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Removal of Non-Tunneled

Central Venous Catheter (CVC)


(Approved Aug 15, 2011/Rev Dec 16, 2011/Rev Jun 13, 2012)

Vascular Access Guideline

Table of Contents
This procedure is posted on the BC Provincial Renal Agency website – Health Professionals
Channel – Vascular Access –
http://www.bcrenalagency.ca/professionals/VascularAccess/ProvGuide.htm

1.0 Practice Standard ................................................................................................ 1


2.0 Equipment .......................................................................................................... 2
3.0 Assessment & Interventions ................................................................................. 3
4.0 Patient Education & Resources ............................................................................. 4
5.0 Documentation ................................................................................................... 4
6.0 References .......................................................................................................... 4
7.0 Developed By ...................................................................................................... 5
8.0 Reviewed By........................................................................................................ 5

1.0 Practice Standard


Skill Level (Nursing): Specialized

The following Registered Nurses (RNs) may perform this procedure:


1. RNs who have completed the required hemodialysis (HD) specialty education and who
provide nursing care in a BC In-Centre and/or Community Renal Program AND have
received the appropriate training for removal of non-tunneled CVCs; &
2. Designated RNs who have received the appropriate training for central venous catheter
care including removal of temporary CVC lines (e.g., inpatient, home care or ambulatory
care RNs or LPNs).

Need to Know:

1. Nurses may remove non-tunneled catheters upon the order of a physician. Physicians
remove tunneled catheters.

2. Standard/routine precautions are used for removing non-tunneled catheters to reduce


the risk of transmission of blood-borne and other pathogens.

Approved Aug 15, 2011/Rev Dec 16, 2011/Rev Jun 13, 2012 Page 1
Removal of Non-Tunneled CVC

 Wash hands before and after manipulation of the CVC and administration lines. If
hands visibly soiled, wash with antimicrobial soap; if not, may use either an
antimicrobial soap or alcohol hand sanitizer.
 Wear gloves (non-sterile to remove the dressing and sterile for the rest of the
procedure), non-sterile gown and non-sterile mask/face shield during catheter
removal procedures.

3. Medical/clean aseptic technique is used for removing non-tunneled catheters, with


additional precautions as follows:
 Use sterile equipment and supplies and a “no touch” technique when handling the
catheter and catheter ports and performing exit site care.
 Maintain a sterile drape under the catheter ports.

4. Recommended antiseptic solutions, in order of priority:

Solution Required Drying Time


Chlorhexidine gluconate 2% with alcohol 30 seconds (persistent antimicrobial
activity, up to 48 hours)
Chlorhexidine gluconate without alcohol 2 minutes
Sodium hypochlorite 0.11% (ExSept Plus®) 2 minutes
or Amuchina 10%
Povidone-iodine 10% (Betadine) 2 minutes

5. Air embolus is a potential catastrophic complication during CVC removal.

Two ways to reduce the risk include:


 Place the patient supine in as flat a position as the patient can comfortably tolerate.
 Instruct the patient to take a deep breath and to breath out while the catheter is
being removed (increases the intra-thoracic pressure which minimizes the possibility
of air being accidentally drawn into the systemic venous circulation and creating an
air embolus).

2.0 Equipment

 Non-sterile gloves  Antiseptic solution, preferably


 Non-sterile gown chlorhexidine gluconate 2% with alcohol
 Non-sterile mask/eye protection (2)  2x C&S containers (for exit site and
 Sterile gloves (2 pair) catheter tip swabs), if suspect infection.
 Sterile dressing tray  Tape
 Sterile suture scissors  Garbage receptacle
 4 x 4 sterile gauzes (several)

Approved Aug 15, 2011/Rev Dec 16, 2011/Rev Jun 13, 2012 Page 2
Removal of Non-Tunneled CVC

3.0 Assessment & Interventions


Preparation:
1. Place the patient supine in as flat a position as the patient can comfortably tolerate.

2. Wash hands with antimicrobial soap.

3. Don non-sterile gown (staff).

4. Don non-sterile mask (staff and patient).

5. Open the tray and add supplies.

6. Don non-sterile gloves.

Remove dressing:
7. Remove exit site dressing and discard dressing.

8. Take C&S around the exit site, if ordered or if suspect a local infection.

9. Remove gloves and wash hands with antimicrobial soap.

10. Don sterile gloves.

Exit site care:


11. Using a sterile 4x4 gauze soaked in an antiseptic solution, cleanse the catheter exit site
skin in a circular motion (exit-site outward to cover a diameter of 10 cm). Discard used
gauze.

