PICC Line Removal: Techniques, Tips, and Troubleshooting

PICC line removal is an essential part of patient care, often performed by nurses to discontinue intravenous therapy when it’s no longer needed. Peripherally inserted central catheters (PICC lines) are used for long-term access to administer treatments like antibiotics, nutrition, or chemotherapy.

While the removal process may seem routine, it carries risks if performed improperly, with studies showing that 1.2 percent of PICCs develop central line-associated infections and 6.7 percent result in symptomatic venous thromboembolism.¹ These risks emphasize the importance of having the proper technique and knowledge to ensure patient safety and support a smooth recovery.

In this article, we’ll guide you through the key steps of PICC line removal, offer practical tips, and outline troubleshooting strategies to handle common complications during the procedure.

Techniques for PICC line removal

PICC line removal involves a series of carefully executed steps. Following proper techniques ensures the procedure is performed efficiently while minimizing the risk of complications.

1. Preparing the patient and environment

Preparation is the foundation of a successful PICC line removal. You need to take several steps before starting the removal to create a safe and comfortable environment for the patient.

• Review the plan of care. Always confirm the provider’s orders for removing the PICC line, and make sure that the removal aligns with the patient’s current treatment plan​​. Taking the time to verify this helps prevent misunderstandings and ensures the timing of the removal is appropriate.
• Gain informed consent. Communicate with the patient about the procedure, including why it’s necessary and what to expect during and after the removal​. This conversation is vital to alleviating patient anxiety and ensuring cooperation.
• Hand hygiene and infection control. PICC lines carry an increased risk of infection, with studies finding that up to 8.1 percent of PICCs result in bloodstream infections,² making proper hand hygiene essential in preventing complications. Washing your hands thoroughly for at least 20 seconds and wearing clean gloves during the procedure can significantly reduce the risk of infection and ensure patient safety.
• Position the patient in a supine (flat) position. This facilitates easy access to the PICC insertion site and helps prevent complications such as air embolism during removal​. Additionally, keeping the patient comfortable contributes to an efficient removal process.

2. Step-by-step removal process

Once the patient and environment are prepared, you can begin the removal process.

• Remove the dressing. Start by slowly and gently peeling off the dressing from the insertion site. Pull from the bottom of the dressing and work upward to avoid accidentally dislodging the catheter​.
• Inspect the insertion site. Always assess the area around the catheter for redness, swelling, or discharge, as these may signal infection or irritation. The CDC advises against removing PICCs solely due to the presence of fever.³ Instead, evaluate whether there is evidence of infection in other areas or if the fever could be due to a noninfectious cause. Use your clinical judgment to determine whether removal is necessary. This approach helps avoid unnecessary catheter removal and ensures decisions are made based on the patient’s overall clinical context.
• Remove the securement device. You should follow the manufacturer’s guidelines when removing the securement device. Careful removal is essential to avoid damaging the catheter​, whether it’s an adhesive anchor or sutures.
• Remove the catheter. Using your dominant hand, remove the PICC line slowly and steadily while applying gentle pressure on the exit site with sterile gauze. It’s essential to ensure that the patient either holds their breath or exhales during removal to prevent air embolism​​.

3. Managing resistance during removal

Occasionally, you may encounter resistance while removing the catheter. Resistance can be caused by vasospasm (a sudden narrowing of the blood vessels) or tissue ingrowth, where tissue has grown around the catheter. Here’s what you can do if resistance occurs:

• Stop immediately. Avoid pulling harder, as this could damage the catheter or surrounding tissue. Place sterile gauze over the site and stop the procedure​.
• Apply a warm compress. Doing so can help relax the surrounding tissue and promote vasodilation, making it easier to remove the catheter​.
• Wait and reattempt. After 15 minutes, try removing the catheter again. If you still find resistance, inform the provider and follow institutional policies for further intervention​​.

4. Dressing the exit site and post-removal care

After the PICC line has been successfully removed, the exit site must be managed appropriately to ensure safe recovery.

