation. If
bleeding is still present after 15 minutes for subclavian, radial,
or internal jugular sites or 30 minutes for femoral site of
undisturbed pressure, contact the physician. Inspect catheter to
make sure tip was removed intact.
Intact catheter tip will be a smooth, beveled, or blunt cut.
If catheter tip is not completely recovered:
1.
Keep
patient calm
2.
Monitor for
signs of distress
3.
Notify the
physician
9. If catheter tip is to be
cultured: have a colleague assist by cutting 1-2 inches of the
catheter tip into a sterile container using the second pair of
scissors – NOT the ones used to cut sutures.
10. Once hemostasis has been
achieved, apply occlusive sterile
dressing over the site.
Label dressing with date and time of removal and ones initials.
11. Document:
a.
Patient and Family education
b.
Date and
time of removal
c.
Site assessment
d.
Ease of
catheter removal
e.
Inspection of catheter
f.
Length of time pressure applied to obtain hemostasis
g.
Application
of occlusive dressing
h.
Patient
tolerance of procedure
i.
Unexpected outcomes and interventions
POST REMOVAL CARE AND PATIENT/ FAMILY EDUCATION
A.
Site care:
1.
Instruct patient to avoid lifting, stooping, squatting, or any strenuous
activity for 24-72 hours.
2.
Instruct patient to avoid getting dressing wet or soiled.
3.
Leave dressing in place for 24 hours.
B.
Signs and
symptoms to report:
1.
Bleeding
2.
Shortness of breath
3.
Fever
4.
Swelling of the site, face, neck, arm, groin
5.
Drainage from the site
C.
How to
contact treatment team:
1.
Give 24 hour contact numbers
2.
Explain procedure for contacting the physician after clinic hours.
REFERENCES:
Lynn-McHale Wiegand, Debra J.,
Carlson, Karen K. (2005).
AACN Procedure Manual for Critical Care pp. 498-501 &
451-461.
RESOURCE PERSON(S):
Celeste Bryson, RN, MSN,
CCRN, CCNS, MBA; Shelly Armstrong, RN, BSN, CCRN; Ed Horton, RN,
BSN, MBA, CCRN; Cheryl
Whittington, RN, BSN, CCRN; Mark S. Rowe RNP, MNSc |
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