Chapter 8: IV Therapy
8.9 Removal of a PVAD-Short, Midline Catheter, Percutaneous Non Hemodialysis CVC, and PICC
Critical Thinking Exercises: Questions, Answers, and Sources / References
- What is the purpose of applying pressure to the site after the cannula has been removed?
Answer: to promote hemostasis (clotting) at the site
2. Name five factors to consider prior to discontinuing an IV.
Answer:
- Is the patient drinking enough fluids?
- Is the patient voiding, passing gas, and having bowel sounds?
- Is there a need for the IV (IV meds)?
- Are the lab values within normal limits (Hgb, K)?
- Is the patient using an epidural/PCA and needs IV access as part of safety protocols?
- Do you have an order from the prescriber, or are you doing this under your independent scope of practice? If the later, is this in agreement with agency policy?
3. What is the purpose of Trendelenburg positioning and the Valsalva maneuver during CVC (percutaneous non hemodialysis central catheter, PICC) removal?
Answer: Trendelenburg position reduces risk of air emboli during catheter removal by decreasing negative pressure in the intrathoracic cavity. If you aren’t able to position the client as such, have the patient perform the Valsalva maneuver just prior to catheter removal. If they can’t do that either, remove the catheter at the end of inspiration.
Sources:
Interior Health. (2012). Parenteral practices manual. http://insidenet.interiorhealth.ca/Clinical/parenteralccr/Pages/Manual.aspx
Perry, A.G., Potter, P.A., & Ostendorf, W. (2017). Clinical skills and nursing techniques (9th ed). St. Louis, MO: Elsevier-Mosby.
- When removing a CVC, the primary reason to position the patient in Trendelenberg and get them to perform the Valsalva maneuver is to: (Select all that apply)
| Distractor | Answer | More information |
| a. Provide distraction while removing the catheter. | Incorrect | While these things do provide some distraction, the rationale for Trendelenberg positioning and the Valsalva maneuver is safety. Specifically these increase intrathoracic pressure and reduce the risk of air being drawn into the line during removal |
| b. To prevent air embolism | Correct | This position and maneuver increases intrathoracic pressure and reduces risk of air being drawn into the line during removal |
| c. To reduce the risk of bleeding by increasing intrathoracic pressure. | Incorrect | Trendelenburg positioning and Valsalva maneuver do not reduce risk of bleeding. Instead these increase intrathoracic pressure and reduce the risk of air being drawn into the line during removal |
| d.To reduce risk of infection. | Incorrect | Trendelenburg positioning and Valsalva maneuver do not reduce risk of infection. Instead these increase intrathoracic pressure and reduce the risk of air being drawn into the line during removal |
Source:
Perry, A.G., Potter, P.A., & Ostendorf, W. (2017). Clinical skills and nursing techniques (9th ed). St. Louis, MO: Elsevier-Mosby.
Phillips, L. D. (2005). Manual of IV therapies. Philadelphia, PA: F.A. Davis Company.
