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. 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. Procedure

4. 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. Procedure

5. 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. Procedure

6. 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. Procedure

7. 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. Procedure

8. 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. Procedure

9. 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. Procedure

10. 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. Procedure

11. 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 Outcomes

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.