Removing Arterial and Femoral Lines

Goal: The line is removed intact and without injury to the patient.

1. Verify the order for removal of arterial or femoral line in the patient’s medical record.

2. Gather all equipment and bring to bedside.

3. Perform hand hygiene and put on PPE, if indicated.

4. Identify the patient.

5. Close curtains around bed and close the door to the room, if possible. Explain the procedure to the patient.

6. Ask the patient to empty his or her bladder. Maintain an IV infusion of normal saline via another venous access during the procedure, as per medical orders or facility guidelines.

7. If the bed is adjustable, raise it to a comfortable working height, usually elbow height of the caregiver (VISN 8 Patient Safety Center, 2009).

8. Put on clean gloves, goggles, and gown.

9. If the line being removed is in a femoral site, use Doppler ultrasound to locate femoral artery 1 to 2 inches above the entrance site of the femoral line. Mark with ‘X’ using indelible pen.

10. Turn off the monitor alarms and then turn off the flow clamp to the flush solution. Carefully remove the dressing over the insertion site. Remove any sutures using the suture removal kit; make sure all sutures have been removed.

11. Withdraw the catheter using a gentle, steady motion. Keep the catheter parallel to the blood vessel during withdrawal. Watch for hematoma formation during catheter removal by gently palpating surrounding tissue. If hematoma starts to form, reposition your hands until optimal pressure is obtained to prevent further leakage of blood.

12. Immediately after withdrawing the catheter, apply pressure 1 or 2 inches above the site at the previously marked spot with a sterile 4 4 gauze pad. Maintain pressure for at least 10 minutes, or per facility policy (longer if bleeding or oozing persists). Apply additional pressure to a femoral site or if the patient has coagulopathy or is receiving anticoagulants.

13. Assess distal pulses every 3 to 5 minutes while pressure is being applied. Note: dorsalis pedis and posterior tibial pulses should be markedly weaker from baseline if sufficient pressure is applied to the femoral artery.

14. Cover the site with an appropriate dressing and secure the dressing with tape. If stipulated by facility policy, make a pressure dressing for a femoral site by folding four sterile 4 4 gauze pads in half, and then applying the dressing.

15. Cover the dressing with a tight adhesive bandage, per policy, and then cover the femoral bandage with a sandbag. Remove gloves. Maintain the patient on bed rest, with the head of the bed elevated less than 30º, for 6 hours with the sandbag in place. Lower the bed height. Remind the patient not to lift his or her head while on bed rest.

16. Remove additional PPE. Perform hand hygiene. Send specimens to the laboratory immediately.

17. Observe the site for bleeding. Assess circulation in the extremity distal to the site by evaluating color, pulses, and sensation. Repeat this assessment every 15 minutes for the first 1 hour, every 30 minutes for the next 2 hours, hourly for the next 2 hours, then every 4 hours, or according to facility policy. Use log rolling to assist the patient in using the bedpan, if needed.