Removing a nontunneled central venous catheter

Hollister, Bard, Invacare, Hydrophilic Personal Catheter Closed System, Rochester Medical

TAKE THESE STEPS to ensure your patient's safety when you remove a single-, dual-, or triple-lumen nontunneled central venous catheter.

DON'T

Don't pull hard if you meet resistance when removing the catheter.

Don't remove the catheter while the patient is inhaling; this could cause an air embolism.

Don't use a nonocclusive dressing, such as plain gauze and tape, to cover the insertion site because it could allow air to enter.

DO

Tell the patient what you'll be doing. Explain that you'll ask him to take a deep breath, hold it, and bear down at a certain point in the procedure.

Wash your hands and ask him to lie supine.

Put on clean gloves and remove the dressing, assessing the catheter site for signs of infection. Turn off all infusions to the site.

Remove the gloves and wash your hands. Open the suture removal kit and put on sterile gloves.

Cut and remove the sutures, being very careful not to damage the catheter.

Ask your patient to perform the Valsalva maneuver:

Take a deep breath, hold it, and bear down until you tell him to stop.

While he's bearing down, gently pull out the catheter. Hold a sterile 4x4 gauze pad over the site while you apply continuous pressure to stop bleeding and prevent air from entering the open tract. Tell him to breathe normally.

Examine the catheter tip to make sure it's intact.

Apply a small amount of antimicrobial ointment and a sterile occlusive dressing to the insertion site.

Measure the catheter and compare the length with the measurement documented in the patient's chart after insertion. In case of a discrepancy, notify the physician. Dispose of the catheter appropriately.