A midline catheter is a long, flexible tube inserted into a peripheral vein in the upper arm, typically the basilic, cephalic, or brachial vein. The catheter tip terminates in a large vein near the armpit, such as the axillary or subclavian vein, stopping short of the central circulation near the heart. This positioning makes it a long peripheral intravenous (IV) line, distinct from a PICC line, which extends to the superior vena cava. Midline catheters deliver IV fluids and medications compatible with peripheral veins, often for therapies lasting up to 30 days. Because the removal process involves puncturing a vein and carries a small risk of complication, the procedure must only be performed by a trained healthcare professional, such as a certified nurse or physician. The steps for removal require strict adherence to sterile technique and safety protocols.
Preparation and Necessary Supplies
Before removal, the clinician must confirm the order, explain the procedure, and obtain patient consent. Patient positioning is an important safety measure; the patient should be lying flat in a supine position with the arm extended, often at a right angle to the body. This positioning helps reduce the risk of air entering the vein.
A sterile field must be prepared by gathering all necessary supplies before the old dressing is removed. Required items generally include clean gloves for initial dressing removal, sterile gloves for the procedure, antiseptic swabs like chlorhexidine, and sterile gauze pads. If the catheter is secured with sutures, a sterile suture removal kit is also needed.
The clinician will first remove the old dressing and external tape. The insertion site is then thoroughly cleaned with the antiseptic solution and allowed to air dry completely. This cleaning step is performed immediately before donning sterile gloves to reduce the microbial count on the skin surface.
The Midline Removal Procedure
Once the site is prepped, the clinician carefully removes any securement device, such as a locking device or sutures. The skin near the insertion point is stabilized with the non-dominant hand. A sterile gauze pad is placed over the site, but pressure is not yet applied.
The patient may be instructed to take a deep breath and hold it, or to exhale forcefully. This maneuver increases pressure in the chest and helps prevent air from being drawn into the vein during removal.
The catheter is then gently grasped near the insertion site and withdrawn slowly and steadily, parallel to the skin. A controlled, non-forceful motion is used to avoid causing trauma to the vein wall or breaking the catheter. If any resistance is met during withdrawal, the clinician must immediately stop and not force the removal. Resistance may indicate a venous spasm or a fibrin sheath and requires notification of a physician.
The moment the catheter tip is completely out of the skin, firm and immediate pressure is applied to the insertion site with the sterile gauze. This pressure is maintained to promote coagulation and stop any bleeding from the venipuncture. After the catheter is fully removed, it is a mandatory safety step to inspect the entire length of the line, especially the tip, to ensure it is intact and that no fragments remain in the patient’s bloodstream.
Immediate Post-Removal Care
After the catheter is removed and the tip is confirmed intact, manual pressure must be sustained over the insertion site to achieve hemostasis. For non-anticoagulated patients, pressure is typically maintained for 2 to 3 minutes. Individuals taking blood thinners may require pressure for 5 to 10 minutes or longer until all bleeding has completely stopped.
Once bleeding has ceased, a sterile occlusive dressing is applied over the site. This may be a transparent plastic film or sterile gauze covered with tape. Some protocols recommend applying a petroleum-based ointment or sealant to the opening before the dressing to further seal the skin-to-vein tract and minimize the risk of air entry.
The dressing should remain in place for at least 24 hours to protect the site from contamination. For the first 24 hours, the patient should keep the insertion site completely dry and avoid activities that place significant strain on the arm, such as heavy lifting. Patients are also advised not to submerge the arm in water for bathing until the site is healed. The patient may also be asked to remain resting in a supine position for up to 30 minutes following the procedure to reduce the possibility of an air embolism.
Recognizing and Managing Complications
Midline catheter removal is generally safe, but patients and caregivers must be aware of signs that may indicate a problem requiring prompt medical attention.
Persistent Bleeding
The most common issue post-removal is localized bleeding that does not stop. If firm pressure has been applied for 10 to 15 minutes and the site continues to bleed or ooze significantly, the healthcare provider should be contacted immediately for assessment.
Localized Infection
Signs of a localized site infection are a concern, as the insertion point is an open wound. Symptoms include increasing redness, swelling, warmth, or tenderness at the former access site. Pus-like drainage or a fever also warrant immediate contact with a medical professional to prevent a potentially serious bloodstream infection.
Air Embolism
Although rare, a potentially severe complication is an air embolism, where air enters the bloodstream through the open vein. Symptoms can be vague but include sudden shortness of breath, chest pain, dizziness, confusion, or a feeling of lightheadedness. If these symptoms occur, emergency medical services should be accessed immediately. The patient should be positioned on their left side with the head lower than the feet, if possible, while awaiting help.