A Registered Nurse (RN) manages patient care, administers treatments, and prevents complications, often involving specialized intravenous access devices, known as central venous access devices (CVADs). These devices provide reliable, long-term access to the bloodstream for necessary therapies. The question of whether an RN can remove a Peripherally Inserted Central Catheter (PICC) line addresses the intersection of nursing skill, clinical risk, and regulatory authority. This procedure exemplifies how a nurse’s scope of practice is defined by specialized training and institutional policy.
Understanding the PICC Line
A Peripherally Inserted Central Catheter (PICC) line is a thin, flexible tube used for prolonged intravenous (IV) therapy. While inserted peripherally, typically in the upper arm, the catheter tip rests in a large central vein near the heart, often the superior vena cava. This central location provides rapid dilution of medications and classifies the PICC as a central line.
PICC lines are routinely used for long-term treatments, such as extended courses of antibiotics, chemotherapy, or specialized nutritional support. Because a PICC line can remain in place for weeks or months, it reduces the need for repeated needle sticks and handles medications too irritating for smaller veins. This central placement is why its removal requires specific precautions.
RN Authority: State Laws and Institutional Policy
RN removal of a PICC line is generally permitted, but authorization depends on two intersecting regulatory frameworks. The first is the state Nurse Practice Act, which legally defines the maximum scope of practice for an RN. Many state Boards of Nursing explicitly include PICC line removal within the legal scope, provided specific training and competency requirements are met.
This permission requires the RN to complete specialized education that includes theoretical and practical components. This training ensures the nurse possesses knowledge regarding vascular anatomy, potential complications, and proper removal techniques. The second, and often more restrictive, factor is the specific policy of the healthcare facility where the nurse is employed.
Hospital policies frequently mandate stricter requirements than state law, often requiring documented competency verification before an RN is granted “certified” status. This verification typically involves supervised clinical practice and a skills checklist. Therefore, an individual RN cannot perform the removal without a specific prescriber’s order and current institutional certification. The procedure is not considered standard entry-level RN practice and requires documented, advanced training.
The Removal Procedure and Associated Risks
PICC line removal is complicated by the catheter’s central tip location and specific risks. The procedure requires the nurse to position the patient lying flat, or supine, to help prevent air embolism. This positioning ensures the exit site is level with or below the heart, minimizing the pressure gradient that could draw air into the vein.
The nurse removes the catheter slowly, instructing the patient to perform a Valsalva maneuver or exhale during the final moments of removal. This breath-holding technique increases pressure within the chest, reducing the risk of air being pulled into the central circulation. After withdrawal, the nurse must inspect the entire line to confirm the tip is intact, as a fragmented catheter can lead to serious vascular complications.
The most significant risk is the potential for an air embolism, which occurs when air enters the bloodstream and travels toward the heart. Other concerns include bleeding or difficulty in extraction if the catheter adheres to the vessel wall. To mitigate these issues, the nurse applies firm digital pressure to the exit site for a minimum of five minutes, followed by the placement of an occlusive dressing, often petroleum-based gauze, which seals the skin tract and remains in place for at least 24 hours.