Central Line: Removal

Background

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

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