12. Using sterile scissors, carefully remove the sutures that anchor the temporary catheter
in place (usually two sutures).

13. Place a dry, sterile 4x4 gauze, folded into four, over the exit site (to help stop the
bleeding when the catheter is removed).

14. Instruct the patient to take a deep breath and to breathe out while the catheter is being
removed.

15. Using a dry, sterile 4x4 gauze, grasp the catheter at its exit site from the skin. Remove
the catheter, pulling straight out and parallel to the vein while maintaining gentle,
constant traction. If resistance is encountered, contact the physician.

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Removal of Non-Tunneled CVC

16. Apply pressure to the exit site for a minimum of 10 minutes (longer if bleeding persists).
Do not lift the 4x4 gauze to determine if bleeding has stopped (could cause an air
embolus).

17. Apply occlusive dressing over venipuncture site.

18. Send catheter tip for C&S if ordered or if a systemic infection is suspected.

4.0 Patient Education & Resources


 Occlusive dressing will be in place for at least 24 hours (usually removed at the next
dialysis treatment).
 Notify kidney doctor (nephrologist) or dialysis unit for any of the following:
 Oozing or drainage from catheter exit site.
 Noticeable swelling or itching around neck.
 Shortness of breath.
 Feverish and any of the above symptoms.

Resource: Care of Your Catheter


 http://www.bcrenalagency.ca

5.0 Documentation

 Document date, time, procedure, integrity of the catheter, condition of the exit site, any
bleeding and patient tolerance of the procedure.

 Document if an exit site swab and/or catheter tip is sent for C&S.

 Document the procedure in Dialysis Access module in PROMIS.

6.0 References
1. Besarab, A., and Brouwer, D. (2004). Aligning hemodialysis treatment practices with the
National Kidney Foundation’s K/DOQI vascular access guidelines. Dialysis &
Transplantation, 33 (11): 694 – 702.

2. BC Provincial Renal Agency Guideline, Prevention, Treatment, & Monitoring of VA


Related Infection in HD Patients (March 2008). http://www.bcrenalagency.ca

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Removal of Non-Tunneled CVC

3. BC Provincial Renal Agency Patient Teaching Pamphlet, Your Catheter (2008).


http://www.bcrenalagency.ca

4. Canadian Society of Nephrology Guidelines: Vascular access. (2006). Journal of American


Society of Nephrology, 17: S18 - S21.

5. O’ Grady et al. (2011). Guidelines for the prevention of intravascular catheter- related
infections. Centre for Disease Control (US). 51 (RR-10): 1-26.

6. Counts, Caroline. (Ed). (2008). Core Curriculum for Nephrology Nursing. American
Nephrology Nurses’ Association; Pitman, NJ.

7. Marschall, Jonas et al. (2008). Strategies to Prevent Central Line-Associated Bloodstream


Infections in Acute Care Hospitals, Infection Control and Hospital Epidemiology, 29: supp
1, S22-S30.

8. National Kidney Foundation (2006). KDOQI Clinical Practice Guidelines and Clinical
Practice Recommendations for 2006 Updates: Hemodialysis Adequacy, Peritoneal
Dialysis Adequacy and Vascular Access. Am J Kidney Dis 48:S1-S322, 2006 (suppl 1).

9. O’Grady, Naomi et al. (2002). Prevention Guidelines for Catheter-Related Infections,


Clinical Infection Diseases, 24: 1281-307

10. Registered Nurses Association of Ontario, Care and Maintenance to Reduce VA


Complications. (2008). http://rnao.ca/sites/rnao-
ca/files/Care_and_Maintenance_to_Reduce_Vascular_Access_Complications.pdf

11. Safer Healthcare Now! Campaign. (2006). How-to-Guide: Prevent Central Line
Infections. http://www.saferhealthcarenow.ca

7.0 Developed By
1. BCs Vascular Access Educators Group (VAEG).
2. Adapted from Fraser Health Renal Program guidelines/standards.

8.0 Reviewed By
1. British Columbia Renal Educators Group (BCREG)
2. BC Provincial Renal Agency – Medical Advisory Committee (MAC)

Approved Aug 15, 2011/Rev Dec 16, 2011/Rev Jun 13, 2012 Page 5