Pre‐procedure

ActionRationale

1. 1.Show
   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 [356], C).
2. 2.Show
   Screen the bed.
   To allow dust and airborne organisms to settle before the insertion site and the sterile field are exposed. E
3. 3.Show
   Wash hands with soap and water, or an alcohol‐based handrub, and dry. Place all equipment required for the dressing on the bottom shelf of a clean dressing trolley.
   To reduce the risk of cross‐infection (DH [117], C; Fraise and Bradley [156], E).

Procedure

1. 4.Show
   Take the trolley to the patient's bedside, disturbing the screens as little as possible.
   To minimize airborne contamination (DH [117], C).
2. 5.Show
   Open the sterile dressing pack.
   To gain access to the sterile field. E
3. 6.Show
   Attach an orange clinical waste bag to the side of the trolley below the level of the top shelf.
   So that contaminated material is below the level of the sterile field (DH [117], C).
4. 7.Show
   Open the other sterile packs, tipping their contents gently onto the centre of the sterile field. Pour lotions into gallipots or an indented plastic tray where required.
   To reduce the risk of contamination of contents. E
5. 8.Show
   Discontinue the infusion, if in progress, and disconnect the infusion system from the catheter. Clamp the catheter.
   To prevent entry of air or leakage of blood when the catheter is disconnected. E
6. 9.Show
   Assist the patient into the Trendelenburg position – that is, head slightly lower than feet.
   To prevent air entering the vein on catheter removal (Drewett [134], E).
7. 10.Show
   Wash hands with soap and water, or an alcohol‐based handrub, and dry.
   To reduce the risk of cross‐contamination (Fraise and Bradley [156], E).
8. 11.Show
   Loosen the old dressing gently.
   So that the dressing can be lifted off easily. E
9. 12.Show
   Put on clean gloves.
   To protect the nurse from any contact with the patient's blood. E
10. 13.Show
    Using gloved hands, remove the old dressing and discard it. Remove tapes or securing device.
    To remove the old dressing without contaminating hands (DH [117], C).
11. 14.Show
    Remove gloves, clean hands with an alcohol‐based handrub and put on sterile gloves from pack.
    To minimize the risk of introducing infection (DH [117], C; Fraise and Bradley [156], E).
12. 15.Show
    Clean the wound with 2% chlorhexidine in 70% alcohol using back‐and‐forth strokes, with friction.
    To prevent contamination of the catheter on removal and a false‐positive culture result (DH [117], C; Loveday et al. [278], C).
13. 16.Show
    Cut and remove any skin suture securing the catheter.
    To facilitate removal. E
14. 17.Show
    Cover the insertion site with low‐linting gauze.
    Swabs are used to discourage the entry of organisms into the insertion site and to absorb any leakage of blood. E
15. 18.Show
    Ask the patient to perform the Valsalva manoeuvre.
    To reduce the risk of air embolism (Drewett [134], E).
16. 19.Show
    Hold the catheter with one hand near the point of insertion and pull firmly and gently. As the catheter begins to move, press firmly down on the site with the swabs. Maintain pressure on the swabs for about 5 minutes after the catheter has been removed.
    Pressure is applied to prevent haemorrhage and to encourage resealing of the vein wall. It also prevents the entry of air into the vein. E

    Continued pressure is necessary to allow time for the puncture in the vein to close. E
17. 20.Show
    Remove the catheter and check the tip is intact.
    To ensure that all of the catheter has been removed. E
18. 21.Show
    If the catheter has been removed because of infection, carefully cut off the tip (approximately 5 cm) of the catheter using sterile scissors and place it in a sterile container for microbiological investigation.
    To detect any infection related to the catheter and thus provide necessary treatment (DH [117], C; Loveday et al. [278], C).

Post‐procedure

1. 22.Show
   When bleeding has stopped (approximately 5 minutes), cover the site with a small gauze pad and a transparent dressing.
   To detect any infection at the exit site. To prevent air entering the vein via the site (Scales [400], E).
2. 23.Show
   Fold up the sterile field, place it in the orange clinical waste bag and seal the bag before moving the trolley. Dispose of the equipment in the appropriate containers.
   To reduce the risk of environmental contamination (DH [117], C).
3. 24.Show
   Make the patient comfortable.
   To ensure patient comfort. E
4. 25.Show
   Document the date and time and reason for removal in the patient's notes or care plan.
   To ensure adequate records are maintained and to enable continued care of the patient and device (NMC [356], C).