CVC Removal Guideline

Care Algorithm for Determining Line RemovalDRAFTv.2017 0424START Indication for line removal Ongoing access needs Therapy Complete*1 A No Utilize “Line Selection Tool” to determine appropriate accessYes Remove line InfectionOngoing access needsLine is not functioning Remove line No Yes Vessel thrombosis Catheter occlusion Ensure appropriate new accessYes No NoYesUse VAT Guideline Page 1 of 2 *1. Consider removing line if ≥48h w/o use for NICU and ICU.Prior to Removal:Always consider ongoing access needs and if patient meets high risk criteria for accessIf Patient in need of new access, utilize line stratification tool Per ACCP Guideline, consider:-Flushing and aspirating-Tip placement appropriate-Patient’s symptoms (e.g. pain) Obtain chest x-ray Position related issueRemove/Replace reposition as possible (consider power flushNo Yes Remove/replace vs. reposition as possible(*consider power flush) Use ACCP guideline to determine if removal and Hem consult need Updated 1/2019 Care Algorithm for Determining Line RemovalDRAFTv.2017 0424 Patient typeDialysis dependent A Maintain line, treat for 7-10 days *1 Staph aureus, gram negbacilli, fungal Complicatedinfection? Other Yes Type of infection Response to treatment Yes No Coagnegstaph, enterococcus Tunnel infection,port abscessType of complication Remove line/treat for 7-10 days Remove line/treat for 4-6 weeks Septic thrombosis, osteomyelitis,endocarditis Uncomplicated infection:Fever resolution within 72 hours with no otherintravascular hardware Critical line in high risk line insertion patient Non-responsive to treatment if: -Clinical deterioration-Relapsing/persistent bacteremia-Fever >72 hours-Conversion to complicatedinfectionKeep line Remove lineNon-responsive Responsive No Type ofinfection Treat 10-14 days*1Treat 10-14 days*1 Remove lineFungal Enterococcus Coagnegstaph, staph aureus,gram negbacilli Page 2 of 2 *1-Consider antibiotic/ethanol lockComplete treatment or at least negative cultures for 48h.If patient to receive high dose immunosuppression (i.e. BMT), consider replacing line even if cultures become negative T BD High risk criteria for line insertion:-≥3 prior tunneled lines-History of venous thrombosis-Documented abnormal vascular anatomy-History of congenital hearth disease or cardiac surgery-History of difficult access Question for ID-Enterococcus for non-high risk-When to consult