How do I remove a midline catheter?

How to Remove a Midline Catheter

Remove a midline catheter by first performing hand hygiene and donning clean gloves, then removing the dressing, stabilizing the skin near the insertion site with one hand while applying steady, gentle traction on the catheter with the other hand until it is completely withdrawn, followed by immediate application of pressure to the site with sterile gauze until hemostasis is achieved.

Indications for Midline Removal

Remove the midline catheter immediately if any of the following are present 1:

• Signs of phlebitis: warmth, tenderness, erythema, or palpable venous cord
• Signs of infection at the insertion site or systemically
• Catheter malfunction (inability to flush or aspirate)
• Completion of therapy - the catheter is no longer clinically necessary
• Catheter has not been used for 48 hours or longer

Do not routinely replace midline catheters on a scheduled basis to reduce infection risk 2, 1. Replace only when there is a specific clinical indication 1.

Step-by-Step Removal Procedure

Preparation

1. Perform hand hygiene thoroughly
2. Don clean gloves (sterile gloves are not required for removal)
3. Explain the procedure to the patient
4. Position the patient comfortably with the arm extended

Removal Technique

1. Remove the dressing carefully, noting any signs of infection or inflammation at the site
2. Inspect the insertion site for erythema, drainage, or other abnormalities
3. Stabilize the skin immediately adjacent to the insertion site with your non-dominant hand
4. Grasp the catheter close to the insertion site with your dominant hand
5. Apply steady, gentle traction - pull the catheter straight out along the vein's path
   • Use smooth, continuous motion
   • Do NOT use forceful or jerking movements
6. If resistance is encountered, STOP immediately - do not force removal 3

Post-Removal Care

1. Apply immediate pressure with sterile gauze to the insertion site until bleeding stops
2. Inspect the catheter to ensure it was removed intact (tip should be present)
3. Apply a sterile dressing or adhesive bandage to the site
4. Document the procedure, catheter integrity, and site appearance

Critical Pitfalls to Avoid

When Resistance is Encountered

If you meet unexpected resistance during removal, STOP pulling immediately 4, 3. Forceful traction can cause:

• Catheter fracture and embolization 5
• Vascular injury
• Hemorrhage

In cases of stuck catheters:

• Do not continue forceful extraction
• Consider imaging (ultrasound or fluoroscopy) to assess the cause
• Consult vascular access specialists or interventional radiology
• Intraluminal balloon dilation may be attempted before surgical intervention 3

Infection Considerations

• Culture the catheter tip only if catheter-related bloodstream infection is suspected - not routinely 6
• Use quantitative or semi-quantitative culture methods if culturing 6
• Continue appropriate antibiotics after removal if infection is confirmed

Documentation Requirements

Document:

• Date and time of removal
• Reason for removal
• Catheter integrity (intact vs. fractured)
• Insertion site appearance
• Any complications
• Patient tolerance of procedure

Special Circumstances

Pediatric patients: The same removal technique applies, though additional assistance may be needed for patient cooperation 1.

Suspected infection: Remove the catheter promptly and do not attempt guidewire exchange 1. Place a new device at a different site only after appropriate antimicrobial therapy is initiated and if central access remains indicated 6.

No physician notification required for routine removal in most settings, though institutional policies may vary 7. However, ensure removal is clinically appropriate before proceeding.