How to remove a Peripherally Inserted Central Catheter (PICC) line with a suture thread?

Removing a PICC Line with a Suture Thread

If a suture is present alongside the PICC line, remove the suture first before attempting catheter removal, though manufactured stabilization devices are strongly preferred over sutures for PICC lines. 1, 2

Pre-Removal Preparation

• Position the patient supine with the exit site below heart level to minimize air embolism risk 2, 1, 3
• Gather sterile supplies including gloves, antiseptic solution (chlorhexidine with alcohol preferred), sterile dressings, and suture removal kit 1
• Remove any stabilization device (such as StatLock) that may be securing the catheter 1

Suture Removal and Catheter Extraction

• Apply sterile gloves and maintain strict aseptic technique throughout the procedure 1
• Clean the exit site with chlorhexidine-alcohol solution and allow to dry completely 1
• Carefully identify and remove any sutures present at the exit site before attempting catheter removal 1
  • Note: Sutures are not the preferred method for PICC stabilization; manufactured devices should be used instead 1
• After suture removal, apply gentle, steady traction to withdraw the catheter 1
  • Avoid excessive force that could cause catheter breakage or stretching 1, 4

Post-Removal Management

• Apply firm digital pressure to the exit site for at least 5 minutes until hemostasis is achieved 2, 1, 3
• Apply a sterile occlusive dressing to protect against infection 2, 1, 3
• Inspect the removed catheter to ensure it is intact and complete 1
• If persistent bleeding occurs, a skin stitch may be required 2, 3
• Document the procedure including exit site condition and catheter integrity 1

Critical Pitfalls to Avoid

• Never attempt removal by clinicians trained only in CVC removal but not specifically in PICC removal 2
• Do not advance a migrated PICC back into position; guidewire exchange is appropriate if no infection is present 2
• If resistance is encountered during removal, do not apply excessive force—this may indicate adherent fibrin or thrombus formation requiring specialized intervention 5, 4
• For long-term catheters (especially cuffed devices), be aware that complex fibrin sleeves and scar tissue may develop, potentially requiring surgical intervention 2

When Standard Removal Fails

• If the catheter cannot be removed with gentle traction, seek consultation from vascular surgery or interventional radiology 2
• Very long-term catheters may become attached to vessel walls and cannot be removed by traction alone 2
• Specialized endovascular techniques exist for tightly adherent PICCs but require interventional expertise 5