PICC line removal
is usually accomplished without complication. However, to reduce catheter related blood stream infection and the potential for foreign body embolus, PICCs should be removed by a physician
or trained registered nurse. Adherence to your facility's policy and procedure is the best guide to safe patient care.
- Standard precautions Personal Protective Equipment: mask, eye protection, gown, cap
- Sterile gloves
- Suture removal kit if necessary (scissor, forceps)
- Sterile hemostat (available)
- 70% alcohol pads & swabs
- Chlorhexidine skin prep applicator
- Sterile container if sending tip for C&S
- Sterile towel pack
- Tape measure
- Dressing sponges/tape
- Verify order to remove PICC
- Prepare the work area: disinfect work surface, position waste containment, etc.
- Open sterile towel pack on work area - aseptic technique
- Open sterile supplies on to towel - aseptic technique
- Explain procedure to patient: turn head away, keep arm still, draping, cold solutions, etc.
- Position the patient
for comfort, with the insertion arm extended 45-90 degrees.
- Standard precautions: cap, mask, eye protection, gloves, gown
- Wash hands (chlorhexidine and alcohol based antiseptic hand washing preparations are most effective).
- Don sterile gloves - aseptic technique.
- Cleanse dressing with alcohol pad to release transparent dressing
- Carefully remove the
old dressing (lift distal edge toward proximal edge).
- Moisten securing device with alcohol if needed to release (do not force removal).
- Dispose of old dressings
- Remove gloves and re-wash hands
- Don sterile gloves - aseptic technique
- Assess insertion site
- Clean around the insertion
site with alcohol swab to remove blood or residue
- Prep insertion site and at least 3 inches around with chlorhexidine skin prep
- Drape or towel off unprepped skin of lower arm
- Grasp catheter
near the insertion site. Keeping catheter parallel to the arm an withdraw about one inch (2.5 cm)
- Continue this procedure
until the catheter is removed.
- Hold pressure on site a few minutes to promote hemostasis as needed
- Measure the device and confirm that it is intact.
- Confirm hemostasis
- Secure gauze
Culture & Sensitivity
- Using aseptic technique, cut a section of catheter equal to about half the length of sterile specimen container. Place specimen in sterile container
- Specimen should include the distal end
- Label: patient, source for C&S, site, date, time.
- Package specimen for safe transport
- Resistance - STOP; Never pull against resistance
- Release any pressure along catheter path
- Venous spasm can cause resistance, waiting a few minutes may allow the vein to relax
- Warm packs placed proximal to the insertion site may help relax the vein walls
- Reposition the limb and try again
- Continued resistance; stop, clean, re-prep, secure the catheter, re-dress, notify the physician.
- Non-intact catheter - this is an emergent situation
- Catheter breaks while withdrawing
- Clamp catheter if enough projects from the insertion site
- Carefully consider the option to continue withdrawal
- Retained catheter or fragments
- Immobilize the limb, explain the need to remain still
- Carefully apply dressing, avoid dislodging fragments
- Trendelenburg position only if patient does not have to move
- Measure removed catheter to determine how much is retained (save all catheter pieces for subsequent report of medical device failure)
- Notify physician of potential embolus
- Prepare patient for transport
- Initial patient assessment
- Description of the procedure
- patient position
- aseptic technique
- Standard Precautions, draping, safety measures
- Patient tolerance
of the procedure
- Insertion site
- Patient response to teaching and follow-up instructions
- Condition and disposition of the removed catheter