identify your patient what is your name Sir James Smith what is your date of birth 9785 explain the Val Sal and maneuver to the patient and have the patient demonstrate I'm going to ask you to hold your breath and bear down as if you're having a ball movement can you please demonstrate that okay wash your hands and put on gloves clamp and disconnect any IV that is running through the central line place the patient lying flat without pillows or in a slight trolenberg position if tolerated have the patient turn their head away from the catheter
remove the old dress in to avoid dislodgment of the central line discard the dressing and gloves put on clean exam gloves remove the sutures if a catheter tip culture has been ordered cleanse the site thoroughly with c HG in a back and forth motion for a minimum of 30 seconds and then allow the site to dry instruct the patient to take a deep breath and hold it in take a deep breath and Bear Down sir gently withdraw the catheter while applying firm direct pressure at the insertion site using an occlusive dressing if your patient is
unable to follow instructions remove the catheter at the end inspiration if any resistance is felt removal is aborted and the attending physician is notified immediately if a catheter fra cure occurs apply direct pressure over the site notify the attending physician immediately obtain a stat chest x-ray and notify in Interventional Radiology for removal if the catheter fragment is identified if the catheter fragment is palpable apply additional pressure distal to the catheter to prevent migration and proximal to the catheter to prevent air embolism if tolerated position position your PL patient in Trendelenburg and on their left side
I'll roll you on your left side okay sir to determine whether a tip has been fractured note that the tip of a good catheter is blue and the tip of a fractured catheter is missing the blue tip okay lay him back on his back if a culture was ordered once the catheter is removed them from the patient and with assistance from your assistant cut one inch from the catheter tip and place into a sterile culture cup the remaining portion may be discarded appropriately Do not sit the patient up at any time during the removal or
immediately afterwards do not massage the JJ site after the removal continue applying firm pressure for several minutes until the bleeding stops without lifting the dressing if there is an absolute need to assess the insertion site Peak slightly by lifting the edge of the dressing without decreasing pressure at the site when bleeding has stopped secure occlusive dressing and label with date time and initials dispose of equipment appropriately and wash hands the patient should be instructed to remain supine for 30 minutes post removal or as appropriate for the clinical situation please remain still for 30 minutes sir
for removal of a central line from the femoral site the patient should remain flat without hip flexion for at least 2 hours monitor for signs of distress during and after removal if distress is observed call rtt immediately place the patient on their left side use to the trendelenberg position if tolerated and put the patient on 100% oxygen side roll your patient if nausea or vomiting occurs Do not sit the patient up observe the site for bleeding and hematoma formation recheck dressing within 10 minutes and as needed thereafter dressing remains in place for at least 24
hours periodically the ass site needs to be assessed for circulation and movement as appropriate to the clinical situation document the removal in the electronic medical records
