CVAD Removal

Section Recommendation statement Grading
38. When removing a CVAD the patient MUST be placed in bed in a supine position (1). Prior to repositioning the patient following removal of a CVAD , ensure the dressing is airtight and occlusive. Consensus
39. Removal of a CVAD should be timed to occur at end inspiration or during expiration for patients who are not on a ventilator. Consensus
40. Following CVAD removal pressure must be applied with sterile gauze until haemostasis is achieved. The insertion site must be sealed immediately using an airtight occlusive dressing. This dressing is to remain intact and insitu for 48 hours to reduce the risk of late air embolism. Consensus
41. Routine collection of the CVAD tip is not required when removing the device. If a catheter-related bloodstream infection is suspected the medical team may request that the tip is sent for microbiological examination and a blood culture collected from a peripheral vein within 4 hours of CVAD removal (2). Consensus
42.

Removal of the CVAD must be documented in the clinical record.
The documentation must include:

  • visual inspection and description of the integrity of the CVAD
  • whether the CVAD tip was collected and sent to pathology
  • the condition of the CVAD insertion site.
NSW Policy
43. Following removal of a CVAD the condition of the site must be monitored at 24 and 48 hours at a minimum. This must be documented in the clinical record. Consensus

Safety alert 3: Air embolism

Many of the recommendations relating to removal have been made in the context of risk minimisation for air embolus. Data from the Incident Information Management System in NSW indicates that a number of patients are subject to this complication every year and in some cases this has been related to the removal technique. The practice review yielded numerous techniques for ensuring patients (without positive pressure ventilation) do not inhale during the procedure. See also the CEC Clinical Focus Reports.

Practice point 6 - Check CVAD when removed

When removing a CVAD, which may have been trimmed on insertion (i.e. PICC), the entire length removed must be visualised and checked against the original documentation to ensure that the entire catheter has been removed. This should be recorded in the patient’s medical record.

Grading of recommendations

Grade of recommendation Description
A Body of evidence can be trusted to guide evidence
B Body of evidence can be trusted to guide practice in most situations
C Body of evidence provides some support for recommendation/s but care should be taken in its application
D Body of evidence is weak and recommendation must be applied with caution
Consensus Consensus was set as a median of ≥ 7

Grades A–D are based on NHMRC grades (3)

References

  1. Bishop L, Dougherty L, Bodenham A, Mansi J, Crowe P, Kibbler C, et al. Guidelines on the insertion and management of central venous access devices in adults. International Journal of Laboratory Hematology. 2007;29(4):261-78. PubMed PMID: 17617077.
  2. Safdar N, Fine JP, Maki DG. Meta-analysis: methods for diagnosing intravascular device-related bloodstream infection. Ann Intern Med. 2005 Mar 15;142(6):451-66. PubMed PMID: 15767623. Epub 2005/03/16. eng.
  3. Hillier S, Grimmer-Somers K, Merlin T, Middleton P, Salisbury J, Tooher R, et al. FORM: an Australian method for formulating and grading recommendations in evidence-based clinical guidelines. BMC Medical Research Methodology. 2011;11:23. PubMed PMID: 21356039.

Disclaimer

The information on this page is general in nature and cannot reflect individual patient variation. It reflects Australian intensive care practice, which may differ from that in other countries. It is intended as a supplement to the more specific information provided by the doctors and nurses caring for your loved one. ICNSW attests to the accuracy of the information contained here but takes no responsibility for how it may apply to an individual patient. Please refer to the full disclaimer.