Chapter 17: Vascular access devices: insertion and management
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Removal of short‐term percutaneous central venous catheters (non‐tunnelled)
Pre‐procedural considerations
Central venous catheters should not be removed and replaced routinely as there is no evidence that this prevents catheter‐related infection (Loveday et al. [278]). Devices should be removed when they are no longer required or are causing problems (Bodenham et al. [43]).
Procedure guideline 17.10
Short‐term central venous catheter (non‐cuffed and non‐tunnelled): removal
Post‐procedural considerations
Immediate care
The patient should lie flat with the exit site below the heart to reduce the risk of air embolism. Major vessels usually heal quickly, but firm and direct digital pressure must be applied to the site to help this process for at least 5 minutes or until cessation of bleeding (Bodenham et al. [43], Dougherty [129], Gorski et al. [181]). A sterile transparent occlusive dressing should be applied (Bodenham et al. [43], Dougherty [129], RCN [381], Scales [400]). Patients should remain flat for a short time after catheter removal, usually 30 minutes (Dougherty [129]), to maintain positive intrathoracic pressure and allow the tissue tract time to seal (Bodenham et al. [43], Drewett [134]).
Ongoing care
The dressing should remain intact for 72 hours, until the tract is epithelialized, to minimize the risk of air embolism following CVC removal (Dougherty [129], Gorski et al. [181], RCN [381]). The integrity of the catheter should be ascertained, and the date, time and reason for removal must be documented (NMC [356], RCN [381]).
