Forum topic

Interesting to see this post today! It directly relates to my recent experience with a physician regarding this type of line and home care. Please see my post from earlier today regarding safe lines for home care. Under what circumstances are patients using these particular lines in the home setting? Why is this type of line in place and not a tunneled, an implanted port or a PICC line being used? As stated in my post from earlier today......I understand that there can be an exception to every rule depending on patient situation and need. However, in general, it is my opinion that these types of lines should not be used in the home setting. They are higher risk for infection, airembolism, etc. Just not a good idea! As far as removing these lines the same protocol followed to remove them while still an inpatient should be used. In my facility, we lay the patient as flat as possible (considering patient tolerance and condition of course), have them take a deep breath and valsalva (or coordinate with ventilator breaths), gently pull back the line assuring that the tip is intact, apply pressure until hemostasis (may require putting head of bed back upright), apply antibiotic ointment to the site and cover with sterile gauze and occlusive dressing. Should also work in the home setting as the same principles would apply. The worst complication that can be seen (from my experience) is air embolus upon removal if patient head left upright and/or without employing the concept of the "deep breath and hold it" with valsalva maneuver. These lines seem to be a 7fr or larger so you also may have some bleeding issues depending on patient condition, meds, etc. A dialysis line would be much larger in size so the complication risk would be higher as expected. I also have a question for you..........do you have reference for these lines being safe in the home environment? I would like actual evidence to present to a physician in support of other vascular access devices being safer for home use? Thanks for any input you may have into my issue as well. :-)

Interesting to see this post today! It directly relates to my recent experience with a physician regarding this type of line and home care. Please see my post from earlier today regarding safe lines for home care. Under what circumstances are patients using these particular lines in the home setting? Why is this type of line in place and not a tunneled, an implanted port or a PICC line being used? As stated in my post from earlier today......I understand that there can be an exception to every rule depending on patient situation and need. However, in general, it is my opinion that these types of lines should not be used in the home setting. They are higher risk for infection, airembolism, etc. Just not a good idea! As far as removing these lines the same protocol followed to remove them while still an inpatient should be used. In my facility, we lay the patient as flat as possible (considering patient tolerance and condition of course), have them take a deep breath and valsalva (or coordinate with ventilator breaths), gently pull back the line assuring that the tip is intact, apply pressure until hemostasis (may require putting head of bed back upright), apply antibiotic ointment to the site and cover with sterile gauze and occlusive dressing. Should also work in the home setting as the same principles would apply. The worst complication that can be seen (from my experience) is air embolus upon removal if patient head left upright and/or without employing the concept of the "deep breath and hold it" with valsalva maneuver. These lines seem to be a 7fr or larger so you also may have some bleeding issues depending on patient condition, meds, etc. A dialysis line would be much larger in size so the complication risk would be higher as expected. I also have a question for you..........do you have reference for these lines being safe in the home environment? I would like actual evidence to present to a physician in support of other vascular access devices being safer for home use? Thanks for any input you may have into my issue as well. :-)

 Technically, the procedure could be performed anywhere the patient can be placed in the flat position. The question is whether you can manage all of the possible outcomes in the home or other alternative setting. I have seen lots of strange things happen when the catheters are pulled in the hospital

Air emboli is the one we have the greatest concern about. The ointment and dressing on the site should create a seal over the skin-to-vein tract. But there is a published case of the catheter being removed and shortly afterward the patient going out to smoke. Deep inhalation from smoking pulled air into the fibrin sheath still attached to the puncture site. They were able to get an image of air inside this sheath. 

Thrombus emboli - pulling any CVC can mean an attached thrombus is dislodged and sent to the lungs. I have seen this in a post-op nephrectomy patient that was being discharged. He remained in ICU for a few more days and discharge was cancelled

AV fistula creation and excessive bleeding. I saw this occur when a subclavian catheter was removed. There has been erosion between the subclavian vein and artery and the presence of the catheter prevented the bleeding. When the IV nurse pulled the catheter, the bleeding started and could not be stopped. This was arterial bleeding under the clavicle so we could not hold direct pressure. This required immediate surgical repair. I have only seen this once but it does happen. 

So you would need to decide how you would be able to manage these and all other possible outcomes such as catheter fracture and embolism, plus air, and thrombus and bleeding. If you decide you can manage all of these in the home, then your answer would be yes for removal in the home setting. 

Lynn