A midline catheter is a soft, thin tube inserted into a peripheral vein, typically in the upper arm. Its tip advances to the level of the armpit (axilla) but remains outside the central veins. This vascular access device is longer than a standard short peripheral intravenous (IV) line but shorter than a peripherally inserted central catheter (PICC). Midlines are used for intravenous therapies lasting a moderate duration, commonly one to four weeks, such as for prolonged antibiotic treatment or long-term hydration. Positioning the tip in a larger vein helps conserve the patient’s smaller veins. Removal is generally a straightforward procedure performed by a trained healthcare provider once therapy is complete.
Necessary Preparation for Removal
Before beginning the removal process, systematic preparation is necessary to ensure patient safety and maintain aseptic technique. The patient should be positioned comfortably, ideally lying flat on their back (supine position). This positioning helps reduce the risk of air entering the vein during catheter extraction.
Specific, sterile supplies must be gathered and organized on a clean surface, often contained within a sterile dressing change kit. These supplies include:
- Clean and sterile gloves
- An antiseptic solution like chlorhexidine
- Sterile gauze pads
- A transparent occlusive dressing for the final site
- A suture removal kit or sterile scissors, if the catheter is secured with stitches
Preparation concludes with hand hygiene and donning clean gloves to carefully remove the existing external dressing and assess the insertion site for any signs of complication.
Step-by-Step Removal Process
The removal process begins by gently peeling back the transparent dressing and any securement device, taking care not to dislodge the line or cause skin injury. Any sutures or adhesive securement strips must be carefully removed using sterile tools. If the site appears clean, the area around the catheter is prepped with antiseptic solution and allowed to air dry completely.
Once the securing mechanisms are removed and the antiseptic has dried, the patient is instructed to perform the Valsalva maneuver, if appropriate. This involves holding one’s breath and bearing down, which temporarily increases pressure in the chest cavity. This action helps prevent air from entering the vein as the catheter is withdrawn.
While the patient performs the maneuver, the healthcare provider firmly grasps the catheter hub near the skin and begins a slow, steady withdrawal, keeping the line parallel to the skin. The catheter should be pulled out in small, controlled increments without excessive force. If resistance is felt, withdrawal must be immediately stopped, and the physician notified, as forcing the line can cause it to break.
Once the catheter is fully removed, the entire length of the line, especially the tip, must be inspected to ensure it is intact. This check is a crucial safety step to rule out the possibility of a catheter embolism, confirming no fragment remains in the patient’s vein.
Immediate Post-Removal Site Care
Immediately upon full removal, firm and continuous pressure must be applied directly over the insertion site using sterile gauze. This pressure is maintained until hemostasis is achieved (bleeding has completely stopped), typically requiring five to ten minutes, especially if the patient is taking blood thinners. Adequate pressure seals the tract from the skin surface down to the vein, preventing both bleeding and the entry of air into the bloodstream.
After bleeding stops, the site is inspected for swelling or persistent oozing before the final dressing is applied. A sterile, occlusive dressing is placed over the puncture site to create a barrier against bacteria and maintain the seal. Sometimes, a petroleum-based ointment or gauze is applied first to further ensure an airtight seal and reduce the risk of air entry. The patient must keep this final dressing dry and in place for a minimum of 24 hours to allow the skin tract to fully close and heal.
Patients should avoid strenuous exercise or heavy lifting with the affected arm for the first 24 to 48 hours. Monitoring the site for any discharge or change in appearance is an ongoing part of the post-removal care.
Recognizing and Responding to Potential Complications
Patients and caregivers must be aware of specific signs that require immediate medical attention following midline catheter removal. One serious, though rare, complication is a venous air embolism, which occurs if air enters the vein and travels toward the heart. Signs include sudden shortness of breath, chest pain, confusion, or a sudden drop in blood pressure. If these symptoms occur, the patient should be immediately placed on their left side with their head down, and emergency medical services must be contacted.
Signs of infection at the insertion site or systemically also necessitate prompt medical evaluation. Local signs include increased redness, warmth, persistent pain, or the presence of pus lasting beyond 24 hours. Systemic infection (bacteraemia) can present with an unexplained fever, chills, or a general feeling of being unwell.
A mechanical complication is the inability to retrieve the entire catheter, which is why the tip must be inspected meticulously after removal. If the catheter is not intact, a fragment may have broken off and migrated into the bloodstream (a catheter embolism). Excessive or uncontrollable bleeding that does not stop after ten minutes of firm pressure is also an urgent concern. Immediate contact with a healthcare provider or emergency services is required in all these instances.