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Fluids & Electrolytes
WHEN YOUR PATIENT no longer needs a central venous catheter (CVC) or its integrity is compromised, it should be removed. Here you'll see how to remove a percutaneously inserted nontunneled CVC. Removing it correctly lessens the risk of life-threatening complications, such as air embolism. Before you begin, make sure your facility's policies and procedures permit nurses to remove this type of CVC.
* Verify the physician's order and check the patient's lab results for uncorrected coagulopathies. If you find any, stop and notify the physician according to facility policy.
* Identify the patient and explain the procedure.
* To reduce the risk of air embolism, place him supine with the head of the bed flat unless contraindicated.
* Close the flow clamp if an administration set is attached.
* Perform hand hygiene and put on clean gloves. Remove the dressing carefully and discard it with your gloves. Repeat hand hygiene and put on sterile gloves.
* Assess the catheter insertion site for evidence of complications such as redness, swelling, or drainage. Notify the physician if you see any of these signs; she may order a culture. Clean the site according to facility policy, preferably with chlorhexidine.
* Remove the catheter-securing device.
* Ask the patient to take a deep breath, hold it, and bear down. If he can't do this or it's contraindicated, have him exhale or place him in the Trendelenburg position.
* After you've removed the catheter, tell the patient to breathe normally. Apply pressure with the sterile gauze until bleeding stops.
* Apply a sterile air-occlusive dressing over the insertion site to prevent a delayed air embolism.
* Assess the length and integrity of the catheter and visually inspect the tip for smoothness. Remove your gloves and perform hand hygiene.
* Document the date and time of CVC removal, noting the CVC's length and integrity, the site assessment, patient response, and nursing interventions.
* Don't pull harder if you meet resistance while removing a CVC.
* Don't remove it when the patient is inhaling.
* Don't apply any dressing that's not air-occlusive-this would increase the risk of a delayed air embolism.
Getting Started Kit: Prevent Central Line Infections. Institute for Healthcare Improvement, 2007. http://www.ihi.org/nr/rdonlyres/0ad706aa-0e76-457b-a4b0-78c31a5172d8/0/centralli. Accessed on August 10, 2007.
Hankins J, et al. (eds). Infusion Therapy in Clinical Practice, 2nd edition. W.B. Saunders, 2001.
Ingram P, et al. The safe removal of central venous catheters. Nursing Standard. 20(49):42-46, August 2006.
Peter D, Saxman C. Preventing air embolism when removing CVCs: An evidence-based approach to changing practice. Medsurg Nursing. 12(4):223-228, August 2003.
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