Jugular, Subclavian or PICC
- Lower head of bed. Position insertion site below the patient's heart level or use Trendelenburg position if tolerated.
- Apply DRY gauze over insertion site and gently attempt to withdraw the catheter 2.5 cm to assess for easy of removal. If resistance is met, notify physician and do not attempt removal.
- Ask the patient to breath hold during removal or remove at the end of inspiration if mechanically ventilated.
- Pull the catheter in a slow but steady withdrawal motion, applying immediate and directly pressure slightly above the insertion site upon removal
- If resistance is met, stop procedure and notify physician.
- Apply continuous and direct pressure for a minimum of 5 minutes before assessing for bleeding.
- Inspect catheter for intactness. Notify physician Immediately if catheter is damaged.
- Send tip for culture if ordered.
Femoral Line Removal
Follow above procedure. Healthcare provider should be positioned directly over the femoral site to ensure direct application of pressure at 90 degrees.
Apply direct pressure above the puncture site to occlude blood flow. Position patient on left side with head down (Trendelenburg position) and notify physician STAT.
If catheter fracture is palpable, apply additional pressure to prevent catheter migration.
Air Embolism :
Suspect air embolism for sudden respiratory symptoms during removal, disconnection or access of central venous line.
If possible, aspirate large volume of blood from catheter until no air bubbles are detected.
Initiate 100% oxygen and position patient head down on their left side (L decubitus Trendelenburg). Notify physician STAT. If patient has cardiac arrest, prolonged CPR may break air bubbles apart to open up pulmonary blood flow obstruction.
Air embolism risk increases when heart pressure is less than atmospheric pressure.
Risk for air embolism increases when the catheter insertion site is above heart level (e.g., in a sitting position), if the patient is hypovolemic or during spontaneous inspiration.
Breath holding or valsalva maneuver will increase intracardiac pressures. Immediate occlusion is required to prevent air embolism.
It takes only a 5 cmH20 pressure gradient across a 14 gauge needle to permit 100 cc of air/second to enter a central venous catheter.
Clots on the tip of a central venous catheter can be dislodged during removal and cause small pulmonary emboli.
Left side down Trendelenburg position places the right ventricle higher than the pulmonary circuit to potentially trap air, fractured catheters or clot and prevent pulmonary embolization.