PICC LINE REMOVAL

IVRUS, BSN, RN · Aug 10, 2015

My first question to you Hawaii is this: Should you be removing the IV catheter when you really aren't sure about the catheter itself, nor what you are looking for after its removal????

First of all, I am assuming that you have an MD order for removal. Then, once you have that, you should be checking the chart for documentation regarding the length of IV catheter which was placed on insertion. Then using appropriate technique, removal should include knowledge of whether or not you are removing an IV catheter which is valved on non valved and if valved, is that valve at the distal or proximal aspect of the catheter. Was the catheter cut prior to insertion and was that cut on a bevel or straight across? Then, once removed (after having then do the valsalva or removal with the start of exhalation, and applying a vaseline gauze, or 4x4 with ointment ) how long did you have to hold pressure till hemostasis resumed... that of course is individualized and is dependant on several factors (Remember the blood clotting cascade?) Groshong IV catheters will have a black bullet tip on its distal tip, and it is one type of valved IV catheter.

ixchel · Aug 10, 2015

Hawaii, picc line removal is not like IV or central line removal. You need to look at your facility's policies on this. Had you gone through proper training on this and the piccs your facility might use/manage, you would probably know the answer to this. Unfortunately, without knowing the types you removed, I'm not sure any of us will have an answer for you. If you did not go through training for picc removal, I highly recommend talking to a charge nurse or floor manager immediately. Tell them the truth, and ask for guidance. This is for patient safety. If you don't know if you left anything behind, you need to find out immediately.

iluvivt, BSN, RN · Aug 10, 2015

Arrow Catheters have a blue flex tip . You can leave this as is and not trim prior to insertion or you CAN trim prior to insertion so you can make a custom for for the patient. It is imperative that you know if it has been trimmed PRIOR to discontinuing it! You can probably find that information on the PICC insertion record which you need to locate and look at before performing the procedure so you know what to expect. You then need to measure the PICC once you DC it to make certain you have not left any retained par(s)t and this is another reason you need to look at the PICC insertion record. DO not be alarmed if it is a tad longer as polyurethane and silicone (if you use a silicone PICC as well) can stretch a bit. Always document that measurement in cms when you chart your removal.

Please know what position you need to place your patient in when discontinue any central line. We had a recent death when a nurse discontinued a CVC with a patient sitting upright in a chair! Within minutes after the removal the patient started to have a seizure from the ensuing air embolus (AE) and died!

Everything IVRUS stated is perfect and you would wise to follow that advice. Please make sure you know how to make an air occlusive dressing as an air embolus is considered a NEVER event. While more common with percutaneous placed infraclavicular or supraclavicular or from the neck (IJ) CVCs it can still happen with PICC lines.

SierraBravo · Aug 10, 2015

I seriously hope that the OP was trained and qualified to remove a PICC line and did so with an order. The fact that he/she says they are a new nurse leads me to believe that they might not be qualified to do this procedure, but maybe I'm wrong. For the sake of the patients that had their PICC lines removed I hope I am wrong.

OP - how long have you been a nurse? And have you received training to perform this procedure?

MendedHeart · Aug 10, 2015

Don't forget to check the platelet count prior to discontinuing, especially with a CVC.

Like above posters said, you should review policy of facility before you do anything new, or that you dont know the policy for(Im a policy fanatic) as they all could differ for example : one of the above posters mentioned they put Vaseline gauze on after. We use Betaine tincture and Tegaderm.

IVRUS, BSN, RN · Aug 10, 2015

[ We use Betaine tincture and Tegaderm.

Indeed, The objective in this is to make sure that you have an gel of some sort to occlude the vessel track. And then cover with the TSM and the patient must remain supine x 30 minutes s/p removal. Checks thereafter are done frequently for the first hour to monitor for complication r/t removal.

Catzilla · Aug 10, 2015

, The objective in this is to make sure that you have an gel of some sort to occlude the vessel track. And then cover with the TSM and the patient must remain supine x 30 minutes s/p removal. Checks thereafter are done frequently for the first hour to monitor for complication r/t removal.

Post removal, if the insertion site is covered with an occlusive substance and an occlusive dressing, why would it be necessary to remain supine s/p CVC removal?

IVRUS, BSN, RN · Aug 11, 2015

Post removal, if the insertion site is covered with an occlusive substance and an occlusive dressing, why would it be necessary to remain supine s/p CVC removal?

Many times an air embolism is caused by an intact fibrin sheath which extends along the catheter to the insertion site. And remember that and AIR EMBOLISM (AE) is a NEVER event. What one must be concerned about to prevent an AE is the pressure gradient. The supine position causes the pressure in the central vasculature to be higher than air pressure, thus preventing air to be sucked into the system. Venous pressure in the arms is approx. 35-40 Hg. This pressure decreases as the veins get larger in the SVC to approx 0. Most institutions are more cautious than ever to prevent this NEVER event.