What are the steps to remove a dialysis catheter?

Steps to Remove a Dialysis Catheter

The proper removal of a dialysis catheter requires strict adherence to aseptic technique and specific procedural steps to minimize complications and infection risk.

Preparation Phase

• The patient should wear a surgical mask during the catheter removal procedure to reduce the risk of contamination from respiratory droplets 1
• Healthcare staff must wear gloves and a surgical mask or face shield for all procedures that involve accessing the patient's bloodstream 1
• Gather all necessary supplies in advance, including sterile gloves, mask, sterile dressing materials, and suture removal kit 1
• Ensure the patient is positioned appropriately (typically supine) for the procedure 2

Pre-Removal Assessment

• Verify that the catheter is ready for removal - ensure no active infection is present unless catheter removal is part of infection management 1
• For infected catheters, ensure appropriate antibiotic therapy has been initiated before removal, especially for bloodstream infections 1
• Confirm that any replacement catheter has been placed if continued dialysis access is needed 1
• Review recent blood cultures if the catheter is being removed due to infection 1

Removal Procedure

1. Prepare the site by cleaning with povidone-iodine solution and allow to dry completely 1
2. Remove any sutures securing the catheter using sterile technique 2
3. For tunneled catheters, apply gentle traction to mobilize the cuff if present 2
4. For cuffed tunneled catheters, make a small incision over the cuff location if the cuff cannot be removed with traction alone 2
5. Apply steady, gentle traction to remove the catheter in a smooth motion 2
6. If resistance is encountered, do not use excessive force as this may lead to catheter breakage or vascular damage 3
7. Once removed, inspect the catheter to ensure it is intact and complete 2
8. Apply firm pressure to the exit site for at least 5 minutes to achieve hemostasis 2

Post-Removal Care

• Apply a sterile dressing to the exit site after achieving hemostasis 1
• Monitor the site for bleeding, infection, or other complications 2
• For catheters removed due to infection, consider sending the catheter tip for culture if clinically indicated 1
• Document the procedure, including any complications and the condition of the removal site 2

Special Considerations

• For catheters that are difficult to remove or "tethered" (adhered to vessel walls), more advanced techniques may be required, such as using a laser sheath extraction under fluoroscopic guidance 3
• For infected catheters, the timing of removal depends on the pathogen:
  • Immediate removal is indicated for S. aureus, Pseudomonas species, or Candida species infections 1
  • For other pathogens, catheter exchange over a guidewire may be considered if symptoms resolve within 2-3 days of antibiotic therapy 1

Potential Complications to Monitor

• Bleeding from the exit site or along the tunnel tract 2
• Air embolism (rare but serious) - keep patient in supine position during removal 2
• Retained catheter fragments if breakage occurs during removal 3
• Post-removal infection at the site 1

Documentation Requirements

• Document the procedure, including the condition of the catheter upon removal 2
• Record any complications encountered during the procedure 2
• Note post-procedure instructions provided to the patient 2