Central Venous Catheter Removal
Office of Graduate Medical EducationPerelman School of MedicineUniversity of Pennsylvania
Which CVC Catheters are at risk of venous air embolism complication?
Internal Jugular and Subclavian CentralVenous CathetersBoth during insertion and removal
Removing a CVC Catheter:Best Practice for Safe Removal and Prevention of Venous Air Embolism
Step 1: Gather EquipmentSuture removal kit, petroleum gauze and 4 x 4 combination, occlusive dressingStep 2: Notify RN so that they can be available forptmonitoringStep 3: Place patient inTrendelenburgpositionIf patient is unable to toleratetrendelenburg, the patient should be placed supine. Never remove a CVC in the sitting/upright position.Step 4: Ask patient to forcibly exhale (hum) orvalsalva(bear down). During these maneuversintrathoracicpressure is great than atmospheric pressure.Step 5: Quickly remove catheterStep 6: Secure petroleum gauze 4 x 4 combination with an occlusive dressing over site.Apply firm pressure. If the patient iscoagulopathic, apply pressure for a longer time period (several minutes)
What is Venous Air Embolism?
Serious complication of CVC insertion or removalAir can enter the vascular space if a needle or catheter is left open to atmospheric pressure.Factors that increase the risk of air embolism:Upright positionHypovolemiaInhalation during instrumentationInattention to catheter seals and insertion/removal technique
What are the Signs and Symptoms of VenousAirEmbolism?
Chest painShortness of breathCoughingTachyarrhythmiasSyncopeAnxietyConfusion or change in mental statusRespiratory distress or cardiovascular collapse*Any of these symptoms or signs in association with central line insertion or removal are highly suspicious for venous air embolism
What Should I Do If I Suspect Venous Air Embolism in my Patient?
Place patient in the left lateral decubitus position and in theTrendelenburgpositionIn attempt to trap air in the right ventricular apexPlace patient on 100% non-rebreathermaskAdminister IVFAlwaysnotify the patients’nurse, yourresident/fellow, andattendingso that they can provide more help.Depending on the severity of the patients’ signs and symptoms, consider calling a rapid response.