PROCEDURE FOR REMOVAL OF PULMONARY ARTERY CATHETERS


  1. Apply Related Procedures and Policies
  2. Prepare Dressing Tray
  3. Confirm Balloon Deflation/Prepare Cathter
  4. Evaluate and Stop Infusions
  5. Remove Dressing
  6. Cleanse Site
  7. Unlock Sleeve
  8. Prepare for Removal
  9. Remove Catheter
  10. Post Removal
  11. Document


Equipment Required:

  • Sterile Central and Arterial Line Dressing Change Tray
  • Two extra chlorhexidine swabstick.
  • Sterile gloves
  • Obturator for introducer

This procedure is for use by RNs in CCTC who are approved to remove pulmonary artery catheters.

RNs are not approved to remove a Swan Ganz(TM) Paceport pulmonary artery catheter IF a temporary pacing wire is in place.  RNs are not approved to remove the Paceport(TM) temporary pacemaker wire (Chandler Probe)(TM).

 Patients must be connected to Continuous ECG monitoring during removal.  Removal should be performed in a location where a Cardiac Arrest Cart is available in case of persistent arrhythmia (rare, most arrhythmias resolve once catheter is out).

If the Introducer is also to be removed, the pulmonary artery catheter should be removed first and an obturator inserted into the introducer.  The introducer should be removed separately according to the Procedure for Removal of a Central Venous Catheter.  

 

PROCEDURE

RATIONALE FOR PROCEDURE

 1.

Apply Related Procedures and Policies

Confirm order

Follow LHSC policies for hand hygiene and infection control before, during and after procedure. Perform hand hygiene and don a mask with eye shield and non-sterile gloves prior to blood sampling.

LHSC Hand Hygiene Policy

LHSC Routine Practices

LHSC Donning and Doffing Policy

 

Confirm 2 patient identifiers as per LHSC Policy for Patient Identification


 1.


 2.

Prepare Dressing Tray

Perform hand hygiene and open central line dressing change tray.

Don non-sterile gown, gloves, bouffant and mask with face shield.

Perform hand hygiene and prepare dressing tray aseptically using transfer forceps to add supplies.

  1. Open chlorhexidine swabstick and partially remove swabstick with transfer forcep.
  2. Open obturator and transfer to tray.

 2.



Sterile technique is used to prevent contamination of introducer.

Image 1

Image 1:  Obturator and cap that is used to occlude the introducer once the pulmonary artery (or CVC catheter) is removed.

 3.

Confirm Balloon Deflation and Prepare Catheter

  1. Confirm that the balloon is deflated and in the unlocked position.
  2. Confirm a PA waveform from the tip of the catheter prior to starting
  3. Remove any tape or anchors on the sleeve that would impeded smooth removal.
  4. Unlock the Twist Lock Adapter(TM) that is located at the end of the sleeve farthest from the introducer
  5. Gently withdraw 0.5 cm of catheter to ensure that the adapter is unlocked and catheter will move freely

 3.

 

To prevent injury to valve during removal.

 

Removal should be a steady withdrawal. Catheter restriction could result in the catheter tip resting in the ventricle (with ventricular ectope) while impedence is removed.

Image 2

 

Image 2:  Unlock Twist Lock Adapter(TM)

 4.

Evaluate and Stop Infusions

Ensure that all infusions have been relocated. Vasoactive medications should be moved to the introducer (or another central venous catheter if in place).

Turn off all infusions to the poximal injectate or proximal infusion ports (blue, white or orange).

Turn the stopcock to the CVP off but leave PA pressure circuit on to display pressure at tip of catheter.


 4.



Upon removal of pulmonary artery catheter, all infusions will be disrupted.

 

 5.

Remove Dressing


Remove the old dressing wearing non-sterile gloves and discard. 

Use a CHG swabstick with a shoveling technique to loosen the CHG pad. 

Scrub the insertion site per standard procedure and allow 2 minute dry time. (Procedure for Central Line Dressing Change).

Discard dressing appropriately and perform hand hygiene.

 5.

 

Sterile technique is maintained to prevent introduction of bacteria into introducer.

The dressing will need to be removed and replaced to access the connection to the introducer.

6.

Cleanse Site


Don sterile gloves.

Scrub the locking cap vigorously and allow minimum 2 minute dry time.

 6.

 

 

Cleanse thoroughly prior to unlocking.

7.

Unlock the Sleeve from Introducer

Turn the locking device end of the sleeve until the cap is loose and can be disconnected easily. 

 7.

 

The sleeve must be disconnected before removal of the pulmonary artery catheter.

 

Image 3

Image 3: Sleeve in unlocked position

8.

Prepare for Removal

Slide the entire locking device and sleeve back to full expose several inches of pulmonary artery catheter.

Cleanse catheter at insertion point to introducer and allow to dry.


 8.

 

The catheter will be removed from the introducer independent from the sleeve to avoid having catheter withdrawal impeded.

Cleaning the entry point to the introducer is done to ensure bacteria are removed before obturator is inserted.

9.

Remove Pulmonary Artery Catheter

  1. Grab the pulmonary artery catheter close to the entry point and pull back 0.5 cm to ensure it will move freely.
  2. While observing the ECG, steadily withdraw the catheter with your dominant hand, while securing the introducer with your non-dominant hand. 
  3. Continue until there is 5-10 cm of catheter remaining inside the introducer, then pause.
  4. Place the obturator within ease of reach. 
  5. Remove the final segment of the catheter and quickly apply the obturator cap as soon as removal is completed.

 9.

 

Goal is to remove the catheter steadily, without allowing the tip to linger in the right ventricle.

The obturator should be placed quickly to ensure air entry does not occur.

10.

Post Removal

If introducer is being removed, use Procedure for Removal of a Temporary Central Venous Catheter.  

Complete dressing change as per Procedure for Central Line Dressing Change.

10.  
11.

Document

Document procedure and follow-up assessment in clinical record.

11.  
 

Developed: November 30, 2000 (Morgan, B)

Reviewed: March 29, 2010

Revised: February 27, 2017

 


Brenda Morgan

Clinical Nurse Specialist

RN BScN MSc CNCC, CCTC

 

LHSCHealth Professionals

Last Updated March 13, 2017 | © 2007, LHSC, London Ontario Canada