Ver el código de «Central line: removal»

==Background==
*Assess daily the need for central lines
*Discontinue as soon as possible

==Equipment==
*Suture Removal Kit
*Sterile 4 X 4’s
*Antibiotic Ointment
*Face mask/splash guard, sterile/non-sterile gloves
*Tape or Transparent Dressings
*In order to culture tip:
**CHG or alcohol swabs
**Sterile gloves
**Sterile container 

==Procedure==
*Verify review of labs (INR, plts, etc.)
*Verify timing of CVC removal with transfusion services if the patient has received plasmapheresis in the last 24 hours
*Patient in Trendelenburg position (IJ/Subclavian) or supine (femoral or cannot tolerate Trendelenburg) 
*Explain valsalva, have patient perform
**For mechanically ventilated pull catheter at the end-inspiration.
*Mask, hand hygiene, gloves
*Remove old dressing and cut sutures, discard old gloves and change to sterile
*Remove CVC
**Instruct the patient to valsalva
**Gently withdraw catheter while applying firm direct pressure using sterile gauze with antibiotic ointment (occlusive dressing) to insertion site.
**Tell the patient to breathe normally after the CVC is removed.
**If you encounter resistance, stop the removal and escalate following the chain of command
*Continuously apply firm pressure for several minutes until bleeding stops
*Observe site for bleeding and hematoma formation
*Patient remains supine for 30 minutes post CVC removal or as appropriate to the clinical situation

==Complications==
*If catheter fracture during withdrawl
**Pressure over site
**Stat CXR
**Notify interventional radiology
**If fragment felt
***Apply pressure proximal to prevent migration to heart
***Apply pressure distal to prevent air embolism
**Place patient Trendelenburg and left side
*If signs of respiratory distress:
**Consider [[Air embolism|air embolism]]
**Call RRT
**Place patient on left side, Trendelenburg position
***Side roll patient if nausea or vomiting develops; do not sit up
**Administer 100% oxygen

==See Also==
*[[Central line]]

==References==
<references/> 

[[Category:Procedures]][[Category:Critical Care]]