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





sitting up

lying flat or in the Trendelenburg position

hydration status



breathing as catheter removed

deep or frequent breathing

hold breath or perform Valsalva maneuver


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


loose dressing

airtight dressing over exit wound for 12 hours

after removal

active ambulation immediately after

lie still for 30 minutes



• An airtight dressing is a Xeroform petrolatum dressing (Sherwood Medical).


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