HEALTH SERVICES - PDF document

Approved: February 11, 2015 Page 1 of 4 HEALTH SERVICES CODE H.2 NURSING PROCEDURE TITLE : HEMODIALYSIS: UNCUF FED CENTRAL VENOUS HEMODIALYSIS CATHETER: REMOVAL CATEGORY : RN – S pecial N ursing P rocedure PURPOSE  To provide R.N. with a guide for safe, aseptic removal of a n uncuffed central venous hemodialysis catheter from a subclavian, jugular or femoral vein. NURSING ALERT:  Certification required.  Ensure catheter is uncuffed ( temporary ) and NOT cuffed ( permanent )  Catheter removal should be without res istance.  Do not force removal. If resistance is felt: 1. stop withdrawal 2. re - dress site 3. notify physician EQUIPMENT 1. PPE 2. Mask 3. Sterile dressing set 4. Sterile gloves (if catheter tip is going to be sent) 5. Chlorhexidine 2% with 70% alcohol or Chlorhexidi ne 2% (may use swab stick or aqueous) (#310400 for box of swab sticks) 6. S terile stitch cutter (#310085) 7. Occlusive dressing  2x2 sterile gauze  S terile petroleum j elly (sing l e use packet) (#312115)  Transparent dressing (#319315) 8. C & S swab ( if signs of infecti on present ) 9. Sterile specimen container if tip is to be sent for culture PROCEDURE 1. Verify p hysician ’s o rder for CVC removal.

2. Verify (2 R.N.’s) that catheter is UNCUFFED . Approved: February 11, 2015 Page 2 of 4 HEALTH SERVICES CODE H.2 3. Review lab data for platelet count, P T, PTT, INR and notify physician of abnormalities prior to removal . 4. Explain procedure to patient. 5. Perform hand hygiene. 6. Don PPE including mask . 7. Assemble equipment and set up sterile field . 8. Position patient in s upine or Trendelenburg unless contraind icated. 9. Remove CVC exit site dressing. 10. Perform hand hygiene. 11. Inspect catheter exit site. NOTE: If signs of infection are present, have physician assess and obtain an order to swab site for C&S. Have blood cultures drawn , one set via CVC and one via ve nipuncture . Send catheter tip for C&S. 12. Obtain swab for C&S, if indicated per nursing procedure H.11. 13. Don sterile gloves. 14. Cleanse skin at insertion site. 14.1 Cleanse entire area where dressing is placed using Chlorhexidine swab sticks from centre outward in clockwise circular motion. 14.2 Repeat cleansing in counter clockwise direction. 14.3 Cleanse length of exposed catheter (let dry 2 - 3 minutes). 15. Remove suture ( s ) holding catheter in place. 16. Place dry, sterile 4 x 4 gauze folded into four over catheter exit site with non - dominant hand. 17.

Remove catheter as follows: 17.1 Instruct patient to forcefully exhale (perform Valsalva maneuver) as catheter is withdrawn. If patient is on a ventilator or unable to follow instruction, withdraw catheter during expiratory cycl e. 17.2 Grasp catheter with dominant hand and withdraw catheter in one continuous motion. 17.3 Lay catheter on sterile towel (if tip to be sent for C&S). 17.4 Inspect tip of catheter. NOTE: If catheter t ip is not intact, contact physician immediately and document. 18. Apply direct pressure over exit site immediately with gauze. Approved: February 11, 2015 Page 3 of 4 HEALTH SERVICES CODE H.2 19. Continue to apply firm pressure over site for a minimum of 10 minutes and until bleeding and oozing stops . 20. Apply occlusive dressing ( ap proximately 2 - 5 mL of petroleum jelly, 2x2 gauze and transparent dressing ) . 21. Instruct patient to remain in supine position (or low Fowlers if supine is not tolerated) for 30 minutes after removal. NOTE: For removal of CVC from FEMORAL SITE , patient is to lie flat x 2 hours following. DO NOT allow hip flexion during this period. Assess dressing for bleeding. 22. Document date and time of catheter removal, assessment of site, application of dressing and patient’s tolerance of procedure. 23. Inform patient that occlusive dressing will b

e in place for 24 - 48 hrs (usually removed at next dialysis treatment). 24. Instruct patient to inform dialysis unit or go to Emergency for any of the following:  Oozing or drainage from catheter exit site  Noticeable swelling or itchin g around neck  Shortness of breath  Feverish and any of above symptoms Approved: February 11, 2015 Page 4 of 4 HEALTH SERVICES CODE H.2 REFERENCES BC Renal Agency: Removal of Non - Tunneled Central Venous Catheter (CVC). Vascular Guideline s (June 2012) . Retrieved : http://www.bcrenalagency.ca/node/789 National Kidney Foundation, Kidney Disease Improving Global Outcomes – KDIGO (2012). Clinical Practice Guidelines for the Evaluation and Management of Chronic Kidney D isease. Manitoba Renal Program. Removal of Non - Tunnelled Hemodialysis Central Venous Catheters (April 2012). Retrieved: http://www.kidneyhealth.ca/wp/wpcontent/up loads/pdfs/P&P/P&P_30.30.11.pdf Revised by: Rhiannon Thomas, CN E ; Shelley Stamm, CN E & Sandi Ell, RN Date: Dec. 20, 2011 Revised by: Ashley Curts RN, CNE; Rhiannon Thomas, RN, CRN: Sandy Ell RN, Access Nurse; Shannon Claypool RN, Access Nurse Date: December 2014 Approved by: Date: Regina Qu’Appelle Health Region Health Servic es Nursing Procedure Committee Feb. 11, 2015 Keywords: Terminat