This is carried out in the tertiary centre and suitable arrangements will be made with the child (if appropriate) and the family for this to be done.

This procedure should only be carried out by nurses and doctors deemed competent in PICC line removal.

Equipment required

• sterile pack
• chloraprep swab
• sterile gloves
• bandage for pressure dressing
• sterile scissors
• white top universal container
• microbiology form.

Procedure

1. Explain procedure to the child or young person and reassure them that this is normally a simple uncomplicated procedure. Obtain verbal consent and ensure that they are comfortably positioned. The play leader and/or distraction therapy may help the child cope more easily with the procedure;
2. Put on plastic apron for personal protection;
3. Perform hand hygiene as per the WHO 5 moments for hand hygiene and prepare equipment;
4. Make the child or young person comfortable and ensure the insertion site is below the level of the heart. This is to minimise the risk of air embolism;
5. Loosen the existing dressing use sterile adhesive remover;
6. Perform hand hygiene as per the WHO 5 moments for hand hygiene. Put on sterile gloves;
7. Remove dressing. Clean the site with Chloraprep swab;
8. Hold a piece of gauze above the excision site to support the surrounding skin;
9. Apply traction on the PICC and gently pull the catheter in a steady and even manner moving the hand along the length of the PICC and pulling from the insertion point;
10. When the line is completely removed hold the sterile gauze over the insertion/ excision site point and apply gentle finger pressure until any bleeding stops.
11. Once any bleeding has stopped, replace the gauze with further sterile dressing and then bandage the site. This will act as a pressure bandage and will minimise the risk of a haematoma formation;
12. Tip of catheter must be sent to microbiology for culture and sensitivity;
13. Remove apron and gloves and dispose of as per local policy;
14. Perform hand hygiene as per the WHO 5 moments for hand hygiene;
15. Ensure that patient is left comfortable and that the child or young person (if appropriate) and family are aware of any adverse affects that may result from PICC line being removed;
16. Document the removal of line in child or young person’s notes;
17. Remove dressing in 24 hrs and check for signs of infection around the PICC line exit site.

If any difficulty when removing PICC Line:

1. If resistance is encountered when removing the line it may be due to venospasm within the arm. Stop the traction on the catheter and apply a warm compress to the arm for 20 minutes to encourage venous dilation.
2. Again attempt to remove line. Do not stretch the PICC line or add undue pressure as the line may break. Always inspect the line after removal and ensure it is the same length as was documented at time of insertion.
3. If problems removing PICC cannot be resolved, seek advice from medical staff. Referral for removal under fluoroscopy may occasionally be necessary.