208 Section V ■ Vascular Access

from flowing back into catheter. Positive-pressure

injection caps are available to prevent backflow.

f. Changing IV catheter injection cap: Most manufacturers recommend changing injection caps every 3

to 7 days, after blood product administration, or

when they appear damaged (see specific manufacturer’s instructions).

Catheter Removal

A. Indications

1. Patient’s condition no longer necessitates use.

2. Occluded catheter

3. Local infection/phlebitis

4. Sepsis and/or positive blood cultures obtained through

the catheter (catheter colonization). There are rare

clinical circumstances when a catheter is left in place

despite sepsis and antibiotic or antifungal therapy is

administered through it in an attempt to clear the infection, but this may be associated with an increased risk

of morbidity and mortality (18,19).

B. Technique

Surgically implanted central venous catheters should be

removed by a physician or other person specifically trained

to remove cuffed and/or tunneled catheters.

1. Remove dressing.

2. Make sure that the patient is in the Trendelenburg

position (or reverse Trendelenburg position if the catheter is in the lower extremity) to minimize the risk of an

air embolism.

3. Pull catheter from vessel slowly over 2 to 3 minutes.

Avoid excessive traction if catheter is tethered, because

the catheter may snap (see Complications).

4. Apply continuous pressure to the catheter insertion site

for 5 to 10 minutes, until no bleeding is noted.

5. Inspect catheter (without contaminating tip) to ensure

that entire length has been removed.

6. The cuff on the tunneled catheter should be dissected

out under local anesthesia with IV sedation. If cuffs are

retained, they rarely cause more than a persistent small

subcutaneous lump, although they can occasionally

extrude through the skin.

7. If desired, antibiotic ointment may be placed over site.