WOMEN AND NEWBORN HEALTH SERVICE
King Edward Memorial Hospital
CLINICAL GUIDELINES
OBSTETRICS & GYNAECOLOGY
PARENTAL THERAPY
CENTRAL VENOUS CATHETER (CVC)
REMOVAL OF A CENTRAL VENOUS CATHETER (CVC)
Keywords: CVC removal, central venous catheter
AIM
To remove the central venous catheter safely preventing complications.
KEY POINTS
1.
Indications for catheter removal are:
therapy requiring central venous access is completed
1, 2
unresolved catheter related complications of infection, occlusion or thrombosis
faulty device
2.
3.
1, 2
1, 2
at the direction of the medical staff
When venous thrombosis is suspected the CVC should not be removed until tests confirm the
3
size and location of the thrombosis.
Prevention of infection principles should be employed during removal of a CVC including:
hand hygiene – see Infection Control Manual Policy 2.2 Hand Hygiene
standard precautions – see Infection Control Manual Policy 2.1 Standard Precautions
4.
5.
6.
7.
8.
an aseptic technique
The CVC should be removed utilising safety measures to prevent complications such as air
1
embolism, haemorrhage, catheter fracture or dislodgement of thrombosis.
Nursing and midwifery staff can remove non-tunnelled CVC’s if they have been deemed
4
competent and are fully aware of potential risks ; otherwise they should be supervised by trained
personnel until they can safely perform the procedure.
All tunnelled CVC should be removed by a medical practitioner competent in the procedure.
A patient’s clotting status should be assessed prior to CVC removal to decrease risk for bleeding
1
or haematoma formation.
If infection or phlebitis is suspected the catheter tip should be sent for culture and blood cultures
4, 5
collected.
EQUIPMENT
Dressing Pack
Stitch cutter
Personal Protective Equipment
Single use Chlorhexidine 2% with 70% alcohol swab
Sterile gauze
Sterile Transparent Semipermeable Membrane (TSM) dressing
Sterile scissors and specimen jar with label (if tip is required)
DPMS
Ref: 8745
All guidelines should be read in conjunction with the Disclaimer at the beginning of this manual
Page 1 of 4
PROCEDURE
1
Preparation
1.1
Confirm the patient’s clotting status is normal.
ADDITIONAL INFORMATION
Confirm the patient’s identity.
1.2
Explain the procedure and obtain verbal
consent.
Explanation about the procedure reduces
patient anxiety and promotes co-operation.
Discussion should include the Trendelenburg
or supine positioning, and the Valsalva
1
manoeuvre.
1.3
Prepare the equipment.
A second co-worker may beneficial to assist
positioning the patient or for collection of a
6
catheter tip.
1.4
Visually assess the wound.
If a catheter related infection is suspected, an
appropriate plan of action should be
7
discussed with the medical staff. This may
include microscopy culture of the exit site,
and blood culture specimens from the
cannula and the peripheral circulation.
2
Technique
2.1
Position the patient in the Trendelenburg or
supine position.
The sitting position increases risk for air
embolism as air may be pulled into the
6
venous system.
2.2
Close the catheter and roller clamp(s) to the
administration sets as required.
If a needle less valve port is in situ the
attached administration set may be removed.
2.3
Perform hand hygiene and don personal
protective equipment (PPE).
Personal protective equipment includes
9
gloves and protective eye wear.
Remove the dressing and any tape in situ.
Remove gloves and perform hand hygiene.
2.4
Gloves are contaminated from removing the
9
dressing.
Assess the wound and perform a wound
swab for culture if the wound appears
1
infected.
Perform hand hygiene and don gloves.
2.5
Clean the exit site with a single use
Chlorhexidine 2% and 70% alcohol wipe.
2.6
Remove any sutures taking particular care
not to cut through the catheter.
Catheter fragments can cause embolism.
2.7
Holding a sterile swab over the insertion site
grasp the catheter and smoothly remove the
CVC while the patient:
The Valsalva manoeuvre is forced expiration
of air against a closed glottis. This causes
increased intrathoracic pressure and
decreases risk of air entering the
subcutaneous exit tract. This can be
achieved if the patient blows into a 20mL
syringe with enough force to push the
plunger back, or by the patient bearing down
8
with catheter removal.
performs the Valsalva manoeuvre
is exhaling (when unable to perform the
Valsalva manoeuvre)
If the catheter is difficult to remove, STOP
and contact the medical officer for review.
