What are the risks if a patient removes their IV lines?

Risks of Patient-Removed IV Lines

Patient removal of IV lines can cause significant complications including bleeding, air embolism, catheter embolism, and infection, potentially leading to serious morbidity or mortality. 1

Immediate Risks

Bleeding

• Firm digital pressure should be applied for at least 5 minutes after IV removal to prevent bleeding 1, 2
• Risk factors for excessive bleeding include:
  • Coagulopathy (INR >1.8, aPTT >1.3 times normal, platelets <50 × 10⁹/L) 1
  • Larger catheter size 1
  • Central venous access devices vs. peripheral lines 1
• Management of persistent bleeding may require skin sutures or vascular surgery consultation 2

Air Embolism

• Air embolism can occur during IV removal and may be fatal (incidence up to 0.8%) 1
• Presentation ranges from subtle neurological, respiratory, or cardiovascular signs to shock, loss of consciousness, and cardiac arrest 1
• Prevention requires proper removal techniques including:
  • Patient positioned flat with exit site below heart level 1
  • Application of occlusive dressings after removal 1
  • Head-down positioning and left lateral tilt if air embolism is suspected 1

Catheter/Guidewire Embolism

• Risk of catheter fragment embolization is higher during uncontrolled removal 1
• Catheter embolism occurs more often with long-term devices 1
• Retained catheter fragments are usually asymptomatic and discovered incidentally on imaging 1
• Management requires urgent radiological or surgical retrieval 1

Delayed Risks

Infection

• Improper IV removal increases risk of catheter-related bloodstream infections (CRBSI) 1
• Common pathogens include:
  • Coagulase-negative staphylococci (most common) 1
  • Candida species 1
  • Staphylococcus aureus 1
  • Enterococcus 1
• Infection risk is higher with central lines vs. peripheral lines 1
• Proper exit site care after removal reduces infection risk 1

Venous Thrombosis

• Abrupt removal may disrupt thrombi that have formed around the catheter 1
• For central venous catheters with associated thrombosis, guidelines recommend:
  • Delayed removal until after anticoagulation initiation (days) rather than immediate removal 1
  • This approach reduces risk of emboli leading to pulmonary embolism or paradoxical stroke 1

Special Considerations for Different Types of Lines

Peripheral IV Lines

• Generally lower risk of serious complications compared to central lines 1
• Main risks include:
  • Local bleeding
  • Phlebitis
  • Infiltration/extravasation injury 1

Central Venous Catheters

• Higher risk of serious complications 1
• For tunneled or implanted devices:
  • Require surgical cut-downs for proper removal 1
  • Fibrin sleeves frequently left behind in the vein 1
  • Long-term catheters may become attached to vessel walls and cannot be removed by simple traction 1

Inferior Vena Cava (IVC) Filters

• While not typically removed by patients, improper removal by healthcare providers carries significant risks 1
• Institutions should have systems to monitor patients with IVC filters and ensure proper reassessment for removal 1

Management After Patient-Removed IV

1. Immediate assessment:

   • Evaluate for active bleeding and apply firm pressure for at least 5 minutes 1
   • Check for signs of air embolism (hypotension, altered mental status, respiratory distress) 1
   • Inspect the removed catheter to ensure it's intact 1

2. Documentation:

   • Document the condition of the catheter (intact vs. damaged)
   • Note any bleeding or other complications

3. Monitoring:

   • Monitor vital signs if central line was removed
   • Watch for delayed complications (infection, thrombosis)

4. Replacement considerations:

   • Assess ongoing need for vascular access
   • For central lines, consider ultrasound-guided insertion by experienced operators if replacement is necessary 2

5. Infection prevention:

   • Apply appropriate dressing to the exit site 1
   • Consider antibiotic therapy if signs of infection are present 1

Prevention Strategies

• Secure fixation of catheters to prevent accidental dislodgement 1
• Patient education about the importance of IV access and risks of removal
• Consider less visible or accessible placement sites for confused patients
• Use of specialized securement devices for high-risk patients

By understanding these risks and implementing appropriate preventive and management strategies, healthcare providers can minimize complications when patients remove their IV lines.