Removal of a Temp Catheter

iluvivt, BSN, RN · Feb 16, 2013

Gather the following supplies: suture removal kit (if it is sutured in ),some ointment or some Vaseline gauze,chlorhexadine wand or swabs,several 2 x 2s, non sterile gloves,sterile gloves, occlusive tape such as Blenderm of hypa-fix , You need to make an air occlusive dressing and prevent air embolism (AE) during the removal of the catheter. A transparent semi permeable membrane dressing is not occlusive.

1. Explain the procedure to the pt and check for allergies and prepare your supplies on a clean work area. assess the CVC for any other complications and see if it is sutured in.

2. Position the pt supine or trendelenburg at 10 to 30 degrees

3.Apply non sterile gloves and remove the dressing

4, Put on sterile gloves and prepare the ointment of Vaseline gauze. If using ointment get a dime to quarter size blob on several 2 x 2s or bunch up the Vaseline gauze and set it on some 2 x 2s. The goal here it to seal that hole and HD catheters are large and leave big holes. Cleanse site with CHG and allow to air dry Remove any sutures

5 Instruct you pt to perform a Valsala maneuver ( forced expiration with the mouth closed or on expiration if the pt cannot perform this)

6 Now pull the catheter out in a continuous motion while reminding the pt to keep holding their breath and performing the Valsava. Please make sure you pt knows the instructions before you star the procedure

7. Immediately apply the ung or Vaseline gauze and hold pressure. Remind the pt that can now breath normally. Hold pressure for 5 minutes or so and then finish making an occlusive dressing. You may need skin prep to get the dressing to stay in place especially if it is the Jugular site

8, Dressing needs to stay in place at least 24 hrs b/c you can still get an AE fro the SQ tract that forms when a CVC has been placed,

9 Check that the catheter is intact and document

NEVER take out a CVC with the pt sitting in a chair!!! any ?s There is a slight variation for pts with a high ICP

Joni's Mom · Feb 16, 2013

This is going to happen in the outpatient clinic, the patient will have to be sitting in the chair. I will not have all the material that you suggest, not sure if we even have sterile gloves.

How often are you asked to do this? If there is no P&P do I still do this proceedure?

iluvivt, BSN, RN · Feb 16, 2013

Please do not take out that catheter with the patient sitting in the chair and you must have the proper material to do this or you should not do it all, You can use some bacitracin or A and D ointment but NOT K Y jelly, Do you have a dressing kit? you can use that and add to it. I am telling you what standard you will be held to if you discontinue this catheter. It must be done in a manner so the pt does not have an AE..that can be fatal and it can happen fast. There are are also potential other neuro complications I did not mention . Please do not think this does not happen.....IT does and I have seen it

Please see the following: http://anaesthesiaconference.kiev.ua/Downloads/Central%20venous%20catheter%20removal_2000.pdf

http://www.nursingtimes.net/Journals/2011/10/27/r/y/c/111101-safety-cvc.pdf

stavros_rn · Feb 16, 2013

Will you please help me also how to take good care of the AVF and AVG access.?

stavros_rn · Feb 16, 2013

Iluvivt. Our patient had poor back flow because their AVF is to small and weak bruit.. how to do to increase the lifespan of AVF

Joni's Mom · Feb 16, 2013

Thank you iluvivt this is exactly what I wanted.

Doc did state that if I felt uncomfortable with the cath removal he would come to the facility and remove the cath. I may have him come just so I can see the correct way to do this for the next time, but with your instructions I should be fine in case he didn't show up.

What occlusive dressing do you suggest on the outpt floor we also have suture kits and triple antibiotic ointment packs I could use.