Central Venous Catheter Removal: Procedural Steps
When removing a central venous catheter, position the patient supine or in Trendelenburg to prevent air embolism, remove the catheter during expiration or breath-holding, apply immediate pressure to the site, and cut the distal 5 cm of the catheter tip for culture if infection is suspected.
Pre-Removal Assessment
Before proceeding with catheter removal, verify the indication for removal is appropriate:
- Confirm removal is indicated based on clinical deterioration, sepsis/septic shock, purulence at exit site, erythema overlying the catheter, or positive blood cultures for S. aureus, Candida species, or gram-negative bacilli 1, 2
- Assess coagulation status to identify bleeding risk, though this is based on general medical practice
- Review the patient's respiratory status to determine optimal positioning for air embolism prevention 3
Patient Positioning
- Place the patient supine or in Trendelenburg position (head down 15-30 degrees) to increase central venous pressure and minimize air embolism risk during removal 3
- Avoid upright or semi-upright positioning as this increases the risk of air entrainment into the venous system 3
Sterile Technique and Preparation
- Perform hand hygiene and don sterile gloves to maintain aseptic technique during the procedure 4, 5
- Prepare sterile gauze, occlusive dressing materials, and a sterile container for catheter tip collection if culture is needed 1
- Have emergency equipment available including materials to manage potential complications 3
Catheter Removal Procedure
- Remove the securing sutures or stabilization device carefully to avoid catheter fragmentation 5, 3
- Instruct the patient to perform a Valsalva maneuver, hold their breath in expiration, or exhale during catheter withdrawal to prevent air embolism by increasing intrathoracic pressure 3
- Withdraw the catheter slowly and steadily in a smooth motion parallel to the vein to avoid shearing or breaking the catheter 3
- Apply firm, direct pressure to the insertion site immediately upon catheter removal using sterile gauze 3
Immediate Post-Removal Management
- Maintain pressure for 5-10 minutes (longer if the patient has coagulopathy or received anticoagulation) until hemostasis is achieved 3
- Apply an occlusive dressing (preferably air-occlusive) to the site and keep it in place for at least 24 hours to prevent delayed air embolism 3
- Position the patient supine for 30 minutes post-removal to further minimize air embolism risk 3
Catheter Tip Handling for Suspected Infection
- Cut the distal 5 cm of the catheter tip using sterile technique if catheter-related infection is suspected or confirmed 1
- Place the catheter tip in a sterile, dry container (not in transport media or saline) for microbiological culture 1
- Transport the specimen to the laboratory within 12 hours to optimize culture yield 1
Post-Removal Monitoring
- Inspect the entire catheter length to ensure it was removed intact without fragmentation 3
- Examine the insertion site for bleeding, hematoma formation, or signs of infection 5, 3
- Monitor vital signs for evidence of air embolism (sudden dyspnea, chest pain, hypotension, altered mental status) or bleeding complications 3
- Document the catheter removal including indication, patient tolerance, catheter integrity, and whether the tip was sent for culture 6, 3
Critical Pitfalls to Avoid
- Never remove a catheter with the patient sitting upright or during inspiration, as this dramatically increases air embolism risk 3
- Do not apply excessive force during removal if resistance is encountered, as this may indicate catheter adherence or thrombosis requiring imaging evaluation 1, 3
- Avoid contaminating the catheter tip if culture is needed—use sterile scissors and container, not the scissors used to remove sutures 1
- Do not assume the catheter is completely removed without visual inspection of the entire length, as retained catheter fragments can cause serious complications 3
- Be aware of the risk of clot embolization during removal if catheter-related thrombosis is present; removal should be performed carefully in this setting 1