Ensure that 

patient and health care provider safety standards are met

 Risk assessment and appropriate PPE

 4 Moments of Hand Hygiene
 Procedural Safety Pause is performed
 Two patient identification
 Safe patient handling practices
 Biomedical waste disposal policies

Equipment Needed:
1. Sterile tray with suture removal scissors.
2. Chlorhexidine 2% and 70% alcohol swabs.
3. 2 - 4X4 sterile gauze squares.
4. Transparent occlusive dressing.
5. Non-sterile gloves
6. Sterile gloves
7. Bedside stool (if required).

1. Apply Related Procedures and Policies

Confirm order. Follow LHSC policies for hand hygiene and infection control before, during
and after procedure. Perform hand hygiene and don a mask with eye shield and non-sterile
gloves prior to blood sampling.
Do not clamp of a vascular device in anticipation of removal. This will not reduce
bleeding from the site but may lead to thrombosis/embolus to the distal extremity.

2. Check Coagulation Tests/Medications

Check INR/PTT and platelets. If INR/PTT is prolonged (INR > 1.5) or platelets < 50,000
review orders with physician.
If patient is receiving any medications that affect coagulation (e.g., anticoagulants,
fibrinolytics, antiplatelet agents), review with physician prior to removal.
To reduce risk for bleeding. If the patient has a significant coagulopathy the removal order
should be reviewed to determine whether treatment is warranted (e.g. administration of
plasma or platelets) or whether removal should be delayed.  Medications that interfere with
clotting should also be reviewed.
The catheter site may also influence bleeding risk. Additional site pressure may be
required
3. Prepare Bedside and Assess Patient
Administer analgesic and sedative (if indicated).
4. Prepare Tray
Perform hand hygiene and open central line dressing change tray.
Don non-sterile gloves and mask with face shield.
Perform hand hygiene and prepare dressing tray aseptically using transfer forceps to add
supplies.
Add sterile scissors or additional chlorhexidine for removal of securement device. Add
sterile 4 X 4 gauze and occlusive dressing to tray.

5. Remove Dressing
Remove dressing.
Discard dressing appropriately and perform hand hygiene.
6. Cleanse Site
Don sterile gloves and cleanse site. Wait until chlorhexidine has completely dried.
Remove sutures if present.  To remove an adhesive securement device, use a
chlorhexidine and/or alcohol based swabstick to "shovel" under the dressing from edge to
centre until released from the skin.
7. Remove Catheter
Position gauze over insertion site and gently withdraw catheter slightly to ensure that
catheter will withdraw easily.
Pull the catheter in a slow but steady withdrawal motion, applying immediate and directly
pressure slightly above the insertion site upon removal
Inspect catheter for intactness. Notify physician Immediately if catheter is damaged. Send
tip for culture if ordered.
EMERGENCY RESPONSE
Catheter Breakage:
Apply direct pressure above the puncture site to occlude blood flow. Position patient on left
side with head down (Trendelenburg position) and notify physician STAT.
If catheter fracture is palpable, apply additional pressure to prevent catheter migration.
8. Ensure Hemostasis
Hold direct pressure firmly and continuously for a minimum of 5 minutes BEYOND the
point when hemostasis has been achieved.
Carefully check site and distal circulation every 5 minutes and reapply pressure for 5 more
minutes if oozing is observed.
Adequate and direct pressure is required to stop bleeding from a central venous or arterial
catheter.
The only way to stop bleeding and ensure occlusion of catheter tract is through direct
pressure until hemostasis is achieved.
Inadequate hemostasis can facilitate hematoma formation with subsequent vessel
occlusion, limb ischemia or fistula formation.
9. Apply Occlusive Dressing
When bleeding has stopped completely, apply a transparent dressing or bandaid to the
site.
Do not apply pressure dressings or sandbag to site. Direct pressure is required until
bleeding has stopped. The occlusive dressing allows visualization of site while preventing
pathogens from entering tract.
Pressure dressings and sandbags will not stop a vascular bleed but will delay detection of
bleeding. Inadequate pressure can result in hemorrhage or hematoma.
10. Post Removal Assessment
Minimize limb movement for at least one hour post removal. Ensure limb site is visible in
order to promptly detect bleeding.
Monitor for hematoma or bleeding q 5 minutes X 30 minutes, then q 30 minutes X 2 then q
1 h X 4. Reapply pressure if bleeding present.
Assess distal extremity and monitor for decreased circulation, change in limb color or delay
in capillary refill q 5 minutes X 30 minutes, then q 30 minutes X 2 then q 1 h X 4. .
11. Document
Document procedure and follow-up assessment in clinical record.