WHEN YOUR PATIENT no longer needs a central venous catheter (CVC) or its integrity is compromised, it should be removed. Here you'll see how to remove a percutaneously inserted nontunneled CVC. Removing it correctly lessens the risk of life-threatening complications, such as air embolism. Before you begin, make sure your facility's policies and procedures permit nurses to remove this type of CVC.
* Verify the physician's order and check the patient's lab results for uncorrected coagulopathies. If you find any, stop and notify the physician according to facility policy.
* Identify the patient and explain the procedure.
* To reduce the risk of air embolism, place him supine with the head of the bed flat unless contraindicated.
* Close the flow clamp if an administration set is attached.
* Perform hand hygiene and put on clean gloves. Remove the dressing carefully and discard it with your gloves. Repeat hand hygiene and put on sterile gloves.
* Assess the catheter insertion site for evidence of complications such as redness, swelling, or drainage. Notify the physician if you see any of these signs; she may order a culture. Clean the site according to facility policy, preferably with chlorhexidine.
* Remove the catheter-securing device.
* Ask the patient to take a deep breath, hold it, and bear down. If he can't do this or it's contraindicated, have him exhale or place him in the Trendelenburg position.
* After you've removed the catheter, tell the patient to breathe normally. Apply pressure with the sterile gauze until bleeding stops.
* Apply a sterile air-occlusive dressing over the insertion site to prevent a delayed air embolism.
* Assess the length and integrity of the catheter and visually inspect the tip for smoothness. Remove your gloves and perform hand hygiene.
* Document the date and time of CVC removal, noting the CVC's length and integrity, the site assessment, patient response, and nursing interventions.
* Don't pull harder if you meet resistance while removing a CVC.
* Don't remove it when the patient is inhaling.
* Don't apply any dressing that's not air-occlusive-this would increase the risk of a delayed air embolism.
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Hankins J, et al. (eds). Infusion Therapy in Clinical Practice, 2nd edition. W.B. Saunders, 2001.
Ingram P, et al. The safe removal of central venous catheters. Nursing Standard. 20(49):42-46, August 2006.
Peter D, Saxman C. Preventing air embolism when removing CVCs: An evidence-based approach to changing practice. Medsurg Nursing. 12(4):223-228, August 2003.