Intravenous (IV) therapy is a common medical procedure that delivers fluids, blood, and medications directly into a patient’s bloodstream. While the initiation of an IV is important, knowing the correct procedure for discontinuation is equally critical for preventing complications like infection or bleeding. Following a standardized protocol ensures patient comfort and safety throughout the process.
Pre-Procedure Checklist
Before attempting to discontinue an IV, a healthcare provider must follow a specific checklist to ensure both patient and provider safety. This includes verification of the medical order, patient identification, and proper assessment.
Verifying the Order and Patient Identification
The first step in the process is to verify the healthcare provider's order for the IV removal. This prevents accidental discontinuation of necessary therapy. Once confirmed, use two patient identifiers, such as name and date of birth, and compare them against the patient's wristband and medical record. Explaining the procedure to the patient helps reduce anxiety and secures their cooperation.
Gathering Necessary Supplies
Ensure all required equipment is readily available to maintain a sterile and efficient process. Essential supplies include:
- Clean, non-sterile gloves
- Sterile 2x2 gauze pads
- Tape or a bandage for securing the site afterward
- An alcohol swab (as per facility protocol)
- An absorbent pad to protect the patient's bedding
- A sharps container for safe catheter disposal
Assessing the IV Site and Patient
Before touching the IV, inspect the insertion site for any signs of complications, including redness, swelling, warmth, tenderness, or bruising. Palpate the area gently, noting any temperature changes or firmness, which could indicate inflammation or infiltration. If any complications are detected, the removal should be re-evaluated, and a different course of action may be necessary. Also, confirm if the patient is on anticoagulant therapy, as this will affect how long pressure is applied to the site.
The Step-by-Step Discontinuation Process
Once all preparations are complete, follow these steps for safe IV removal:
- Stop the Infusion: Turn off the electronic infusion device (EID) or slide the roller clamp on the tubing to occlude it and stop the flow of fluid.
- Perform Hand Hygiene and Apply Gloves: Wash hands thoroughly and put on a pair of clean, non-sterile gloves.
- Remove the Dressing: Gently loosen and remove the transparent dressing and any tape securing the IV. Stabilize the catheter hub with one hand to prevent accidental dislodgement while peeling the dressing back towards the insertion site.
- Withdraw the Catheter: Place a sterile gauze pad above the insertion site. Holding the gauze in place without applying pressure, grasp the catheter hub and smoothly withdraw the catheter out of the vein, pulling it parallel to the skin.
- Apply Pressure: Immediately apply firm, direct pressure with the gauze to the insertion site for 2 to 3 minutes, or until bleeding stops. Patients on anticoagulant therapy will require longer pressure, typically 5 to 10 minutes.
- Inspect the Catheter: After removal, inspect the catheter tip to ensure it is intact and not broken. A fragmented catheter must be reported immediately to a healthcare provider.
- Cover the Site: Once bleeding has stopped, apply a clean, sterile gauze or a Band-Aid to the site.
Special Considerations and Complications
While most IV discontinuations are straightforward, certain situations require extra care.
Patients on Anticoagulants
For patients on anticoagulant therapy (blood thinners), the time required for hemostasis (the stopping of bleeding) is significantly longer. Instead of the standard 2-3 minutes, apply firm pressure for at least 5 to 10 minutes to prevent a hematoma.
Dealing with Resistance
If you encounter resistance when attempting to withdraw the catheter, do not force it. This may indicate a complication such as a thrombosis. If resistance is felt, stop and notify the supervising nurse or physician immediately.
Documentation of IV Discontinuation
Accurate documentation is a crucial final step. In the patient's medical record, document the following information:
- Date and time of IV removal
- Reason for discontinuation
- Appearance of the IV site upon removal (e.g., no signs of infection)
- The condition of the catheter (intact or fragmented)
- Any patient response or complications noted
- The type of dressing applied
Comparison of Peripheral IV vs. Central Line Removal
| Feature | Peripheral IV (PIV) Removal | Central Venous Catheter (CVC) Removal |
|---|---|---|
| Catheter Type | Short, flexible catheter in a peripheral vein (e.g., arm or hand). | Longer catheter inserted into a large central vein (e.g., internal jugular, subclavian). |
| Who Can Remove | Most trained healthcare professionals (e.g., nurses, technicians). | Only specifically trained personnel (e.g., physicians, specially certified nurses). |
| Aseptic Technique | Standard aseptic technique (clean gloves, sterile gauze). | Strict sterile technique required due to the risk of air embolism and infection. |
| Pressure Duration | 2-3 minutes, longer for patients on anticoagulants. | 5 minutes or more, with specific instructions to minimize air embolism risk (e.g., patient bearing down). |
| Positioning | Generally not a major concern; patient can be in a comfortable position. | Patient often positioned in Trendelenburg or supine position to increase central venous pressure. |
Conclusion
Discontinuing an IV infusion is a routine clinical procedure that demands precision and attention to detail. By verifying the order, gathering the right supplies, carefully assessing the site, and following the sterile removal process, healthcare professionals can minimize risks and ensure a positive patient experience. Proper documentation is the final, essential step to complete the procedure safely. Adhering to these guidelines, which are often codified by specific hospital or agency protocols, is paramount for patient safety and effective care delivery, according to resources from institutions like ATI Testing.