• Achieve hemostasis. Apply pressure to the exit site until hemostasis is achieved, typically around 30 seconds. You may need to apply a petroleum-based gauze dressing to help seal the site​.
• Inspect the catheter. Always check the catheter tip to ensure it’s intact and consistent with the original documented length. If a piece of the catheter remains in the patient, emergency services must be contacted immediately​.
• Monitor and instruct the patient. After the procedure, instruct the patient to remain lying down for 30 minutes and to keep the dressing in place for at least 24 hours​. Assess the patient for immediate adverse reactions, such as dizziness or site irritation.

Tips for a successful PICC line removal

Patient and caregiver education is one of the most important aspects of a smooth and safe PICC line removal procedure. To foster patient confidence and minimize anxiety, explain what will happen during the removal process, what they should expect, and the steps they need to follow post-procedure. For example, patients should be aware that they must remain lying down for at least 30 minutes after removal and watch for signs of infection like redness or swelling.

Thorough documentation is equally important. Record any difficulties encountered during the removal, such as resistance, and note how these were managed. Additionally, you should document the patient’s response to the procedure, the condition of the catheter, and any education provided to the patient and caregiver about post-removal care. This provides continuity of care and offers valuable information for future healthcare providers.

Troubleshooting common PICC line removal issues

Despite careful preparation and technique, challenges may arise during PICC line removal. Below are some common issues and how you can address them:

Resistance during catheter removal

Resistance during removal can occur from vasospasm, tissue ingrowth, or catheter entanglement. If you encounter resistance, stop the removal immediately and apply a warm compress. Gentle relaxation techniques, such as elevating the patient’s arm, can also be beneficial. Wait about 15 minutes before attempting removal again. If the issue persists, seek further medical consultation.

Air embolism prevention

Although rare, air embolisms can occur if a catheter is removed while air enters the bloodstream. To prevent this, always instruct the patient to perform the Valsalva maneuver. This technique involves the patient holding their breath and bearing down as if exhaling with the mouth and nose closed. You can also instruct the patient to exhale as you remove the PICC line to reduce the risk of air entering the bloodstream.

Post-removal bleeding or infection

Applying firm pressure to the exit site right after PICC removal helps prevent bleeding. Additionally, monitoring the area for signs of redness, swelling, or pus ensures early detection of any infections, allowing for timely interventions.

Providing a safe PICC line removal

PICC line removal requires close attention to detail to protect your patient from complications. Proper preparation, careful removal, and post-procedure care are vital steps in avoiding complications such as infection, resistance, or catheter damage. Whether you are a seasoned nurse or a nursing student learning the ropes, mastering these steps ensures a smooth and safe process for both you and your patient.

For a step-by-step guide on how to remove a PICC line, with a video demonstration by instructor Lisa A. Gorski, be sure to check out our Peripherally Inserted Central Catheter (PICC) Removal course. Medbridge also offers a comprehensive clinical procedure manual available as part of our home health software ecosystem. This easy to follow, digital-first, manual serves as a way to ensure quality practice in the field.

References

1. Risk Factors for Early PICC Removal: A Retrospective Study of Adult Inpatients at an Academic Medical Center. Burton H. Shen, Lindsey Mahoney, Janine Molino, Leonard Mermel. medRxiv 2022.02.07.22270642; doi: https://doi.org/10.1101/2022.02.07.22270642
2. Barrigah-Benissan, K., Ory, J., Simon, C., Loubet, P., Martin, A., Beregi, J. P., Lavigne, J. P., Sotto, A., & Larcher, R. (2023). Clinical factors associated with peripherally inserted central catheters (PICC) related bloodstream infections: a single centre retrospective cohort. Antimicrobial resistance and infection control, 12(1), 5. https://doi.org/10.1186/s13756-023-01209-z
3. Centers for Disease Control and Prevention. (2022, April 15). Intravascular catheter-related infection (BSI) prevention strategies for healthcare personnel (HCP). U.S. Department of Health & Human Services. https://www.cdc.gov/infection-control/hcp/intravascular-catheter-related-infection/prevention-strategies.html