8
If a patient cannot perform the Valsalva
DPMS Ref: 8745
All guidelines should be read in conjunction with the Disclaimer at the beginning of this manual
Page 2 of 4
PROCEDURE
ADDITIONAL INFORMATION
manoeuvre the CVC can be removed
immediately following end inspiration when
8
the patient exhales.
Forceful removal of a CVC could fracture it or
6
cause embolism.
2.8
Apply gentle digital pressure to the exit site
3,
for 5 minutes until haemostasis is achieved.
Pressure prevents blood loss and risk for air
8
entry.
2.9
Apply a transparent air occlusive sterile
4
dressing.
Prevents air embolus.
2.10
The dressing should be left in place for 24 1
72 hours or until the site is closed.
Inform the patient to advise staff if the
dressing is soiled or has poor contact to the
skin.
8
The site should be inspected as per Clinical
Guideline O&G: Parenteral Therapy:
Monitoring a Peripheral Vascular Site
2.11
2.12
4
Inspect the catheter tip to ensure it is
1
complete.
If the catheter tip is ragged it indicates it has
broken off inside the patient which poses risk
4, 8
for embolus.
Report to the medical team.
Discuss signs of complications that may
occur from CVC removal and advise the
patient to report abnormalities immediately.
Signs of air embolus include patient agitation,
hypotension, light-headedness, pallor,
tachycardia or bradycardia, confusion,
1
desaturation and cardiac arrest.
Other complications that may occur include
catheter fracture and embolus, dislodgement
of thrombus or fibrin sheath,
haemorrhage/bleeding and arterial
complications such as bleeding or
8
compression of the brachial plexus.
3
Collection of a catheter tip
9
Cut a 3-5cm catheter tip off with sterile
scissors and place in a labelled specimen jar
as required.
4
Post procedure
4.1
Position the patient in a supine position for a
1
minimum of 30 minutes.
4.2
Document the condition of the CVC and
wound site in the:
Do not drag the catheter tip over a patient’s
6
skin during removal.
To maximise patient comfort and minimise
the risk of air embolism, pneumothorax and
secondary haemorrhage.
MR250 Progress Notes
Gynaecology Nursing Care Plan
MR285 Midwifery Observation Chart
Document the date and time of removal on
the MR732 CVC & PICC Line Care Plan.
DPMS Ref: 8745
All guidelines should be read in conjunction with the Disclaimer at the beginning of this manual
Page 3 of 4
REFERENCES (STANDARDS)
1.
2.
3.
4.
5.
6.
7.
8.
9.
Luettel D.Nursing Practice Patient Safety Central Venous Catheters. Nursing Times.2011
Green J. Care and management of patients with skin-tunnelled catheters. Nursing Standard. 2008; 22(42):41-8.
Maclin D. Catheter Management. Seminars in Oncology Nursing. 2010;26(2 (May)):113-20.
Guest J. Specimen collection part 6 - central venous catheter tip sampling. Nursing Times. 2008; 104(22):20-1.
Scales K. Central Venous access devices Part 1: devices for acute care. British Journal of Nursing. 2010; 19(2):8892.
Hadaway LC. Targeting therapy with Central Venous Access Devices. Nursing. 2008(June).
Centres for Disease Control and Prevention. Guidelines for the Prevention of Intravascular Catheter-Related Infections.
Morbidity and Mortality Weekly Report. 2002; 51(RR10).
Drewett SR. Central venous catheter removal: procedures and rationale. British Journal of Nursing. 2000;
9(22):2304-15.
Royal Perth Hospital. Central Line Insertion and Management. Royal Perth Hospital Nursing Practice Standards.
2013.
National Standards – 1 Clinical Practice is Guided by Current Best Practice
3 Preventing and Controlling Healthcare Associated Infections
Legislation - Nil
Related Policies – KEMH Clinical Guidelines: O&G: Parenteral Therapy: Central Venous Catheters
Other related documents – Nil
RESPONSIBILITY
Policy Sponsor
Nursing & Midwifery Director OGCCU
Initial Endorsement
September 2007
Last Reviewed
July 2014
Last Amended
January 2015
Review date
July 2017
Do not keep printed versions of guidelines as currency of information cannot be guaranteed.
Access the current version from the WNHS website.
DPMS Ref: 8745
All guidelines should be read in conjunction with the Disclaimer at the beginning of this manual
Page 4 of 4