1. Objective

To safely and effectively remove a Central Venous Pressure (CVP) line, minimizing the risk of complications such as infection, air embolism, and bleeding.

2. Scope

This SOP applies to all licensed healthcare professionals providing CVP line removal services under Upashay’s doctor services. This is intended for planned CVP line removals in a controlled setting, not for emergency procedures.

3. Required Personnel

  • Licensed doctor or registered nurse trained in CVP management and removal

4. Required Equipment and Supplies

  • Sterile gloves
  • Personal protective equipment (PPE): mask, face shield, gown
  • Sterile gauze pads
  • Antiseptic solution (e.g., chlorhexidine)
  • Occlusive dressing (e.g., transparent dressing or petroleum gauze)
  • Suture removal kit (if applicable)
  • Adhesive tape
  • Sterile scissors
  • Sterile saline (optional for flushing)
  • Resuscitation equipment (ambu bag and oxygen, if required)

5. Pre-Procedure Preparation

  1. Patient Assessment
    • Review the patient’s medical history and CVP line records, including reasons for CVP line placement, duration, and any complications.
    • Obtain informed consent, explaining the procedure, potential risks, and expected discomfort.
    • Assess the patient’s vital signs, including blood pressure, heart rate, and respiratory rate.
  2. Environment Preparation
    • Ensure a clean and sterile environment to minimize infection risk.
    • Assemble all required equipment within reach before beginning the procedure.
    • Position the patient in a supine (lying flat) position, with the head slightly lowered if possible (Trendelenburg position) to reduce the risk of air embolism.
  3. Hand Hygiene and PPE
    • Perform thorough hand hygiene before donning sterile gloves.
    • Wear PPE, including a mask, face shield, and sterile gloves, to protect both the patient and the healthcare provider.

6. Procedure Steps

  1. Inspect and Prepare the Site
    • Inspect the CVP insertion site for any signs of infection, redness, or swelling.
    • Remove any sutures securing the CVP line using sterile scissors.
  2. Clean the Site
    • Clean the area around the CVP insertion site with an antiseptic solution, moving outward in a circular motion from the site.
    • Allow the antiseptic solution to dry completely.
  3. CVP Line Removal
    • Instruct the patient to perform the Valsalva maneuver (hold their breath and bear down) as you remove the line to prevent air embolism.
    • Gently but steadily pull the CVP line out in one motion, applying consistent pressure to avoid resistance.
    • Immediately cover the site with sterile gauze and apply firm pressure for 3-5 minutes (or longer if the patient is on anticoagulants) to control bleeding.
  4. Securing the Site
    • Once bleeding has stopped, apply an occlusive dressing to the site to protect it from air entry and infection.
    • Secure the dressing with adhesive tape and instruct the patient to keep the area dry for at least 24 hours.

7. Post-Procedure Care

  1. Observation and Monitoring
    • Monitor the patient’s vital signs and assess for any immediate complications, such as bleeding, swelling, or signs of air embolism (e.g., sudden chest pain, difficulty breathing).
    • Encourage the patient to remain lying flat for a few minutes following the procedure to prevent dizziness or hypotension.
  2. Patient Education
    • Instruct the patient on caring for the site, including keeping the dressing clean and dry.
    • Inform the patient of signs of infection or complications, such as increased redness, swelling, pain, or fever, and when to seek medical attention.
  3. Documentation
    • Document the procedure in the patient’s medical records, including CVP line type, removal time, patient response, and any complications or follow-up instructions provided.

8. Emergency Protocols

  • Be prepared to provide immediate assistance in case of complications, such as bleeding or signs of air embolism.
  • Follow emergency protocols and provide resuscitation if necessary.

9. Quality Assurance and Safety Compliance

  • Ensure adherence to all infection control protocols and safety standards.
  • Conduct regular reviews of the procedure to enhance care standards and address any procedural concerns.