Removing Catheters: Managing Freezes and Fractures
By Deborah Blum, RN, C, CIC
Center for Devices and Radiological Health Food and Drug Administration, Rockville, Md.
As a nurse was removing the last 20 cm of a peripherally inserted central catheter (PICC), he encountered resistance. During repeated attempts to remove it, the PICC fractured. He clamped the exposed portion of the catheter and arranged to have the PICC surgically removed.
What went wrong?
Long-term, indwelling venous catheters (such as PICCs and midline catheters) sometimes "freeze" or fracture externally or internally during removal. Freezing may occur if a fibrin sheath builds up around the catheter's tip or if the vein has spasms (sometimes because of a tortuous vein path). But no evidence currently implicates any particular catheter material or the indwelling time.
What precautions can you take?
If you encounter difficulty removing a catheter, try one or more of the following techniques to promote vasodilation and allow the catheter to move more freely.
- Place warm compresses on the skin along the vein.
- Insert a second catheter in the same vein below the original catheter's insertion site and infuse warm saline. Besides promoting vasodilation, the solution also increases fluid volume around the catheter.
- With a physician's order, administer oral nifedipine or apply nitroglycerin paste to the skin over the vein.
If, despite your efforts, the catheter tip fractures internally, place a tourniquet above the tip's location to prevent migration and immediately notify a physician.
Although you need to support the adverse-event reporting policy of vour health care facility, you may voluntarily report a medical device that doesn’t perform as intended by calling MedWatch at 1-800-FDA 1088 (fax: 1 800-FDA-0178). The opinions and statements contained In this report are those of the author and may not reflect the views of the Department of Health and Human Services.