Procedure: Removal of a Pulmonary Artery Catheter

PROCEDURE FOR REMOVAL OF PULMONARY ARTERY CATHETERS

1. Apply Related Procedures and Policies
2. Determine Brand of Introducer and Prepare Dressing Tray
3. Evaluate and Modify IV Infusions
4. Remove Dressing
5. Cleanse Site
6. Remove Catheter
7. Post Removal
8. Document

This procedure is for use by RNs in CCTC who are approved to remove pulmonary artery catheters.

RNs are not approved to remove a Swan Ganz^TM Paceport pulmonary artery catheter IF a temporary pacing wire is in place.  RNs are not approved to remove the Paceport^TM temporary pacemaker wire Chandler Probe^TM from within the right ventricular lumen of a Paceport^TM model catheter.

Patients must be connected to Continuous ECG monitoring during removal.  Removal should be performed in a location where a Cardiac Arrest Cart is available in case of persistent arrhythmia (rare, most arrhythmias resolve once catheter is out).

If the Introducer is also to be removed, the pulmonary artery catheter should be removed first and an obturator inserted into the introducer to prevent air embolism or contamination. The introducer should be removed separately according to the Procedure for Removal of a Central Venous Catheter.  

PROCEDURE

 1.

Apply Related Procedures and Policies

Confirm order and ensure appropriate PPE.

Determine whether the introducer is and Edwards^TM or Arrow^TM product. Review poster that shows each introducer and correct cap, and reviews instructions for applying and removing each brand (different process for each brand). 

Prepare Dressing Tray

1. Perform hand hygiene and open central line dressing change tray.
2. Don non-sterile gown, gloves, bouffant and mask with face shield.
3. Perform hand hygiene and prepare dressing tray aseptically using transfer forceps to add supplies
4. Open chlorhexidine swabstick and partially remove swabstick with transfer forceps
5. Open obturator and transfer to tray.
6. If available, have a second person assist by inserting the obturator cap upon removal of the catheter

Evaluate and Stop Infusions Before Removing Pulmonary Artery Catheter

Ensure that all vasopressors are infusing into the INTRODUCER.  Infusions into the introducer will be unaffected by catheter removal. 

Relocate any medications that are infusing into the blue, white or orange lumens into another appropriate IV site (peripheral, PICC or another CVC).

Turn off all infusions to the proximal injectate or proximal infusion ports (blue, white or orange). 

 4.

Remove Dressing

Remove the old dressing wearing non-sterile gloves and discard. 

Use a CHG swabstick with a shoveling technique to loosen the CHG pad. 

Scrub the insertion site per standard procedure and allow 2 minute dry time. (Procedure for Central Line Dressing Change).

Discard dressing appropriately and perform hand hygiene.

Sterile technique is maintained to prevent introduction of bacteria into introducer.

The dressing will need to be removed and replaced to access the connection to the introducer.

5.

Cleanse Site

Don sterile gloves.

Scrub the insertion point of the introducer and the insertion site with chlorhexidine 2% and alcohol 70%. Scrub the . Allow minimum 2 minute dry time.

Place the obturator within ease of reach.

6.

Confirm Balloon Deflation and Remove the Catheter

1. Confirm that the balloon is deflated and in the unlocked position.
2. Confirm a PA waveform from the tip of the catheter prior to starting
3. Remove any tape or anchors on the sleeve that would impeded smooth removal.
4. Disconnect the sleeve from the introducer using technique specific to model of Introducer. 
5. Gently withdraw 1-2 cm of catheter to ensure that the adapter is unlocked and catheter will move freely
6. Slide the entire locking device and sleeve back to expose several inches of pulmonary artery catheter.
7. Scrub the introducer at the insertion hub with a Chlorhexidine 2% and alcohol 70% swabstick and allow 2 minute dry time. 
8. Grip the pulmonary artery catheter and remove the device with one steady withdrawal. Monitor for ectopic rhythm. DO NOT attempt to withdraw the catheter through the sleeve - you will restricts the amount of catheter that you can remove at one time, which may results in the catheter being "held up" in the right ventricle.
9. Stop when you reach the 10 -15 cm marking (single thin black band is 10cm). 
10. Pick up the obturator with your dominant hand.
11. Ask the patient to hold their breathe, then withdraw the final segment of catheter with your non-dominant hand (it will slip out easily). Immediately connect the obturator cap as you remove the catheter.
12. Lock the obturator in place according to product specific instructions.

If you encounter any resistance, stop the procedure and notify the physician immediately. If the tip is in the right ventricle at this point, inflate the balloon and lock it in the inflated position to reduce the chance of ventricular ectope. The balloon can be left inflated if the tip is in the right ventricle as blood flow will not be obstructed.

Post Removal

If the introducer is being removed, use Procedure for Removal of a Temporary Central Venous Catheter.  

Complete dressing change as per Procedure for Central Line Dressing Change.

Document

Document date and time of removal in the Device Band, PA Catheter section. 

Document dressing application in the PA Catheter Section.