PICC Removal

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.

Supplies:

• 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
  

Procedure

• 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.

Dressing

• 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

Troubleshooting

• 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

Documentation

• Initial patient assessment
• Description of the procedure
  • patient position
  • aseptic technique
  • Standard Precautions, draping, safety measures
• Patient tolerance of the procedure
• Insertion site
• Hemostasis
• Dressing
• Patient response to teaching and follow-up instructions]
• Condition and disposition of the removed catheter

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