Removal of Central Venous Catheter?

  1. I have the following question in my lab manual:

    Valsalva manuever on the removal of a central venous catheter is performed to prevent?
    a.
    b.

    I have looked everywhere for the answer to the question (my text book, ATI books, internet) and they all say to have the patient perform this on removal, but do not say what the purpose is. Can someone please tell me?

    Thanks!
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  2. 9 Comments

  3. by   RN 4 U
    a. air embolism, sorry do not know b.
  4. by   nurseangel47
    vessel wall spasm/resultant cardiac compromise/CRASH! had a pt. code on me when, after a dialysis treatment, pulled the central line out too quickly and bam! she went out with no VS in the blink of an eye! Very scary! Taught me a valuable lesson about doing it much slower from then on!
  5. by   cardiacRN2006
    Quote from RN 4 U
    a. air embolism.

    :yeahthat:
  6. by   Daytonite
    Quote from Finally2008
    Valsalva manuever on the removal of a central venous catheter is performed to prevent?
    a.
    b.
    a. venospasm
    b. to prevent atmospheric air from being sucked into the venous system through the wound upon removal of the catheter and causing an air embolism
  7. by   L&DICURN
    Hello,

    I have searched for a policy and procedure for the removal of central venous catheter. I have found information on the removal of PICC. Can anyone help with the P&P or direct me to the information that is needed?

    Thanks, Renae
  8. by   UM Review RN
    Quote from L&DICURN
    Hello,

    I have searched for a policy and procedure for the removal of central venous catheter. I have found information on the removal of PICC. Can anyone help with the P&P or direct me to the information that is needed?

    Thanks, Renae
    At our facility, we do pulls PICCs, but for a true central line, I believe the docs have to do that. Other facilities may have different policies. I'd be interested in seeing them myself.
  9. by   Daytonite
    Quote from L&DICURN
    Hello,

    I have searched for a policy and procedure for the removal of central venous catheter. I have found information on the removal of PICC. Can anyone help with the P&P or direct me to the information that is needed?

    Thanks, Renae
    I will look around for an online policy on it. May I suggest that you approach the docs in your facility about it. The docs who insert these the most are likely to be most forthcoming with information, or contact someone in the medical staff office and ask them if there is a doctor who they can suggest would be approachable about this. We had an anesthesiologist who was our mentor and advocate for learning this kind of stuff. Ultimately, the medical staff has to approve you guys doing this as well as a nursing policy being written and approved. Is the nursing department working on this or are you part of getting this process started?
  10. by   Daytonite
    Quote from l&dicurn
    hello,

    i have searched for a policy and procedure for the removal of central venous catheter. i have found information on the removal of picc. can anyone help with the p&p or direct me to the information that is needed?

    thanks, renae
    here you go:
  11. by   hypocaffeinemia
    Here's the extent of my facility's policy:

    " Registered Nurses with demonstrated competence may remove a non-tunneled CVC with a physician’s order.

    Tunneled CVCs must be removed by a physician."

    Here's the procedure that accompanies it:


    "Removal of non-tunneled central venous catheter
    1.Assist patient to supine or trendelenberg position.
    2.Clamp IV administration set, if applicable.
    3.Wash hands.
    4.Don non-sterile gloves.
    5.Remove catheter dressing and discard.
    6.Remove non-sterile gloves and discard.
    7.Open suture removal kit and obtain alcohol pads.
    8.Don sterile gloves.
    9.Cleanse insertion site with alcohol.
    10.Cut sutures with sterile scissors and remove with forceps.
    11.Apply sterile gauze sponges over insertion site.
    12.Instruct patient to inhale and hold breath until catheter is removed.
    13.Grasp the catheter with the dominate hand and withdraw the catheter in one continuous motion while applying pressure at insertion site with non-dominate hand using sterile gauze.
    14.Maintain digital pressure to insertion site for at least three minutes or until homeostasis has been achieved.
    15.Once hemeostatis has been achieved, apply occlusive, sterile dressing to insertion site.
    16.Examine catheter tip to see if intact. Notify physician if not intact or frayed.
    17.Catheter tip may be sent to lab for culture sensitivity.
    18.Discard used supplies and wash hands."

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