How should a nurse remove a tunneled PICC (Peripherally Inserted Central Catheter) line?

Proper Technique for Removing a Tunneled PICC Line

To safely remove a tunneled PICC line, the nurse should use gentle steady traction while maintaining sterile technique, ensuring the catheter remains intact during removal. 1

Preparation for Removal

• Gather all necessary supplies including sterile gloves, sterile dressing materials, and antiseptic solution 1
• Position the patient appropriately, typically supine with the arm extended 1
• Use chlorhexidine solutions with alcohol for skin preparation before the procedure 1
• Remove any stabilization device (such as Statlock) that may be securing the catheter 1

Removal Procedure

• Apply sterile gloves and use aseptic technique throughout the procedure 1
• Clean the exit site with appropriate antiseptic solution and allow to dry completely 1
• Remove any sutures if present (though manufactured stabilization devices are preferred over sutures for PICC lines) 1
• Apply gentle, steady traction to remove the catheter - avoid excessive force that could cause catheter breakage 1
• If resistance is encountered, do not force removal as this could lead to catheter rupture 1, 2
• For difficult removals, allow the patient to relax, reposition the arm, and try again with gentle traction 1

Post-Removal Care

• Once removed, inspect the catheter to ensure it is intact and complete 1, 2
• Apply pressure to the exit site until hemostasis is achieved 1
• Apply a sterile occlusive dressing to the site 1
• Document the procedure, including the condition of the exit site and the integrity of the removed catheter 1

Complications and Special Considerations

• If the catheter cannot be removed with gentle traction, do not use excessive force as this may lead to catheter breakage 1, 2
• For difficult removals that don't respond to gentle traction, specialized techniques may be required and should be referred to interventional radiology 2
• Tunneled catheters may develop fibrin sheaths or thrombus that can make removal challenging 2
• If catheter-related infection is suspected, collect appropriate cultures before removal 1

Difficult Removal Management

• If standard removal techniques fail, do not continue with forceful traction 3, 2
• For catheters that cannot be removed with gentle traction, specialized endovascular techniques may be required 2
• In cases of suspected catheter adherence due to thrombus formation, imaging (ultrasound) may be helpful to assess the situation 2
• For persistently difficult removals, consult with interventional radiology for specialized removal techniques 2

Proper removal technique is essential to prevent complications such as catheter breakage, vein damage, or bleeding. The procedure should be performed by nurses trained in central line management to ensure patient safety and minimize the risk of complications 4.