1. Avoid heparinize the CVC on the day of removal
In the case where it is necessary to remove the CVC, for example for infectious causes and the heparin has been administered, include the administration of protamine (immediate antagonist of heparin) before removal.
2. Place the patient in bed without a pillow, supine or Trendelenburg (upside down). Absolutely avoid the Fowler position, sitting or standing.
3. Instruct the patient to make an inhalation before removing and hold your breath while removing (Valsalva maneuver); if the Valsalva maneuver is contraindicated or impossible, remove the catheter during exhalation; also, indicate: not to cough, not to mention, do not laugh and do deep inhalations during removal.
4. Apply a covering of gauze with abundant gel-based iodine or antibacterial (for example: Betadine ointment, or Aureocort Edeven gel) on the insertion site during the removal and manually compress for 10 minutes, with the patient supine so as to seal instantly the air.
5. Apply waterproof bandage (Tegaderm) always with the patient supine.
6. Advise the patient to remain supine for 30 minutes considering the possible occurrence of bleeding. If this position is not possible to maintain, the patient can assume the position of semi-Fowler.
7. Leave the occlusive patch in place for 24 hours.
8. In case of infection please send the catheter in microbiology
The removal of the CVC is a routine procedure which, however, is not free from risks for the patient. Among these particular attention must be paid to the embolus gas that, in some cases, can get to be fatal.
The CVC, in fact, is by definition a venous catheter whose tip comes in vena cava or right atrium.
Therefore, the removal of the CVC implemented in conditions that favor entry of atmospheric air can cause an air embolism.
These conditions include: negative intrathoracic pressure due to inhalation phase, the CVC insertion site higher than the right atrium, the patient sitting, etc.