5
Fig. 16
• Repeat procedure through other suture eyes, if applicable.
Discard anchoring device upon completion.
27. Dress puncture site per hospital protocol.
Precaution:
Maintain the insertion site with regular, meticulous
redressing using aseptic technique.
28. Record the insertion procedure on the patient’s chart.
Catheter Removal Procedure:
1.
Precaution: Place the patient in a supine position.
2. Remove dressing, if applicable.
Precaution: To minimize
the risk of cutting the access device, do not use scissors to
remove the dressing.
3. Twist distal hub of catheter contamination shield to allow
removal from locking pin on hemostasis valve assembly.
Withdraw catheter from valve.
Warning: Hemostasis valve
must be occluded at all times to minimize the risk of air
embolism or hemorrhage.
Temporarily cover valve opening
with sterile-gloved
fi
nger until catheter or obturator is inserted.
Access Device Removal Procedure:
1.
Precaution: Place the patient in a supine position.
2. Remove dressing, if applicable.
Precaution: To minimize
the risk of cutting the access device, do not use scissors to
remove the dressing.
3. Using staple remover, remove staple(s), where applicable,
or remove sutures from primary suture site.
Precaution: Be
careful not to cut the access device.
4. Withdraw device from hemostasis valve. Cover hemostasis
valve with sterile-gloved
fi
nger.
Warning: Hemostasis valve
must be occluded at all times to minimize the risk of air
embolism or hemorrhage.
5.
Warning: Exposure of the central vein to atmospheric
pressure may result in entry of air into the central venous
system.
Remove access device slowly, pulling it parallel to the
skin. As access device exits the site, apply pressure with a dressing
impermeable to air, e.g. VASELINE
®†
gauze. Because the residual
access device track remains an air entry point until completely
sealed, the occlusive dressing should remain in place for at least
24-72 hours dependent upon the amount of time the access device
was indwelling.
11,15,16,18
6. Upon removal of the access device, inspect it to make sure that
the entire length has been withdrawn.
7. Document removal procedure.
References:
1. Albertson TE, Fisher CJ, Vera Z. Accidental mediastinal entry
via left internal jugular vein cannulation.
Intensive Care Med.
1985;11:154-157.
2. Andrews RT, Bova DA, Venbrux AC. How much guidewire is
too much? Direct measurement of the distance from subclavian
and internal jugular vein access sites to the superior vena cava-
atrial junction during central venous catheter placement.
Crit
Care Med.
Jan. 2000;28:138-142.
3. Ariditis J, Giala M, Anagnostidou A. Accidental puncture of
the right lymphatic duct during pulmonary artery ization.
Acta
Anaesthesiol Scand.
1988;32:67-68.
4. Benumof JL. Thrombosis after pulmonary-artery catheterization
via the internal jugular vein.
NEJM.
1982;306:1487. Letter.
5. Benya RV. Fibrin sheath formation surrounding a pulmonary
artery catheter sheath: eversion of the sleeve during catheter
removal.
Crit Care Med.
1990;18:345. Letter.
6. Bristow A, Batjer H, Chow V, Rosenstein J. Air embolism
via a pulmonary artery catheter introducer.
Anesthesiology.
1985;63:340-341. Letter.
7. Brzowski BK, Mills JL, Beckett WC. Iatrogenic subclavian artery
pseudoaneurysms: case reports.
J Trauma.
1990;30:616-618.
8. Eissa NT, Kvetan V. Guide wire as a cause of complete heart
block in patients with preexisting left bundle branch block.
Anesthesiology.
1990;73:772-774.
9. Hartung EJ, Ender J, Sgouropoulou S, Bierl R, Engelhardt W,
Engemann R. Severe air embolism caused by a pulmonary
artery introducer sheath.
Anesthesiology.
1994;80:1402. Letter.
10. Hightower D, March J, Ausband S, Lawrence BH. Comparison
of Staples vs Suturing for Securing Central Venous Catheters.
Acad. Emerg. Med.
1996;3:1103-1105.
11. Jobes DR, Schwartz AJ, Greenhow DE, Stephenson LW,
Ellison N. Safer jugular vein cannulation: recognition of
arterial punctures and preferential use of the external jugular
route.
Anesthesiology.
1983;59:353-355.
12. Kashuk JL, Penn I. Air embolism after central venous catheterization.
Surg Gynecol Obstet.
September 1984;159:249-252.
13. Kondo K, O’Reily LP, Chiota J. Air embolism associated with
an introducer for pulmonary arterial catheters.
Anesth Analg.
1984;63:871-872.
14. Macksood MJ, Setter M. Hydrothorax and hydromediastinum
after use of an indwelling percutaneous catheter introducer.
Crit Care Med.
1983;11:957-958.
15. Mihm FG, Rosenthal MH. Pulmonary artery catheterization.
In: Benumof JL, ed.
Clinical Procedures in Anesthesia and
Intensive Care.
Philadelphia, PA: JB Lippincott; 1992:419.
16. Paskin DL, Hoffman WS, Tuddenham WJ. A new complication
of subclavian vein catheterization.
Ann Surg.
March
1974;179:266-268.
17. Phifer TJ, Bridges M, Conrad SA. The residual central venous
catheter track – an occult source of lethal air embolism: case
report.
J Trauma.
1991;31:1558-1560.
18. Roy RC. Possible hazards from catheter sheath introducers.
Crit Care Med.
1984;12:616. Letter.
19. Thielen JB, Nyquist J. Subclavian catheter removal.
J Intravenous
Nurs.
March/April 1991;14:114-118.
Arrow International, Inc. recommends that the user be acquainted
with the reference literature.
*If you have any questions or would like additional reference
information, please contact Arrow International, Inc.
†
A registered trademark of Unilever Supply Chain, Inc.
Rx only.
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