How to remove an arterial line (arterial catheter)?

From the Guidelines

To safely remove an arterial line, it is crucial to follow a meticulous procedure to minimize the risk of bleeding, hematoma formation, or other complications, as outlined in the Association of Anaesthetists of Great Britain and Ireland: Safe Vascular Access 2016 guidelines 1. When removing an arterial line, several key steps must be taken to ensure patient safety.

• Gather all necessary supplies, including sterile gauze, adhesive bandage, and clean gloves.
• Turn off any monitoring equipment connected to the line and prepare the sterile gauze for immediate application.
• Remove the securing tape or dressing from the insertion site while wearing gloves.
• Gently withdraw the catheter in a slow, steady motion along the same angle it was inserted.
• Apply firm pressure with the sterile gauze directly over the insertion site for at least 5 minutes for most patients, or up to 15 minutes for anticoagulated patients, as arterial punctures are under high pressure and can lead to significant bleeding or hematoma formation if not properly managed 1.
• After bleeding has stopped, apply an adhesive bandage and monitor the site for any signs of bleeding, hematoma formation, or infection over the next 24 hours.
• Document the procedure, including the time of removal, the condition of the site, and any complications. It is essential to note that larger catheters (6Fr or greater) should be left in place, and their safe removal should be discussed urgently with interventional radiologists or vascular surgeons 1.
• For smaller catheters (5Fr or less), removal can be done following standard procedures, but it is crucial to consider the insertion site, presence of arterial disease or thrombus, and coagulation status.
• In cases of accidental arterial cannulation, especially in the carotid artery, the risk of morbidity and mortality is higher due to the risk of stroke and local pressure effects from hematoma, and thus, removal should be approached with caution and under expert guidance 1.

From the Research

Pulling Out an Arterial Line

There are no specific studies provided that directly address the procedure for pulling out an arterial line. However, the following information may be relevant:

• The management of arterial lines is crucial for patient safety, and there are recommendations for safe arterial line management 2.
• The use of wrong fluid as an arterial flush is a reported risk, and it is essential to follow proper protocols for arterial line management 2.
• Hemostatic agents can be used to control bleeding during surgical procedures, and their effective use is highly dependent on the surgeon's experience or preference and their availability in the surgical setting 3, 4.
• Perioperative nurses should understand the different categories of hemostatic agents, their actions, properties, applications, and limitations to ensure safe practice 5.

Key Considerations

• Proper training and experience are necessary for the safe removal of an arterial line.
• Adherence to established protocols and guidelines for arterial line management is crucial to minimize risks.
• The use of hemostatic agents may be necessary to control bleeding during the removal of an arterial line, and their selection should be based on the patient's condition and the surgeon's preference 4.

Available Techniques

• Various hemostatic techniques are available, including mechanical, thermal, and energy-based methods, each with its benefits and drawbacks 6.
• The choice of technique depends on patient and procedural factors, as well as the surgeon's preference 6.