Internal Jugular Catheter Removal Procedure
Pre-Removal Assessment
Before removing an IJ catheter, confirm the indication for removal and assess for contraindications. 1
- Remove the catheter immediately if: pain, induration, erythema, or purulent exudate is present at the insertion site 1
- Remove the catheter if: unexplained sepsis develops, erythema overlies the insertion site, or purulence is visible 1
- Remove the catheter promptly when it is no longer clinically necessary, as unnecessary catheter retention increases infection risk 2
- Obtain blood cultures from the catheter and percutaneously before removal if catheter-related bloodstream infection is suspected 1
Patient Positioning
Position the patient in Trendelenburg (head-down) position during removal to prevent venous air embolism. 3
- Place the patient supine or in slight Trendelenburg position (10-15 degrees head down) to increase central venous pressure and minimize air entry risk 4, 3
- This positioning is critical as venous air embolism is a potentially life-threatening complication of central line removal 4, 3
Removal Technique
Instruct the patient to perform a Valsalva maneuver or hold their breath in expiration during catheter withdrawal. 3
- Remove any sutures securing the catheter 3
- Remove the dressing and clean the insertion site 1
- Have the patient hold their breath at end-expiration or perform Valsalva maneuver during the actual withdrawal to increase intrathoracic pressure and prevent air entrainment 3
- Withdraw the catheter slowly and steadily in a single smooth motion parallel to the vein 4, 3
- Avoid rapid or jerky movements, as these may increase the risk of complications including the "CVC removal distress syndrome" (neurologic paresis, respiratory failure, or shock) 4
Immediate Post-Removal Care
Apply firm pressure to the insertion site immediately after catheter removal and maintain for at least 5-10 minutes. 3
- Apply direct pressure with sterile gauze until hemostasis is achieved 3
- Apply an occlusive dressing (sterile gauze or transparent semi-permeable dressing) to the site 1, 3
- Keep the patient supine or in Trendelenburg position for 30 minutes after removal to prevent delayed air embolism 4, 3
Catheter Tip Management
Send the catheter tip for culture if catheter-related infection is suspected. 1
- Submit any exudate from the insertion site for Gram staining and culture 1
- Culture the catheter tip using semi-quantitative or quantitative methods if bloodstream infection is suspected 1
Post-Removal Monitoring
Monitor the patient for complications for at least 30-60 minutes after removal. 4
- Observe for signs of air embolism: sudden dyspnea, chest pain, hypotension, altered mental status, or cardiovascular collapse 4, 3
- Monitor for bleeding from the insertion site 3
- Watch for arrhythmias, which can occur during or after removal 3
- Assess for neurologic changes, as rare cases of neurologic paresis or coma have been reported following IJ catheter removal 4
Critical Pitfalls to Avoid
- Never remove a catheter with the patient sitting upright or with head elevated, as this dramatically increases air embolism risk 4, 3
- Never allow the patient to breathe in during catheter withdrawal, as negative intrathoracic pressure facilitates air entry 3
- Do not remove catheters rapidly or forcefully, as this increases risk of vascular injury and the CVC removal distress syndrome 4
- Do not assume the procedure is complete once the catheter is out—maintain pressure and monitoring as complications can occur after removal 4, 3