Arterial Line Removal

1
Arterial Line Removal

• Competency Assessment for Registered Professional
  Nurses in the Critical Care Areas

Reference AACN Procedure Manual for Critical
Care, 5th Edition, pgs 58-59.
2
Equipment

• Non-sterile procedure gloves
• Face mask with fluid shield
• Protective gown
• Suture removal kit
• Sterile 4X4 gauze pads
• Tape
• 3-ml syringe with blunt tip canula

3
Procedure

• Steps
• 1. Assess coagulation
• Consult with MD prior to catheter removal

• Rationale
• ? PT, PTT, INR and/or ? platelets will affect
  bleeding times
• Special considerations
• If laboratory values are abnormal, pressure will
  need to be applied for a longer period in order
  to achieve hemostasis.

4
Procedure

• Steps
• 2. Wash hands and don non-sterile gloves, a
  fluid-shield mask, and a protective gown.

• Rationale
• Reduces the transmission of microorganisms
  standard precautions.
• Special considerations
• RNs may remove radial a-lines ONLY. MD to remove
  femoral a-lines.

5
Procedure

• Steps
• 3. Remove the dressing. Clip sutures if
  present.
• 4. Attach the 3-ml syringe to the blood sampling
  port, turn the stopcock off to the flush solution
  and draw blood back through the tubing.

• Rationale
• Prepares the catheter for removal.

6
Procedure

• Steps
• 5. Apply pressure 1-2 finger widths above the
  insertion site.
• 6. Pull out the arterial catheter using a
  sterile 4 X 4 gauze pad to cover the site as the
  catheter is removed.

• Rationale
• 5. The arterial puncture site is above the skin
  puncture site because the catheter enters the
  skin at an angle.
• 6. Prevents splashing of blood.

7
Procedure

• Steps
• 7. Continue to hold proximal pressure and
  immediately apply firm pressure over the
  insertion site as the catheter is removed.

• Rationale
• Prevents bleeding
• Special considerations
• Inspect the catheter following removal. Insure
  that it has been removed in its entirety.

8
Procedure

• Steps
• 8. Continue to apply pressure for a minimum of 5
  minutes for the radial artery.

• Rationale
• Achieve hemostasis
• Special considerations
• Longer periods of direct pressure may be needed
  to achieve hemostasis in patients receiving
  systemic heparin or thrombolytics or those who
  have coagulopathies.

9
Procedure

• Steps
• 9. Apply a pressure dressing to the insertion
  site.

• Rationale
• A pressure dressing will help prevent rebleeding.
• Special considerations
• The dressing should not encircle the extremity in
  order to prevent ischemia of the extremity.

10
Procedure

• Steps
• 10. Discard supplies and wash hands.

• Rationale
• Reduces the transmission of microoorganisms
  standard precautions.
• Special considerations
• Catheter should be discarded in the sharps
  container tubing discarded in the red-bag
  garbage.

11
Outcomes

• Expected
• Adequate circulation to the involved extremity
• Adequate sensory and motor function to the
  involved extremity
• Absence of infection
• The catheter is removed intact

• Unexpected
• Pain or discomfort at the catheter insertion site
• Impaired peripheral tissue perfusion
• Redness, warmth, edema, or drainage at or from
  the insertion site
• Impaired sensory or motor function of the
  extremity

12
Documentation

• Patient and family education
• Date and time of catheter removal
• Peripheral vascular and neurovascular assessment
• Any unexpected outcomes and interventions.

13
Please return to the class page, Click on the
link to the quiz.