When a central venous catheter is inserted at any vein sites, such as the femoral, subclavian and internal jugular vein sites, it is called a central line. These devices are preferred in adults and children who have no peripheral access and in those who require long-term intravenous access. The subclavian route has been the preferred route for many years and allows the patient the greatest mobility. Removal and care of central lines is done by a registered nurse accredited to give intravenous medication. Aseptic technique is used at the insertion site to decrease chances of infection to the patient.
Wash hands and don gloves prior to central line removal and explain the procedure to the patient. Prepare the dressing pack at the bedside prior to positioning the patient, and turn off all infusions.
Place the patient in the Trendelenburg or supine position.
Remove the suture holding in the central venous catheter while ensuring it does not accidentally migrate out. Make sure all suture material has been removed.
Ask the patient to hold his breath as the catheter is removed, and immediately cover the area with sterile gauze and apply pressure.
Cover the site with an occlusive dressing while the patient is still holding his breath, then reposition the patient.
Document in the progress notes the time, date, condition and type of catheter when the central line was removed. Chart the condition of the patient's skin, such as presence of swelling, redness or discharge.
Keep the dressing in place 24 to 72 hours, according to the length of time the catheter was in place. Observe the patient for signs and symptoms of bleeding, air embolism or infection of the site.
Things you need
- Sterile dressing pack
- Air occlusive dressing, e.g., tela gauze with antimicrobial ointment
- Hibitane solution
- Sterile gloves
- Rubbish bin sterile jar to collect catheter tip if infection is suspected
- Stitch cutter for removing sutures
- Sterile scissors