|
Procedure |
|
Rationale |
| 1. |
Check
INR/PTT. If INR/PTT is prolonged or patient has a bleeding problem,
notify the physician. |
1. |
To
reduce risk of bleeding. |
| 2. |
For
femoral venous catheters:
Obtain
a bedside stool if required to ensure that nurse is positioned above the
femoral vein when applying pressure.
|
2. |
Direct,
downward pressure is required to compress the vein, particularly in obese
patients. |
| 3. |
Perform hand hygiene and don non-sterile gloves.
Open sterile dressing tray and set up field. Remove old dressing, discard dressing and gloves.
|
3. |
In accordance with the MoHLTC 4 moments of hand hygiene and LHSC infection control policies in an effort to reduce risk of transmission of microorganisms and secretions. |
| 4. |
Cleanse
site with 2% chlorhexidine and 70% alcohol swab and remove any sutures. |
4. |
Chlorhexidine
2% is the recommended agent for disinfecting vascular access sites
at LHSC because:
-
it
has anti-staphylococcus properties that are equal to alcohol or providine
-
is
less irritating to the skin than iodine preparations
-
has
longer residual action than alcohol
|
| 5. |
For
Jugular or Subclavian Venous Catheters:
Ask
patient to take a deep breath and hold it. Gently withdraw catheter
while applying direct pressure with the sterile gauze. Tell the patient
to breathe normally after the catheter is removed.
For
mechanically ventilated patients, pull the catheter at end-inspiration.
Inspect
catheter for clots and ensure entire catheter has been removed.
IN
THE EVENT OF CATHETER FRACTURE:
Apply
direct pressure over the site and notify the physician immediately.
Position patient in trendelenberg position left side down.
If
the catheter fragment is palpable, apply additional pressure distal to
the catheter to prevent migration. |
5. |
During
spontaneous breathing, negative intrathoracic pressures generate the pressure
gradient for inspiration. This negative intrathoracic pressure can
also encourage air to enter the insertion site and cause air embolism.
A
5-cm water pressure difference across a 14-gauge needle will permit 100
cc air/second to enter a central venous catheter (1).
Breath
holding creates positive pressure in the intrathoracic space. This
will minimize the risk for air entry into the catheter. A mechanically
delivered positive pressure breath will create the same protection.
Clots
can form on catheter tips. These can be dislodged during removal;
clots or catheter fragments can embolize to the lung.
Left
side down-trendelenberg position might trap the embolus in the right ventricle
and prevent migration to the lung.
|
| 6. |
Apply
direct, manual pressure for a minimum of 5 minutes. Apply pressure slightly above puncture site to occlude blood flow. Carefully check
the site. If oozing continues, compress for 5 more minutes before
checking again. Hold direct pressure for a minimum of 5 minutes after
evidence of bleeding has stopped. |
6. |
Direct
pressure is required to stop bleeding from a large vein. Hematoma
at a jugular venous site can impede cerebral blood flow. Bleeding
from a subclavian catheter can impair ventilation. Femoral venous
site hematomas can impair circulation to the distal extremity; significant
occult blood loss can occur from femoral veins, particularly in obese patients. |
| 7. |
When
bleeding has stopped, apply a transparent occlusive dressing over the site and ensure
that it is maintained.
For
Jugular or Subclavian Catheters:
Petroleum
gauze can be applied over the site to reduce the risk for air entry into
the site. Ensure that an occlusive dressing is placed over the site.
DO
NOT APPLY A BULKY PRESSURE DRESSING.
|
7. |
A
dressing should be applied to prevent pathogens from entering the insertion
site. A transparent dressing protects against entry of pathogens while
allowing observation of the site. An occlusive dressing can be used
to prevent air entry into the site provided that occlusive properties are
maintained.
CESSATION
OF BLEEDING FROM A LARGE VEIN REQUIRES DIRECT PRESSURE; A PRESSURE DRESSING
PROVIDES INADEQUATE COMPRESSION. PRESSURE DRESSINGS CAN INCREASE PATIENT
DISCOMFORT AND DELAY THE DETECTION OF BLEEDING.
|
| 8. |
Remove non-sterile gloves and perform hand hygiene. |
8. |
In accordance with the MoHLTC and LHSC infection control policies in an effort to reduce risk of transmission of microorganisms and secretions |
| 9. |
Minimize
activity for at least one hour post removal.
For
Femoral Venous Catheters:
Nurse
patient flat X 2 hours. Do not allow hip flexion during this period.
Place
a sandbag over groin and restrain leg by bed linen tuck.
|
9. |
To
minimize risk for bleeding.
Hip
flexion/activity can trigger bleeding.
Sandbags
will not stop bleeding; they are used to remind the patient not to flex
the hip.
|
| 10. |
Assess
the site for bleeding q 5 minutes X 30 minutes, then q 1 h X 3.
Monitor
respiratory status q 5 minutes X 30 minutes then q 1 h X 3.
REPORT
ANY CHANGES TO THE PHYSICIAN IMMEDIATELY and
document in clinical record.
SUSPECTED
AIR EMBOLISM
Turn
patient left side down, trendelenberg position (head down). If possible,
ask patient to perform valsalva maneuver. Administer 100% oxygen. If the
patient has a right atrial or pulmonary artery catheter, attempt to aspirate
air (2). |
10. |
Bleeding
or bruising is an important complication following catheter removal.
Potential
respiratory complications include pulmonary thromboembolism or air embolism.
Urgent
medical intervention is required if pulmonary embolism occurs.
This
position might trap air in the right atrium and prevent embolism to the
lung.
|
| 11. |
Document
removal in AI record (CCTC), Kardex, graphic record (flowsheet) and vascular
line tracking record (UC). |
11. |
To
communicate. |
Print
Handheld
Contrast
