Central Line Removal. Competency Assessment for Registered Professional Nurses in the Critical Care Areas. References: AACN Procedure Manual for Critical Care, 5 th Edition, pgs 498-501. Critical Care Nursing, A Holistic Approach; 9 th ed; 2009, pages 301-303. General Considerations.
Competency Assessment for Registered Professional Nurses in the Critical Care Areas
References: AACN Procedure Manual for Critical Care, 5th Edition, pgs 498-501.
Critical Care Nursing, A Holistic Approach; 9th ed; 2009, pages 301-303.
1. Wash hands
2. Open suture removal
3. Turn off infusion
4. Don PPE
If catheter tip to be cultured, follow procedure SP-I-8.0 “Collection of IV Catheter for Culture”. MD to culture.
Note: There is poor evidence to support a recommendation for or against use of this practice.Procedure
5. Place patient in slight Trendelenburg position and turn head away from catheter.
Decreases the risk for air entry and reduces the transmission of microorganisms.
Place the patient flat if Trendelenberg is contraindicated or not tolerated.Procedure
6. Remove the dressing, wash hands, and don sterile gloves.
7. Carefully cut the sutures; ensure that the entire suture is removed.
Reduces the transmission of microorganisms.Procedure
8. Instruct the patient to take a deep breath and hold it (if removing IJ or subclavian catheters).
8. Minimizes air being accidently drawn into the systemic venous circulation
If mechanically ventilated, withdraw the catheter during the inspiratory phase of the respiratory cycle.Procedure
9. Remove the catheter
Grasp the catheter and withdraw in one continuous motion.
Quickly apply a drop of betadine ointment over the puncture site and cover immediately with a sterile 4X4 gauze.
Withdrawing the catheter with a continuous motion decreases trauma to the vein.
The distal end of the catheter should be removed quickly because the proximal and medial openings could permit the entry of air. Application of ointment and gauze prevent air entry into the puncture site.Procedure
10. Maintain pressure for a minimum of 5 minutes or until hemostasis is achieved.
Recheck site after 15 minutes, 30 minutes, 60 minutes, and 120 minutes.
Prevents bleeding and hematoma formation.
Longer periods of direct pressure may be needed to achieve hemostasis in patients receiving systemic heparin or thrombolytics or those who have acoagulopathy.Procedure
11. Apply an occlusive, sterile dressing over the site.
12. Inspect the catheter after it is removed.
13. Reposition the patient.
14. Discard supplies in appropriate waste containers, wash hands.
Minimizes the risk for air entry and infection at the site and ensures that the entire catheter has been removed.Procedure
Turn patient on left side in Trendelenburg position
Administer oxygenManagement of Suspected Air Embolus
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