What is the process for the routine discontinuation of a tunneled Central Venous Catheter (CVC)?

From the Guidelines

The routine discontinuation of a tunneled central venous catheter (CVC) should be performed by obtaining informed consent, positioning the patient supine, and using a sterile technique to minimize infection risk and ensure safe removal of the catheter. The process typically involves the following steps:

• Obtain informed consent from the patient.
• Position the patient supine with the head slightly lowered.
• Perform hand hygiene and don sterile gloves, gown, and mask.
• Clean the exit site and surrounding skin with chlorhexidine or povidone-iodine solution, as recommended by 1.
• Administer local anesthesia (e.g., 1% lidocaine) around the exit site if needed.
• Remove any sutures securing the catheter, taking into consideration the guidelines that suggest sutures should no longer be used routinely 1.
• Gently pull the catheter out while applying pressure to the exit site.
• Once removed, apply firm pressure to the site for 5-10 minutes to ensure hemostasis.
• Apply a sterile dressing to the site, preferably a transparent, semi-permeable polyurethane dressing, which should be changed every 7 days or sooner if necessary, as suggested by 1.
• Inspect the catheter tip to ensure it's intact.
• Monitor the patient for any immediate complications. Additional considerations:

• Ensure the patient's coagulation status is adequate before removal.
• If resistance is met during removal, stop and seek medical imaging guidance.
• Instruct the patient to keep the site dry for 24-48 hours post-removal. It is also important to note that routine replacement of CVCs to prevent infection should be avoided in adults and children, as stated by 1, and that catheter removal is necessary if there is evidence of infection at the exit site or evidence of CRBSI.

From the Research

Routine Discontinuation of a Tunneled Central Venous Catheter (CVC)

The process for the routine discontinuation of a tunneled Central Venous Catheter (CVC) involves several steps to minimize complications.

• The decision to remove a CVC should be based on the assessment that the catheter is no longer needed or if there is a radiologically confirmed thrombosis that worsens despite anticoagulation therapy 2.
• Before removal, it is essential to ensure that the patient is not at risk of air embolism, which can be prevented by adopting a 5 to 10 degrees Trendelenburg position, direct puncture of the previous CVC venous lumen for guide-wire insertion, and a light manual compression of the internal jugular vein venotomy site after catheter removal 3.
• The Valsalva maneuver in collaborating patients, valved introducers, and correction of hypovolemia are also useful precautions to prevent air embolism 3.
• The removal procedure should be performed by well-trained healthcare professionals, and patients should be educated on the potential complications associated with CVC removal and methods to prevent them 4.
• After removal, the site should be monitored for any signs of infection or bleeding, and patients should be advised to seek medical attention if they experience any symptoms 4.

Key Considerations

• CVC removal is recommended when the catheter is no longer needed or if there is a radiologically confirmed thrombosis that worsens despite anticoagulation therapy 2.
• Patients should be informed about the potential risks and benefits of CVC removal and involved in the decision-making process 5, 6.
• The removal procedure should be tailored to the individual patient's needs, taking into account their medical history, current condition, and any potential complications 4, 6.