Pre‐procedure

ActionRationale

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   Check the patient's anticoagulation status and time of last administered dose of anticoagulant. For patients receiving prophylactic anticoagulant (e.g. low‐molecular‐weight heparin), wait at least 12 hours post‐dose but commence the procedure at least 4 hours prior to the next dose. Seek medical advice if the clotting profile is deranged.
   To ensure the patients coagulation is not deranged and it is safe to remove the catheter (Harrop‐Griffiths et al. [74], C).
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   Introduce yourself to the patient, explain and discuss the procedure with them, and gain their consent to proceed.
   To ensure that the patient feels at ease, understands the procedure and gives their valid consent (NMC [129], C).
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   Wash hands with bactericidal soap and water or an alcohol‐based handrub, apply personal protective equipment, and clean the trolley or plastic tray following local guidelines for aseptic procedure. Open the dressing pack.
   To minimize the risk of cross‐infection (NHS England and NHSI [122], C).

Procedure

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   Remove the tape and dressing from the catheter insertion site; dispose of them as per local policy.
   To minimize the risk of cross‐infection (Loveday et al. [98], R).
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   Decontaminate hands and apply fresh gloves.
   To minimise the risk of cross‐infection. C
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   Gently, in one swift movement, remove the catheter. Check that the catheter is intact. This can be done by observing that the tip of the catheter is marked blue and that the 1 cm marks along the length of the catheter are all intact.
   To ensure the catheter is removed intact with the minimum of discomfort to the patient. E
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   Clean around the catheter exit site using a skin‐cleaning agent (e.g. aseptic non‐touch technique with normal saline 0.9%).
   To minimize contamination of the site by micro‐organisms. E
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   Apply an occlusive dressing and leave it in situ for 24 hours.
   To prevent inadvertent access of micro‐organisms along the tract. E

Post‐procedure

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   The epidural catheter tip may be sent for culture and sensitivity if infection is suspected, or according to local policy.
   To assess the catheter as a potential source of infection. E
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   Remove gloves and apron and dispose of all material in the clinical waste bag. Decontaminate hands.
   To minimize the risk of cross‐infection (NHS England and NHSI [122], C).
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   Document that the catheter was removed successfully and intact in the nursing notes.
   To ensure accurate documentation of care (NMC [129], C).
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   Conduct post‐removal observations for 48 hours.
   Epidural observations of motor and sensory function must continue for 48 hours after removal of the epidural catheter to detect any signs of developing epidural haematoma (Macintyre and Schug [99], E).