removal central line

  1. Hi, I removed a CVD for the first time. My supervisor was present in the beginning. First I used a sterile gauze for pressure (for about 8 minutes?). But the gauze was so bloody that I used another gauze for the last 5 minutes, but this was a non-sterile one!! I'm really worried that the patient will have an infection.. but my supervisor says not to worry. What do you think?

    Also, I know a complication of removing a CVD is an air embolism. How long does it take for symptoms to occur? And is it true that small air embolisms are normally absorbed with no harm? Thanks!!!
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    About kiki1991

    Joined: Feb '18; Posts: 8; Likes: 2
    Specialty: 1 year(s) of experience

    17 Comments

  3. by   Wuzzie
    Did you drop the gauze on the floor, step on it, wipe the bedside table with it and then use it on the patient? If not you're good to go.

    As for air emboli. It depends on how much air, where it entered and the type of vessel. It could be immediate or days later.
  4. by   Triddin
    You are monitoring for the immediate air embolism by doing vitals more frequently for the first hour or so depending on your hospital policy. I personally have never seen one after removing a Cvc. I also keep the patient in reverse trendelenberg and have them do the valsalva maneuver as long as neither are contraindicated to ze the risk of air embolism. We also use a Vaseline gauze directly against the skin when dressing the wound to prevent air embolisms.

    I'm sure your patient will be fine. Next time, just bring extra gauze just in case
  5. by   kiki1991
    thank you! did you ever hear of any patient getting an infection after removal of a CVC?
  6. by   Buckeye.nurse
    Quote from kiki1991
    thank you! did you ever hear of any patient getting an infection after removal of a CVC?
    Any patient's risk of infection is generally higher while the CVC is *still in*, not during the act of removal. Hand-washing, cleansing the site prior to removal, and covering with a sterile dressing (left in place for 24 hours) can help reduce infection risk.

    As other people have stated, the most common risk factor during line removal is air embolism. For this reason, place your patient's head of bed flat (unless contraindicated), have them take a deep breath and hold it as you are removing the line, and immediately cover with an occlusive dressing (such as Vaseline gauze). Frequent vital signs are never a bad idea, and we ask patients to remain in bed for 30 minutes after line d/c.
  7. by   kiki1991
    Yes, thank you! But I was also referring to my use of a non-sterile dressing for the last few minutes
  8. by   Wuzzie
    Quote from kiki1991
    Yes, thank you! But I was also referring to my use of a non-sterile dressing for the last few minutes
    I think I addressed that in my previous post.
  9. by   kiki1991
    Thanks ! I was also wondering, but more in general, after hemostasis is achieved, can air still go in the body? And when having a CVC and infection, how long will it take until the first symptoms?
  10. by   brownbook
    I appreciate your concerns about possible infection. But honestly you need to "get over it". Your situation was not an emergency, however any urgent situation (after the ABC's), stopping blood loss if the next step. Whatever can be quickly grabbed, a shirt, some tissue, a dish rag, etc., even un-sterile gauze, is used.


    I am 100%, or maybe 99.9% positive there was no possibility of you causing an infection. But even if you did that is what antibiotics are for.

    The other issue, air embolus, is also uncommon, but that can't be easily fixed. Focus on understand air embolus.....forget about maybe causing an infection.
  11. by   Triddin
    I think infection inset depends on several factors including source control and patients immune status. An immune compromised patient would be more likely to develop infection for example.

    In this case, you've removed a direct portal of entry from the outside to the blood stream. Hypothetically any break of skin is a portal of entry for germs, but the body also mounts a protective response when that happens.

    If the patient has developed a clot, there shouldn't be a portal of entry for air into the blood stream, so no air emboli. I guess the patient could develop some subcutaneous emphysema, but all the do with that is monitor the size to ensure it doesn't spread. I've seen some extensive subcutaneous emphysema that we just monitored and the patient was fine.
  12. by   Triddin
    As a thought, next time you do a skill for the first time, see if you can get an educator or a more experienced nurse to do the skill with you. Not only are they support who can guide you with your questions during the procedure, but can lose grab you extra supplies if need be
  13. by   Julius Seizure
    (1) If the bleeding hasn't stopped, don't remove the bloody gauze, jut keep holding pressure and put extra gauze on top. If a clot is forming, you don't want to pull it off.

    (2) Yes, sterile gauze is better. Bring extra. But I would be very surprised if the patient got an infection related to your gauze usage in this situation. Patients get infections from CVLs being in place. If they DO get an infection from the removal, it is almost always still from bacteria that comes off of the CVL as it is being removed. Not from the gauze you hold against their skin.

    (3) You can minimize the chance of air entry by placing an occlusive dressing over the site and leaving it in place for at least 12-24 hours (check your policy). What do your hospital policies say to use after removing a CVL? Check your policy. In my experience, some hospitals say to use a band-aid and gauze, some say gauze and tegaderm, and others say vaseline gauze and tegaderm. Check your policies so that you know what to do in your facility.

    (4) Did I mention to check your policies?
  14. by   kiki1991
    "I appreciate your concerns about possible infection. But honestly you need to "get over it". Your situation was not an emergency, however any urgent situation (after the ABC's), stopping blood loss if the next step. Whatever can be quickly grabbed, a shirt, some tissue, a dish rag, etc., even un-sterile gauze, is used."

    Thanks, you're absolutely true. It's only that the patient is using immunosuppression med which made me a bit concerned

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