Transthoracic line removal in PICU

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Objectives

To provide a consistent and safe approach to transthoracic line removal within PICU.

Scope

Applies to removal of all intrathoracic cardiac lines (LA and PA) within PICU at RHSC, Yorkhill.

Audience

Paediatric critical care staff.

The decision to remove a transthoracic line should be reached during the morning ward round between the PICU Consultant for Cardiac patients and the Cardiothoracic Consultant staff. The line should be removed during the day Monday to Friday between the hours of 0900 to 1600. Further to this the following procedures should take place:

 

1) All lines should be removed by a cardiothoracic surgeon.

 

2) A sterile dressing pack and gloves with suture cutters should be made available to the surgeon.

 

3) Heparin should be stopped for 2 hours prior to line removal. In patients on treatment as opposed to prophylactic heparin this period may have to be shorter.

 

4) Capping off the line. The consultant surgeon responsible for the patient should intimate whether he wishes the line to be capped off and when this has to be done.

 

5) A Full Blood Count and coagulation screen should be performed within four hours prior to line removal.

 

6) The patient should be cross-matched for one unit of blood prior to line removal and this should be readily available.

 

7) Ensure that the patient has adequate IV access.

 

8) Chest tubes, Arterial line and central line to be left in for 2 hours after line

removal.

 

9) Chest tubes should be checked to ensure patency prior to line removal.

 

10) Appropriate analgesia/sedation should be administered, where appropriate, prior to removal on clinical need.

 

11) The child should be closely monitored for signs of tamponade ie narrow pulse pressure, tachycardia, hypotension, raised CVP/JVP, muffled heart sounds, increased chest drain losses for 2 hours post drain removal.

 

12) The child should have hourly neuro-obs performed for the first 2 hours following line removal looking for evidence of stroke from embolusparticularly with LA line removal.

 

13) Heparin should be recommenced one hour after line removal. A bolus should not be given.

 

14) In the event of a suspected cardiac tamponade cardiothoracic surgery and cardiology staff should be informed immediately and preparation made to open the chest emergently.

 

15) An echo should be performed if patient stability allows to confirm diagnosis prior to opening chest.

 

 

 

Editorial Information

Last reviewed: 01 February 2015

Next review: 01 February 2018

Author(s): Richard Levin