DC CVL

[garciadiego]

I know how to DC a PICC line but how do you DC a CVL thats in the jugular? Same way?...withdraw the line and put pressure? What instructions would you give a patient if he was discharged after the line was removed?

Thanks

[iluvivt, BSN, RN]

1.Gather supplies and after hand hygiene set up supplies

2. Explain procedure to the patient

3,Don non-sterile gloves and remove the old dressing

4. Remove any sutures with a steril suture removal kit

5.Apply CHG and allow it to air dry

6 lay pt flat and instuct them to hold their breath when you tell them or instruct on how to perform a Valsalva maneuver. If patient can not cooperate plan to d/c the line on respiratory expiration

7 while pt doing number 6 remove the catheter using a hand over hand technique and apply a small amt of ointment (to prevent air being sucked in through the hole made) then apply a sterle occlusive dressing after any bleeding has stopped.

8 document that the catheter was removed intact ( you can also chart how many cms were removed) what kind of dressing you applied.....how the pt tolerated the procedure and chart if you observed any catheter-related complications...if none say no s/sx of any catheter-related complications observed.

9, teach the patient to keep the dressing on for at least 24 hours and to re-apply a bandaid if when dressing removed skin has not grown over the site. They usually seal over pretty fast.Tell the patient that if they have any bleeding or swelling on that side of the body or if fever or s/sx of infection to notify their health care provider.

[garciadiego]

That was great iluvit.

When you say wait until the bleeding stops, am I going to apply a guaze pressure dressing until the bleeding stops? Is the occlusive dressing your refering to something like tegerderm or opsite?

[iluvivt, BSN, RN]

If your facility has a central line dressing kit you will find almost everything you need in there. They are customized for your facilites preferences. They do not have a suture removal kit...so if you need to remove sutures grab one of those. I also get some extra 2x2s and/or 4 x4s depending upon the type of line I will be discontinuing as well as any patient information that I have that indicates the patient may bleed more than expected ( ie.low platlet ct,on anticoagulants). Add the xtra gauze to your sterile field. When you d/c the line hold pressure until it stops bleeding..then apply some sterile ointment or vaseline (sterile of course). This is a fairly new recommendation to apply an ointment...but never apply any when the catheter is in place only when you d/c it. Then apply some new sterile gauze over that. You then make an occlusive dressing with tape strips so all the edges are sealed or use whatever transparent brand of dressing you have in your dressing kit.