PROCEDURE FOR REMOVAL OF A PERIPHERAL ARTERIAL LINE


  1. Apply Related Procedures and Policies
  2. Check Coagulation Tests
  3. Prepare Bedside
  4. Prepare Tray
  5. Remove Dressing
  6. Cleanse Site and Remove Suture
  7. Remove Catheter
  8. Ensure Hemostasis
  9. Apply Occlusive Dressing
  10. Post Removal Assessment
  11. Document


Equipment Required:

    • Facemask with shield
    • Sterile dressing removal tray
    • Sterile scissors (for sutured line) or extra chlorhexidine swabstick for removal of adhesive catheter securement device
    • Sterile gloves
    • Sterile gauze
    • Transparent occlusive dressing

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.

Check Coagulation Tests/Medications

Check INR/PTT and platelets. If INR/PTT is prolonged (INR > 1.5) or platelets < 50,000 review orders with physician.

If patient is receiving any medications that affect coagulation (e.g., anticoagulants, fibrinolytics, antiplatelet agents), review with physician prior to removal.

 2.

 

To reduce risk for bleeding. If the patient has a significant coagulopathy the removal order should be reviewed to determine whether treatment is warranted (e.g. administration of plasma or platelets) or whether removal should be delayed.  Medications that interfere with clotting should also be reviewed.

The catheter site may also influence bleeding risk. Additional site pressure may be required.

 3.

Prepare Bedside and Assess Patient

Administer analgesic and sedative (if indicated).

 3.

 

Adequate and direct presure is required to stop bleeding from a central venous or arterial catheter.

Field contamination and inadquate hemostatic control can occur if patient is restless, improperly positioned or has pain.

 4.

Prepare Tray

Perform hand hygiene and open central line dressing change tray.

Don non-sterile gloves and mask with face shield.

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

Add sterile scissors or additional chlorhexidine for removal of securement device. Add sterile 4 X 4 gauze and occlusive dressing to tray.

 4.

 

Bacteria can access the catheter tract until it has healed completely.

 5.

Remove Dressing


Remove dressing.

Discard dressing appropriately and perform hand hygiene.

 

 5.

 

6.

Cleanse Site

Don sterile gloves and cleanse site. Wait until chlorhexidine has completely dried.

Remove sutures with scissors.  If adhesive securement device is in place, use a chlorhexidine swab stick to loosen adhesive before attempting removal.

 

 6.

 


7.

Remove Catheter

Position gauze over insertion site and gently withdraw catheter slightly to ensure that catheter will withdraw easily.

Pull the catheter in a slow but steady withdrawal motion, applying immediate and directly pressure slightly above the insertion site upon removal

Inspect catheter for intactness. Notify physician Immediately if catheter is damaged.

Send tip for culture if ordered.

 

EMERGENCY RESPONSE

Catheter Breakage:

Apply direct pressure above the puncture site to occlude blood flow. Postion patient on left side with head down (trendenlenburg position) and notify physician STAT.

If catheter fracture is palpable, apply additional pressure to prevent catheter migration.

 

 7.

 

Clots or catheter fragments can be dislodged during removal and cause ischemia to distal extremity.

 

8.

Ensure Hemostasis

Hold direct pressure firmly and continuously for a minimum of 5 minutes BEYOND the point when hemostasis has been achieved.

Carefully check site every 5 minutes and reapply pressure for 5 more minutes if oozing is observed.


 8.

 

The only way to stop bleeding and ensure occlusion of catheter tract is through direct presure until hemostasis is achieved.

Inadequate hemostasis can facilitate hematoma formation with subsequent vessel occlusion, limb ischemia or fistula formation.

9.

Apply Occlusive Dressing

When bleeding has stopped completely, apply a transparent dressing to the site.

Do not apply pressure dressings or sandbag to site.

Remove gloves and perform hand hygiene.

 9.

 

Direct pressure is required until bleeding has stopped. The occlusive dressing allows visualization of site while preventing pathogens from entering tract.

Pressure dressings and sandbags will not stop a vascular bleed but will delay detection of bleeding.

Inadquate pressure can result in hemorrhage or hematoma.

 

10.

Post Removal Assesssment

Minimize limb movement for at least one hour post removal.

Monitor for hematoma or bleeding q 5 minutes X 30 minutes, then q 30 minutes X 2 then q 1 h X 4. Reapply pressure if bleeding present.

Assess distal extremity and monitor for decreased circulation, change in limb color or delay in capillary refill q 5 minutes X 30 minutes, then q 30 minutes X 2 then q 1 h X 4. .

10.

 

Risk for bleeding is greatest in first hour.

Thrombi can be dislodged during removal that can impair distal circulation..

 

11.

Document

Document procedure and follow-up assessment in clinical record.

 

11.  
 

References:

1. O'Dowd, L. et al. (October 2013). Air embolism. Up-to-Date.

 

2.  LHSC Procedure for Central Line Management.

2. Kaye, W. (1985). Venous and arterial catheterization. In Sprung, C., and Grenvik, A. Eds: Invasive procedures in critical care. Churchill Livingston: New York p. 13.

3.  Daily, E., and Schroeder, J. (1994). Techniques in Bedside Hemodynamic Monitoring (5th Ed.). Mosby: Toronto. p. 71.

 

Developed: November 2000 (Morgan, B)
Revised: March 2010
Last Update: May 26, 2016


Brenda Morgan RN BScN MSc CNCC, CCTC

 

LHSCHealth Professionals

Last Updated May 25, 2016 | © 2007, LHSC, London Ontario Canada