Removing Central Venous Catheters (CVC)

One of the procedures that you will be performing quite regularly in the CVICU is removal of a central venous catheter. This is what you need to know about the procedure

Equipment

  • Suture Removal Kit

  • Sterile 4 X 4’s

  • 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.) If platelets are low and or INR is elevated, discuss with the provider before removing CVC

  • Mask, hand hygiene, gloves

  • Remove old dressing and cut sutures, discard old gloves and change to sterile gloves

  • Remove CVC

Positioning during central line removal is a critical intervention to prevent air embolism

  • Inform the patient

  • Place the patient supine (they should not be sitting or upright) should be placed in the head down (Trendelenburg) position for removal

  • Or supine (femoral or cannot tolerate Trendelenburg)

  • Instruct the patient to hold their breath and perform the Valsalva maneuver (forced expiration with the mouth closed) when the catheter is being removed

  • If the patient is unable to cooperate with instructions, the catheter should be removed following inspiration

  • Gently withdraw catheter while applying firm direct pressure using sterile gauze (occlusive dressing) to insertion site. Cover the insertion site immediately with a sterile gauze

  • Tell the patient to breathe normally after the CVC is removed.

  • Maintain firm manual pressure until haemostasis is achieved. The insertion site must then be covered with an air-occlusive dressing, (like Vaseline gauze) which should remain in place for 24-72 hours

  • Observe site for bleeding and hematoma formation

  • Patient remains supine for 30 minutes post CVC removal or as appropriate to the clinical situation

Symptoms associated with venous air embolism include:

Shortness of breath

Hypotension

Loss of consciousness

Cardiac arrest

Treatment of Venous Air Embolism

Placement of the patient in the head-down, left-side-down position,

Administration of 100% O2, and

Cardiopulmonary resuscitation

Cheryl