With gentle, firm traction, the catheter will slide out from the insertion site. A PICC may resist removal because of venous spasm, vasoconstriction, phlebitis, valve inflammation, thrombophlebitis or the presence of a fibrin sheath (Gorski et al. [182]). Difficulty may occur in 1% of removals (Drewett [133]). Gentle traction and a warm, moist compress can be applied to alleviate venous spasm, resulting in easier removal of the catheter (Gorski et al. [182], Marx [298]). If there is difficulty with removal, the practitioner should wait for 20–30 minutes and try again, or wait for 12–24 hours (Dougherty [123]). Other interventions that can be used to aid removal include smooth muscle relaxants, hand and arm exercises, and relaxation techniques (Gorski et al. [182], Marx [298]).

If SecurAcath was used to secure the PICC, there may be difficulty at removal. Granulation at the anchor site can result in resistance as the device becomes embedded in the tissue. Cutting through the middle of the SecurAcath and pulling each prong out separately can help removal and avoid discomfort (see Action figure 8 in Procedure guideline 17.8: PICC removal; see also Figure 17.33).

Following removal of the PICC, pressure should be applied for at least 2–3 minutes. The site should then be inspected and a sterile occlusive dressing should be applied to ensure the bleeding has stopped. The catheter's integrity should be checked and its length measured to ensure an intact device has been removed (Dougherty [123]).