Removal of a central venous catheter (CVC) or introduction of a guidewire may rarely be followed by a life-threatening complication. This is termed the CVC removal distress syndrome. It can be prevented by being careful before and after catheter removal.
Complications reported ("neurocardiopulmonary distress"):
(1) paresis
(2) coma
(3) respiratory failure
(4) shock
(5) pulmonary sepsis
(6) sudden death
Air embolism is believed to be the most probable cause but additional factors may contribute (thromboembolism, damage to cardiac conducting system, etc.).
Clinical findings that may appear soon after catheter removal:
(1) difficulty breathing
(2) apprehension or confusion
(3) agitation
(4) hearing of a sucking sound
(5) new systolic murmur with a churning sound
Guidelines to Prevent Occurrence
|
Parameter |
Avoid |
Recommend |
|
position |
sitting up |
lying flat or in the Trendelenburg position |
|
hydration status |
dehydration |
well-hydrated |
|
breathing as catheter removed |
deep or frequent breathing |
hold breath or perform Valsalva maneuver |
|
removal |
pressing or rubbing against the neck over the carotid artery |
occlude catheter or exit wound with fingertip |
|
treatment of exit site |
|
apply antibiotic ointment over the exit wound; suture closed if large |
|
dressing |
loose dressing |
airtight dressing over exit wound for 12 hours |
|
after removal |
active ambulation immediately after |
lie still for 30 minutes |
where:
• An airtight dressing is a Xeroform petrolatum dressing (Sherwood Medical).
Purpose: To prevent the central venous catheter (CVC) removal distress syndrome and to detect it if it develops.
Specialty: Cardiology, Emergency Medicine, Pulmonology
Objective: risk factors, complications, adverse effects
ICD-10: R57, T80,
