A Peripherally Inserted Central Catheter, commonly known as a PICC line, is a thin, flexible tube inserted into a peripheral vein in the arm and guided to a large central vein near the heart. This device is used to deliver medications, fluids, or nutrition over an extended period, avoiding the need for repeated needle sticks. Because the catheter tip rests near the heart, both its insertion and removal carry a risk of infection. Understanding the safety protocols used for removing this central line is important. This process does not require the full sterility of the original insertion, but rather a high level of cleanliness to ensure safety.
Understanding Aseptic Technique
PICC line removal is not classified as a fully “sterile procedure,” but rather a procedure performed using strict aseptic technique. A sterile procedure, such as the initial PICC line insertion, requires a complete sterile field to eliminate all microorganisms. Conversely, aseptic technique focuses on preventing the introduction of harmful microorganisms at the exit site. This approach is sufficient because the central portion of the catheter is being pulled out of the body, rather than pushed into it. The primary goal during removal is to prevent bacteria residing on the skin’s surface from following the catheter tract into the bloodstream. Healthcare providers achieve this by using sterile equipment for the parts of the procedure that contact the site, such as gloves, gauze, and the final dressing.
The Step-by-Step Removal Process
The removal process begins with careful patient preparation and positioning to minimize potential complications, particularly the rare but serious risk of an air embolism. The patient is typically asked to lie flat on their back, a position known as supine, with the arm containing the PICC line positioned below the level of the heart. This positioning increases central venous pressure and helps prevent air from being drawn into the vein as the catheter is pulled out.
The clinician first removes the existing protective dressing and any securing device, such as a StatLock, being careful to stabilize the catheter at the exit site. They then don sterile gloves and thoroughly clean the area around the catheter with an antiseptic solution, such as chlorhexidine, to eliminate surface bacteria. The actual removal involves applying gentle, steady traction to the catheter, pulling it out slowly in small, continuous increments.
During the final moments of removal, the patient is often instructed to perform the Valsalva maneuver—taking a deep breath and bearing down—or simply to exhale, which creates positive pressure in the chest cavity to prevent air from entering the open vein. If any resistance is encountered during the pull, the clinician must immediately stop and not use force, as this could lead to catheter breakage or damage to the vein wall.
Once the catheter is completely out, the healthcare professional immediately applies firm, digital pressure to the exit site with sterile gauze for a minimum of five minutes, or until all bleeding has stopped. The removed catheter is then inspected to confirm the tip is intact and that the entire length of the device has been successfully withdrawn.
Monitoring the Exit Site After Removal
Once bleeding has ceased, a sterile occlusive dressing, often petroleum-based gauze covered by a transparent dressing, is applied to the exit site to create an airtight seal. This dressing serves the dual purpose of keeping the site clean and physically preventing air from entering the venous tract as the vessel seals itself. Patients are instructed to keep this final dressing in place, clean, and dry for 24 to 48 hours.
Patients should avoid strenuous activities, heavy lifting, and excessive arm movement for the first 24 to 48 hours following the procedure to promote proper tissue healing. While showering can usually resume after this initial period, patients must avoid immersing the site in water, such as taking a bath or swimming, for up to one to two weeks, or until the skin has fully healed. This precaution prevents waterborne bacteria from entering the healing site.
Patients and caregivers must vigilantly monitor the exit site for signs of potential infection or complication in the days following the removal.
Signs of Complication
- Increasing redness, swelling, warmth, or pain at the site.
- Any unusual drainage or foul odor from the site.
- Systemic infection, which may present as a fever or chills.
- Sudden trouble breathing, chest pain, or severe dizziness, which require immediate emergency medical attention as they may indicate a delayed air embolism.